APPENDIX 1 – CASE STUDY
Mrs Cross is an 82 years old lady who lived at home with her partner George until he was taken into Hospital. Unable to manage on her own at home, having had several falls and living with Parkinson’s her Daughter Amy believed her to be at risk of attempting to take her own life due to depression and asked her to move in with the family until she could go home again.
Sadly, while in Hospital George passed away and soon after Mrs Cross fell again, breaking her hip.
When Mrs Cross was ready to be discharged the housing options were discussed, her wish was to remain independent for as long as possible with Amy’s help, which Amy was happy and able to provide. She did not wish to return to her home.
Care and support was required for this to be safe and appropriate as her need for care had been assessed by the Local Authority as eligible for support to be met in a domiciliary setting.
Referrals were made (with Mrs Cross’ permission) to;
The benefit team who identified a potential entitlement to Pension Credit and an upgrade of Attendance Allowance from the lower rate to the higher rate. Amy could not claim Carers Allowance as she was not caring for 35 hours per week.
The District Council for support in finding a supported living scheme as she was not able to return to live with her family and she did not want to return to her own home
Integrated sensory services provided Infra light and TV loop, re tubed her hearing aid and reassessed once Mrs Cross had moved into her new home.
Falls Prevention service was introduced following discharge to her new home
Occupational Therapy team supported discharge with advising on assisted living aids that may help her to remain independent and an assessment of the new home which included grab rails and bath seat, chair raisers
A voluntary organisation Befriender service could match up a suitable volunteer to visit Mrs Cross and called her once a week until the volunteer was able to start visiting.
The home library
Tele care/assistive technology provided a pendant alarm, a medication reminder and a key safe
The reablement team helped Mrs Cross to be discharged to her new home with 6 weeks’ free support and the District nurse came in twice a day to administer her medication, the Community Matron also visited her once a week to maintain her health support.
A Support Broker helped Mrs Cross to engage her choice of care providers
The Local Authority assessed Amy as her Mother’s main carer and provided support services to enable her to continue with her caring role for example; telephone information, advice, and services from a local support group including an occasional massage!
The Adult Social Care community team reassessed her care need once she had moved back into the community and the re- ablement services were no longer required as ongoing care had been arranged by the local authority to support Amy at Mrs Cross’ request – even though she is paying the full cost, Amy has a care support plan as her Mothers main carer which includes free sitting services and an information, advice and advocacy service.
Mrs Cross was directed to independent regulated financial advice and decided to sell her property having considered all the options. Legal advice was accessed to consider making a Lasting power of attorney, will and provision for her care and family.
This is just one example of the services working together to help Mrs Cross move back into the community, closer to her family to be able to remain living safely at home independently with the care and support needed meaning that she had time with her family, with new friends and a better quality of life.
APPENDIX 2 – GLOSSARY
AA; Attendance Allowance - non means tested benefit for people who are over 65 years of age
CA; Carers Allowance – non- means tested benefit for people who are over 16 years and caring for more than 35 hours per week
and not earning more than £116 (net, after tax)
CB; Child Benefit is a payment that you can claim for your child, rules changed in 2012 affecting people who earn above £50'000
CC; Continuing Care another name for continuing healthcare covers the cost of care for a primarily health need
CCG; Clinical Commissioning Groups are NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery
of NHS services in England
CCG; Community Care Grant - abolished by Welfare Reform Act 2012 - Local Authority administers local emergency support since
CFC; Funding Calculator - tool used by Local Authorities to work out cost of assessed care need
CHC; Continuing Health Care another name for Continuing Care
COP; Court of Protection appoints, regulates and administers Deputies who manage health/welfare and/or property/finance decisions
for someone who no longer has mental capacity to appoint their own
CP; Carers Premium is an amount that may be added to a means tested benefit claim if you have entitlement to Carers Allowance-
even if you are not receiving it
CTB; Council Tax Benefit was replaced with a new system for housing cost support by the Welfare Reform Act 2012 but
may still be administered by the District Council until 2017 when Universal Credit 'roll out' is completed Nationally.
