6. Will I be charged?
HSC trusts can charge for the services that they arrange. However, charges are not usually made for domiciliary care services, with two notable exceptions. These are the home help scheme (where charges may be made on a means-tested basis) and the provision of meals on wheels (which has a non-means-tested charge). Means testing is where your income and savings are taken into account to determine whether you will need to pay for services. A financial assessment will always be carried out where placement in a care home is required.
When a financial assessment is required, only the person receiving the services will be financially assessed. The HSC trust will calculate the cost of the services to be provided (such as home help, residential care) and then financially assess the person using the regional charging policy to see how much the person can contribute to the cost of the services. The HSC trust must provide a breakdown of how they calculated the charge.
If the person with dementia needs to move into a care home, the local trust will assess the person's income and savings according to regional rules.
Rather than receiving services arranged by the HSC trust, the person with dementia or their carer may instead choose to be given a 'direct payment' from the HSC trust so that they can arrange the services themselves. The local trust must be satisfied that the person is willing and able to manage a direct payment, either alone or with assistance.
Direct payments may offer more choice and flexibility, but they can be complicated. Some people feel reluctant to take on the responsibility of managing their own services. The HSC trust must support the person managing a direct payment, which may be through voluntary or charitable services.
If someone has been able to consent to receiving direct payments but is not able to manage them because they lose the capacity to do so, then the trust may continue to make direct payments. This is only if a suitable person is prepared to handle them instead. This person must be prepared to manage the direct payments and care package on a day-to-day basis on behalf of the person and in their best interests.