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Financial, Legal & Benefits

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Ways to pay for care

There are various ways to pay for your care.  If you receive a domiciliary service (service in your own home) the easiest way to pay is by setting up a standing order.  This means that the same amount of money will come out of your bank account every month.  You will be refunded for any overpayments unless you have a debt on the system.  If there is a debt on the system, your credit will be transferred against your debt.

If you prefer to pay by cash, an invoice can be issued to you every 4 weeks for services you have received.  This can then be paid over the internet via www.nelincs.gov.uk or by taking your invoice to any local shop that displays the paypoint sign.

For residential care, you will receive and initial invoice for client contributions and then you can pay the home direct either weekly or 4 weekly by cash or by setting up a standing order.

Understanding Care Charges

If you are assessed as needing any form of care or support, you will be entitled to undertake a financial assessment to ascertain your means to pay.  The assessment will be carried out by a trained adult social care professional that will have a wide knowledge of benefits, charging rules and general adult social care legislation.  As part of the assessment you will need to inform the officer of all of your income and savings, including, pensions, benefits, investments, bank accounts etc. If you do not want to do this, you are entitled to a “light touch” assessment, however; the officer must be assured that the client contribution calculated by this method is sustainable for you.

Disability Related Expenditure (DRE) 2019-2020

It is not possible to give a complete list of DRE as this will vary according to individual needs.  The overall aim is to allow for reasonable expenditure needed for independent living by a disabled person.

Primarily the Service User’s Support Plan will guide the DRE, but allowances for expenses other than for care and support such as heating etc will also be taken into account. 

Any specialised equipment that is not normally purchased every month will be costed on an annual basis and divided into weekly equivalents and repaid over a reasonable period. 

We will require receipts or similar evidence to back up claims for DRE, particularly for unusual items or heavy expenditure.  If receipts are not available when the visit takes place you have 4 weeks to submit them.  If receipts are not submitted within 4 weeks the claim will not be backdated.

Item

Amount

Evidence

1.  All Fuel

Difference between actual annual bill and figures given below (which represent “normal costs”), divided by 52

·  Single in flat and terraced £1421.11*
·  Couple in flat and terraced £1873.02*
·  Single in semi-detached £1509.43*
·  Couple in semi-detached £1987.72*
·  Single in detached £1835.18*
·  Couple in detached £2418.99*
Last 4 quarterly bills for all types of fuel
Notes:  If bills not retained, copies to be provided within 28 days.  If not provided within this timescale the allowance will apply from the date that the evidence is provided. Winter Fuel and Cold Weather Payments should not be taken into account. 

2. Community or Personal Alarm

Actual cost unless included in Housing Benefit or Supporting People Grant Bills from provider
Notes: For couples where only 1 service user still allow actual cost

3. Communication Aids

  Reference in the Support Plan to communication needs

4. Privately arranged care

Actual cost if Social Worker confirms requirement as part of the Support Plan and Council supported care is reduced accordingly Signed receipts, for at least 4 weeks using a proper receipt book 

5. Private Domestic Help

Actual cost if Social Worker confirms requirement as part of the Support Plan and Council supported care is reduced accordingly Signed receipts, for at least 4 weeks using a proper receipt book

6. Laundry/ Washing Powder 

£3.85 per week* Support Plan will have identified an incontinence problem. Identify more than 4 loads per week

7. Bedding

Continence service may provide Protective mattress Covers – check local provision Receipts for a minimum 6 month period

8. Dietary

Discretionary as special dietary needs may not be more expensive than normal Details of special purchases

9. Clothes or Shoes

  Reference within the Support Plan to abnormal wear and tear of clothing or need for specialist clothing.

10. Gardening

Discretionary based on individual costs of garden maintenance Signed receipts, for at least 4 weeks using a proper receipt book
Notes:  Allowances will not normally be given in relation to redecoration or gardening provided by spouse or partner, other close relative or anyone else living in the same household.    A close relative is defined as parent, parent-in-law, aunt, uncle, grandparent, son, daughter, son-in-law, daughter-in-law, step-son, step-daughter, brother, sister or spouse or partner of any of these.