DBC; Disability Benefit Centre - same as DCS
DCS; Disability and Carers Service administers AA/DLA/CA
DLA; Disability Living Allowance is a non-means tested benefit for someone with a care and/or supervision, mobility need. Abolished by Welfare Reform Act 2012 and replaced by PIP.
DoL’s; Deprivation of Liberty safeguards. The Mental Capacity Act Deprivation of Liberty safeguards (formerly known as the Bournewood safeguards) were introduced into the Mental Capacity Act 2005 through the Mental Health Act 2007 to protect people from unlawful deprivation of their liberty
DP; Direct Payments are a way of buying your own services with a budget given by the Local Authority once they have assessed an eligible care need and/or provision
DP/DPA; Deferred Payment agreements have been around since 2001, allowing local authorities to defer permanent care fees against a charge on property
DWP; Department of Works and Pensions is the Government department responsible for welfare benefits/social security benefits
EPA; Enduring powers of attorney have been replaced by lasting powers of attorney. However, they can still be used if they were made and signed before October 2007 when the Mental Capacity Act 20005 came into force.
ESA; Employment Support Allowance CB - Contribution Based (non-means tested) and/or IB -Income Based (means tested)
FACS; Fairer Access to Care Services is the criteria the Local Authority uses to assess an eligible care need
GC; Guarantee Credit
HB; Housing Benefit
IS; Income Support, means tested top up benefit being replaced by Universal Credit
JCP; Job Centre Plus manages benefits for working age people
JSA; Jobseekers Allowance CB; Contribution Based/IB; Income Based benefit for people actively seeking work
LPA; Lasting Power of Attorney, brought in by Mental Capacity Act 2005 - came into force Oct 2007
OPG; Office of Public Guardian, manages the register of Attorney's
PB; Personal Budget This is the amount that the Local Authority has assessed an eligible care need to cost
PIP; Personal Independence Payment, replaces DLA from April 2013 (Welfare Reform Act 2012)
PC; Pension Credit, a means tested benefit for people over the women’s state retirement pension age
RAS; Resource Allocation System is a tool sometimes used by a Local Authority to work out the cost of an eligible need care package
SAQ; Self-Assessment Questionnaire is the form that the Local Authority assess' an eligible care need
SC; Savings Credit; One of two parts to Pension Credit
SDP; Severe Disability Premium is the disability premium on the means tested Pension Credit
SDS; Self Directed Support is designed to allow personalisation for care needs, a way for people to buy their care from their own choice of provider
SFC; Statement of Financial Circumstances form sent by Local Authorities to assess a financial contribution
UC; Universal Credit - Replaces means tested working age benefits, brought in by welfare Reform Act 2012
APPENDIX 3 – CARE / NURSING HOME CHECKLIST
Thinking about moving into permanent care but not sure what to look for, what or who to ask?
It’s worth starting with what is important to you? Consider these key points.
Location – do you want to be closer to family, friends. How easy is it for a spouse/partner or other loved ones to visit?
Size – Would you be more comfortable in a larger bedded property or smaller home with fewer people
Local facilities – Do you want a paper delivered daily or need access to a bus, is there a resident hairdresser, chiropodist?
Access – Can you or your visitors, pets move around easily? Lifts, stairs, wheel chair access. Public transport routes close by? Do you want Wi-Fi or a telephone in your room, can you get a signal on the mobile?
Visitors – Are there any restrictions, can they stay over, and is there a visiting time, can children visit and/or stay?
Grounds - Are they accessible, do you need your own space, is there somewhere to sit outside, does the home grow their own veg for the menu, can you help tend a garden or have a patio area?
Security – are the grounds secure, what are the safeguards for you personally and for your possessions.
Does it feel clean, smell fresh?
Are the rooms light and airy? Are there en-suite facilities if you want/need them?