11. Wheelchair

£4.01 per week manual*
£9.74 per week powered*
Evidence of purchase. No allowance if equipment provided free of charge

12. Powered Bed

Actual costs divided by 500 (10 year life) up to maximum of £4.43 per week* Evidence of purchase if available

13. Turning Bed

Actual costs divided by 500 up to a maximum of £7.76* per week Evidence of purchase if available

14. Powered reclining chair

Actual costs divided by 500 up to a maximum of £3.52* per week input Evidence of purchase if available

15. Stair lift

Actual costs divided by 500 up to a maximum of £6.27* per week Evidence of purchase
without DFG input

16. Hoist 

Actual cost divided by 500 up to a maximum of £3.07* per week Evidence of purchase without DFG input
Notes:
Allowance based on purchase costs over average life expectancy
Other specialist equipment should be supported by Support Plan, receipt or estimate provided and referred to the Charging Appeal Panel for a decision.
Disabled Facilities Grant (DFG)

17. Holidays

Actual additional cost in excess of normal costs for similar holiday divided by 52 Evidence of actual cost comparison purposes.
Notes:
Consider additional costs for partner or companion of the specialist holiday arrangement.

18. Transport

Discretionary based on costs that are greater than those incurred by an able bodied person Evidence in the Support Plan of the need for specialist transport
Notes:  Mobility Allowance cannot be included in the normal financial assessment as an income, but the statutory guidance states that transport costs should be allowed if necessitated by illness or disability, including costs of transport to Day Centres, over and above the mobility component of DLA if in payment and available for these costs.  This implies that transport costs do not need to be allowed if Mobility Allowance is considered available to meet such costs.

19. Wear and Tear on fixtures and fittings

Based on individual circumstances Receipt or estimates for replacement.  Evidence that is not covered by household insurance policy.  Evidence in Support Plan

20. Repair or replacement of items damaged by User

Based on individual circumstances Evidence in Support Plan. Receipt or estimates for replacements. Evidence that is not covered by household insurance policy

*The above DRE figures quoted are correct as of May 2019 and are subjected to change annually.

You will be expected to provide accurate information relating to your financial affairs.

Any false or non-disclosure of information will result in changes to your client contribution which may be backdated to your original financial assessment or to the date the information was provided. Focus independent social work CIC reserve the right to inform other relevant agencies about any financial wrongdoing.

Universal Deferred Payment Agreements

One way to pay for your residential care is under a ‘Universal Deferred Payment Agreement’.  

The Universal Deferred Payments Agreement (DPA) is designed to help you if you have been assessed as able to afford the full cost of your residential care – but not able to pay the full weekly charge because most of your capital is tied up in your home. 

Effectively the Universal DPA offers you a loan from North East Lincolnshire Clinical Commissioning Group (CCG) using your home as security. This means that if you are eligible, the CCG will pay your care home bills on your behalf, which will enable you to delay part of the payment of your care costs.  Although you are delaying payment of your care costs, those costs will have to be repaid at a later date.  

Your care costs build up as a debt, which will be cleared when the money tied up in your home is released.  You can end the agreement at any time (for example if you sell your home) and the loan then becomes payable immediately. Otherwise the agreement ends on your death and the loan becomes payable 90 days later. 

You will need to undergo a financial assessment to quality for a Universal DPA and meet the following criteria: 

  • Have capital (excluding your home) of less than £23,250.
  • Be professionally assessed as requiring care and be going into permanent residential / nursing care in a registered care home.
  • Own or have part legal ownership of a property, which is not benefitting from a property disregard (for more information on property disregards, see below). Your property will need to be registered with the Land Registry to allow the CCG to take a charge against the property (if the property is not registered, registration will be at your own expense).
  • Have mental capacity to enter in to a deferred payment agreement or have a legally appointed representative able to enter into it.
  • Be willing to agree to the terms and conditions of the agreement. 

If you decide to use the Universal DPA, you enter into a legally binding agreement with the CCG.  You will be asked to sign a document (an agreement) and to follow a number of rules while the agreement lasts. 

In addition to care costs the CCG will charge you compound interest on the amount it is loaning to you, and there is also a fee for setting up the Universal DPA. Your Financial Assessment Officer will explain this in more detail when they visit you to complete your financial assessment.

Top Ups and Additional Charges for Residential Care Placements

Choosing a Provider

When the NEL Clinical Commissioning Group (NELCCG) is responsible for meeting your care and support needs, and your needs have been assessed as requiring a particular type of residential accommodation, you have the right to choose between different providers of that type of accommodation, if certain conditions are met.  If you choose a provider that costs more than the amount identified by the NELCCG as necessary to meet your needs, you will be asked to meet the additional costs.  This is known as a ‘top up’ and is the difference between what NELCCG says it costs to meet your needs, and what the provider you have chosen wishes to charge.

Choosing Additional Services

Some providers will want to charge for additional services beyond those required to meet your needs (e.g. for a room with a view, newspapers or Sky TV packages).  These additional charges should not be for the costs of your general care to meet need, but should only be for additional goods or services that you choose to receive.  Providers should explain clearly what any additional costs relate to, and you should not feel under any obligation to pay for additional services that you do not want. 

Difference between a resident paying their top-up as opposed to a third party

A resident can pay for their own top-up in the following circumstances: 

Making Top Up Payments or Payments for Additional Services

Whether you chose a more expensive provider than NELCCG says is necessary to meet your needs, or whether you chose to receive services which are in addition to those required to meet your needs, you or someone or your behalf (usually a family member) must be willing and able to pay the additional costs.  You or your family member will need to continue to pay the additional costs for the duration of the arrangement – which could be for some years into the future i.e. for the duration of your time in the accommodation.   

You or your family member will be asked to sign an agreement to confirm that you are able to continue making payments for as long as they are required.  If you or your family member become unable to continue making payments, this could result in the NELCCG arranging for alternative, less expensive accommodation (which would still meet your needs) and/ or the termination of your chosen additional services.

Different ways to help someone with care & support needs (or a carer with support needs)

Acting as an Appropriate Person

Adults with care and support needs, and carers with support needs, must be involved in the processes designed to support them, such as an assessment, creation of a care and support or support plan, and the review of those plans.  A person with needs must also be involved where they are the subject of a safeguarding enquiry.  Where someone with needs would experience substantial difficulty in being involved, they will need someone appropriate who can facilitate their involvement – usually a family member or a friend.  ‘Facilitate’ means to support the person with needs through these processes, and represent and champion their wishes where necessary.    

You can only act as an ‘Appropriate Person’ if –

  1. You are not already providing the person with needs with care or treatment in a professional capacity or on a paid basis (regardless of who is paying or employing you).  This means that, for example, the person’s GP, nurse, key worker or care and support worker cannot act as an Appropriate Person
  2. The person you want to help wants to be helped by you.  The wishes of the person with needs must be respected if they have capacity to make decisions for themselves.  If the person with needs lacks capacity to make a decision regarding whether you, or someone else, should act as their Appropriate Person, adult social care professionals will take a best interests decision regarding who should act as the Appropriate Person
  3. You are able to support the person.  This may be difficult for practical reasons if, for example, you live some distance away.  Alternatively, if you struggle to understand care and support processes yourself, you may be unable to guide the person with needs through them (for more information on care and support processes, go to HERE)
  4. You are implicated in any enquiry of abuse or neglect, or have been judged as part of a Safeguarding Adults Review to have failed to prevent abuse or neglect.

There could be other circumstances in which it may not be right for you to act as an Appropriate Person.  For example, even where you have strong opinions, you must always seek to obtain and represent the views of the person with needs.  Where your own interests conflict with those of the person with needs (for example you and the person with needs have a different view about where they should live), it may be unwise for you to act as an Appropriate Person.   