Is there enough space? Do you have private outdoor space?
Can you have your own belongings in your room?
Do the other residents seem happy, are they busy and motivated, are there any activities going on. Is that what you want?
Is there somewhere quiet to go for reading, prayer?
Are the staff welcoming and friendly, are they interacting with the residents and seem interested?
Meeting a care need
The home should assess your care needs to make sure that they can meet it before agreeing to a move but you may want to check;
What happens if my needs change in the future?
How many members of staff per resident? How does this ratio change from day to Night time?
Do the staff change frequently, how are they trained?
What specialist equipment is available should you need it?
What % of the staff are agency workers?
What % of staff speak your language, how are your religious and cultural beliefs considered?
How would specific needs be met; pets, church, pub!?
What’s the menu like, can your guests use the facilities?
Do you have any special dietary requirements, can you prepare food in your room, have a small fridge or tea making facilities?
Is there a manager or nurse on site, can you have your own GP?
Has the home had a CQC report?
Financing a permanent move
Everyone has a right to choose where they live but don’t forget to ask, “can I afford this?” Once you have found the right place it will become your home and a move in the future can be devastating for everyone if you cannot afford to live there forever.
Am I/should I be funding this care? Do I need financial advice?
Could NHS Continuing Healthcare funding apply?
How is a funded nursing care payment invoiced in a registered nursing home?
Check benefit entitlement as the circumstances are changing
Request a care needs assessment from the Local Authority, especially if it is possible that the funds may reduce as the Council may not meet the whole cost of your care choice if/when this happens.
Is there a trial period?
Can you see a copy of the contract; does it include everything you need or will there be extra charges for things like transport, hair, nail care, outings.
What are the contractual fees during hospital stay or periods following death or a move?
Top ups – if you are funding your own care and those funds reduce is there someone to ‘top up’ the cost of your choice of care? Will the home accept the amount that the Local Authority would expect to pay to meet your care needs?
APPENDIX 4 - BENEFIT RATES TABLE
This is a basic reference for the main benefits for later life care and NOT a complete listing
APPENDIX 5 - BENEFITS IN HOSPITAL
Attendance Allowance - Payable for 28 days while you are in Hospital, unless you are a private patient paying for your own treatment. Link periods in any 52- week period together.
Disability Living Allowance - Same as Attendance Allowance payable for 28 days
Carers Allowance – Payable for 12- weeks if the carer goes into hospital but will stop if the cared for person goes into hospital and the qualifying disability benefit stops.
Personal Independence Payment - same as DLA
Self-funded care and NON- NHS Hospice-AA, DLA, PIP remain payable
State Pension - Payable while you are in Hospital irrespective of length of stay
Pension Credit - Payable while you are in Hospital, premiums will be affected if a disability benefit stops (Severe Disability Premium after 28 days, Carers Premium after 8 weeks), if you are in Hospital for more than 52 weeks a couple may be assessed as single people after 52 weeks
Carers Allowance - Entitlement to Carer’s Allowance depends on the person you are caring for receiving a qualifying benefit, such as Attendance Allowance (AA), Personal Independence Payment (PIP) or the middle or highest care component of Disability Living Allowance (DLA).
If the person you are caring for goes into hospital AA/DLA/PIP stops after 4 weeks so will Carer’s Allowance.
Carers Allowance can be paid for up to 12 weeks if you or the cared for person go into Hospital, remember though if the cared for persons AA/DLA/PIP stops so does the entitlement to CA (this is really for linked periods of Hospital admissions)
Employment Support Allowance, Incapacity benefit, Severe Disablement Allowance, Income Support are payable for 52 weeks.
APPENDIX 6 – CODE OF GOOD PRACTICE
This is a suggested Code of Practice, developed by Care Adviser Network it reflects the standards outlined in the CAN Framework for Care Advice.
At all times care advisers should;
Treat people with respect and dignity in a non-judgemental manner
Work to national and organisational policies for confidentiality
Comply with data protection and health and safety requirements
Consider safeguarding and raise any concerns using organisational, local and any current national policy
Prior to an interview care advisers should;
Provide accessible interview facilities and adequate systems for responding to enquiries
Identify and work to overcome communication barriers and individual need
Ensure provision of appropriate equipment for engaging in a full and open interview.
During an interview care Advisers should;
Behave in a welcoming, polite and professional manner, giving clients full attention
Explain role and boundary of adviser and service provided
Identify a need for other appropriate professional services
Collect and assess information needed to clarify key issues, priorities, goals and information needs.
Understand how to put person – centred values into practice considering; individuality, independence, privacy, partnerships, choice, respect and rights.
Understand the importance of history, circumstances, wishes, needs, preferences and risks.
Use a clear, non-jargon easy to understand way to explain information
Identify communication barriers and when insufficient information prevents proper diagnosis to assist clients
Offer only relevant information and advice, consider privacy and confidentiality
Summarise agreed further actions, close interview and provide a summary of interaction keeping client updated.
Meet the standards in a lawful, safe and effective way being mindful of a client’s wellbeing.
Post interview care advisers should;
Provide a summary of contact and any further action agreed upon
Keep client informed of any further action
For advisers who are visiting vulnerable adults The Criminal Records Bureau (CRB) and the Independent Safeguarding Authority (ISA) have merged to become the Disclosure and Barring Service (DBS). CRB checks are now called DBS checks.
APPENDIX 7 - ADVICE TEMPLATE
This is an example of template headings for information and advice provision;
Summary of enquiry
*Options discussed/Advice given
Further Action agreed
Information source used
*Under the Options discussed heading consider;
Mental and Legal Capacity
Care and Housing options
Types of Care
Local Authority Funding and services
NHS Funding and services
Welfare Benefits, means tested and non- means tested
Professional Services, for example Financial and legal advice services
Other support services, community resources
PART 1 –PAYING FOR ADULT CARE
GOV.UK - Benefits info and calculators
Welfare benefits and Tax credit handbook by CPAG - Tel: 020 7837 7979
PART 2 – CHOOSING ADULT CARE
Care Quality Commission; 0300 0 61 61 61
Cinnamon Trust - Tel: 01736 757 900
Elderly Accommodation Counsel; 0800 377 7070
Relatives and Residents Association Advice line: 020 7359 8136
Action on Elder Abuse; 0808 808 8141
Age UK; 0800 169 6565
Alzheimer’s Society; 0300 11 22 11
Blue Badge enquiry; 0844 463 0213
Carers UK; 0800 807 77 77
Care Quality Commission; 0300 0 61 61 61
Citizens Advice; 08444 111 444
Care Choices; 0800 389 2077
Cinnamon Trust; 01736 757 900
Elderly Accommodation Counsel; 0800 377 7070
Independent Age; 0800 319 6789
Mind; 0845 766 0163
Money Advice Service; 0300 500 5000
NHS Direct; 111
Office of Public Guardian 0300 456 0300
Relatives and Residents Association: 020 7359 8136
SAFFA; Legion line 08457 725 725
SOLLA; 0300 500 5000
Solicitors for the Elderly; 0844 567 6173
The ‘Care Adviser Network’ is a social enterprise providing technical advice and resources for those committed to providing quality assured information and advice services on choosing and paying for adult care.
Tel; 0800 999 25 27
ALL works are protected by copyright laws with all rights reserved.
No part of this publication may be reproduced or transmitted in part or full without prior permission when full acknowledgement of Author and/or source must be given Copyright © 2011 - 2020 Care Adviser Network.
Correct at time of printing, reasonable care and skill has been taken to provide accurate information but neither the author nor Care Adviser Network can be held responsible for the content of this book or information found on a link to a third party website, individual interpretation and decisions made based on the information provided or content, which should not be used for giving advice.