It is the decision of the adult social care professional who is working with the person with needs to decide whether or not you can act as an Appropriate Person.  If they decide that you are not appropriate, then they will ensure that an independent advocate is appointed instead, to ensure that the person with needs is supported.  If an independent advocate is appointed, where the person with needs requests it, you can still be involved in their care and support processes. 

Money Management

Good money management can mean many things – from living within your means to saving for short and long-term goals, to having a realistic plan to pay off your debts or plan for your retirement.

The Money Advice Service has a lot of video clips, tips and information for managing your money. The link below will take you to a basic money management video, along with other useful links.

Along with money management, there is also information below that may help you if you are preparing for retirement and want to plan ahead in relation to any possible care and support needs you may encounter in the future.

DWP Benefits Information

As part of the financial assessment process, we will carry out a benefits check to make sure you are receiving all of your entitlement.  If you do not want to have a full financial assessment but feel you are not claiming all of your benefit entitlement please contact the following departments in order for the DWP to assist you. 

  • WEBSITE - DWP Pensions >

  • Pension Service Telephone Number 0345 6060265

  • Attendance Allowance Telephone Number 0345 6056055

  • Personal Independence Payment (PIP) Telephone Number 0800 917 2222

  • Income support Telephone Number 0345 6088545

  • Carers Allowance helpline 0345 6084321

Remember that Attendance Allowance and Disability Living Allowance are not means tested benefits and you could qualify for additional monies if you have care and support needs that meet the criteria.

Universal Credit

Universal Credit is a payment to help with your living costs. It’s paid monthly.

You may be able to get it if you’re on a low income or out of work.

Whether you can claim Universal Credit depends on where you live and your circumstances.

If you already get benefits

Universal Credit will replace the following benefits:

  • Child Tax Credit
  • Housing Benefit
  • Income Support
  • income-based Jobseeker’s Allowance (JSA)
  • income-related Employment and Support Allowance (ESA)
  • Working Tax Credit

If you currently receive any of these benefits, you can’t claim Universal Credit at the same time.

Universal Credit is being introduced in stages across the UK. You don’t need to do anything until you hear from the Department for Work and Pensions (DWP) about moving to Universal Credit, unless you have a change in circumstances.

Making Informed financial decisions

The information provided below should enable you to make informed choices in relation to your finances. This information does not just relate to Adult Social Care. It is hoped that by sharing our knowledge, you will have all of the required information in order to plan for your retirement and manage your money effectively in order for you to achieve your goals.

Along with giving you information relating to paying for care and support needs, either immediately or in the future, this page will also signpost you to local Independent Financial Advisors who can offer you a service based on your individual financial position.

*Neither North East Lincolnshire Council, North East Lincolnshire Clinical Commissioning Group, focus independent adult social work nor any of its partners accept any liability for advice given by Independent Financial Advisors.

Pension information & requirements as an employer

Thousands of businesses with fewer than 49 employees will be automatically enrolling their staff from this week—with 14,000 companies in June alone. By 2018 all employers will have to offer their staff a workplace pension regardless of their size, even those with only one employee.

Figures published earlier this year revealed that 59 per cent of all workers are now active members of a pension scheme – up from 47 per cent in 2012.

Businesses can read The Pensions Regulator’s guidance on getting started and check their start date (known as a “staging date”) here.

Feedback

The Patient Advice and Liaison Service (PALS) is an opportunity for you to let us know what it’s like to receive NHS services as a patient, relative or friend.  It offers you the chance to provide comments, compliments or raise concerns about the services you have received and helps the Trust to ensure that high quality, responsive services are available.

PALS is a free, confidential service available to offer help, advice and information on NHS services and is designed to help patients, carers and staff get the best out of what the NHS has to offer.
North East Lincolnshire Clinical Commissioning Group (CCG) has a dedicated PALS team dealing with matters relating to Primary Care Services in the local area. These include those NHS services offered from your GP Practice, Dental Surgery, Pharmacies (chemists) and Opticians and all Adult Social Care Services.

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