Many people rely on their family and friends for their care needs. Although supportive, family and friends may not always be able to provide the most appropriate and efficient levels of support. Home care may take many forms, ranging from personal attention and household tasks to enabling people who are experiencing difficulties eating a balanced diet; taking medications; attending medical appointments and socialising. Trying to cope with challenges in these areas while retaining independence; dignity and continuing to live in their own home may need support outside of the circle of family and friends. Home care may take the form of domiciliary care; live-in care or where appropriate, palliative care.
A live-in carer can cost around £750 per week compared to the average cost of £1,121 per week in a residential care setting. Additionally, live-in care is provided on a one-to-one basis, whereas in a residential care setting the ratio is usually one carer to four clients.
Additionally, home care is more personal and tailored to the client’s needs. Most care agencies will have managers that can help you or signpost you towards government grants, funding, and benefits. But many people would like to know what support may be available before contacting a care agency.
Current Care Availability
In a recent BBC presentation (2016), focussing on the cost of home support, the following facts were highlighted. If you are in the vulnerable position of needing care or are caring for someone else the facts regarding the cost is quite sobering.
NHS services are free, but home care services are not. Over 75% of people over the age of 65 meet the total cost of their care themselves. What these facts fail to acknowledge is that there are exceptions to the rule. If the client needs home care services due to illness, as opposed to social reasons, then home care services will be paid by the NHS.
- 1 in 10 people over the age of 65 are facing bills for home care that can accumulate to over £100K in the course of their life.
- Local councils provide some support to the poorest. In order to share the share the available resources fairly, there is usually a cost to the client based on an assessment of their income. This type of funding is ‘means tested’ and any cost the client is rated on their income.
- Over the last four years, help given by councils has reduced by 25%. This is mainly due to several factors: ongoing reduction in council budgets; more people complex needs requiring support and rising cost of care. These factors mean that available funding is very limited.
- There is an increase in the number of people who are reliant on friends and family for their care. The presentation cites that there are 1 million inhabitants in the UK, who need some help with care but are not receiving it.
The picture is not all gloom; there are several options available for funding, from both central and local government. Some types of funding are means tested, while others awarded through statutory benefits, such as pensions or Personal Independence Payment (PIP).
Eligibility for home care funding is assessed using nationwide criteria. Information regarding benefits, assessments and costs of home care can be found online. Currently, the most comprehensive and impartial starting point would be to visit The Money Advice Service. Not only does this site outline several government benefits and grants that may be beneficial, but it also provides a tool that you can use to determine your eligibility.
The pathways to seek financial support for home care are mainly through:
This allowance is available for people over the age of 65, who require help with personal tasks such as washing; eating; using the toilet; need support to get in and out of bed. There are two rates to this award the lower rate which applies if you only need help in the daytime and the higher rate if help is needed both in the day and at night.
This award is not means tested; it is tax-free and will not affect any other income or benefit that you receive. Additionally, if awarded the Attendance Allowance, you may also have access to other benefits such as Pension Credit, Housing Benefit, and Council Tax reduction. If you are already receiving an Attendance Allowance, this is taken in into consideration if you are seeking financial support for community care through Social Services.
Personal Independence Payment (PIP)
PIP has now replaced Disability Living Allowance (DLA) for those over the age of 16. Similar to DLA, PIP has two components, one for daily living and another for mobility.
Provision of the PIP assessment is through social services. However, the criteria for PIP differs from DLA and is open to much debate. PIP was designed to replace DLA, but unfortunately, due to criteria changes many people who previously received DLA have been refused PIP as they were no longer eligible. This has left many vulnerable people without access to care that was previously funded by DLA. Currently, there is an appeal process, but due to a lack of case-law, the appeal process may appear arbitrary.
Personal Health Budgets/Allowances
Every UK citizen has a personal health budget (since April 2015), which means you have an element of control over the services that you receive. The amount of money allocated to you is dependent on your needs identified through your care plan. The budget can be used to pay for care through an agency of your choosing or used to hire an independent carer. If you choose the latter, then by law you need to contribute to the carer’s pension as you would in effect be their employer.
Local Authority Funding
This funding is made available through local councils and local Social Service. If through assessment, you are eligible for support, the Local Authority is duty bound to provide the support that meets your needs. However, you may have to contribute towards the cost. The amount that you contribute will depend on your income, any other benefits that you’re receiving and the area of the UK in which you live (more about this below).
If you don’t meet the requirement for help from your Local Authority, you may still be able to access a care by paying for the costs yourself. If this is the case, you can still get advice from your local Social Services Department on how your needs can be acknowledged. By seeking help, you may be directed to other sources, such as Age UK Citizens Adviceline before you engage in an equity release scheme (this includes Lifetime Mortgages and Home Reversion). Additionally, there are numerous local charities and trusts which can help people within certain geographical areas, names of these trusts are found online or through your local Citizens Advice Bureau.
Several charities that focus on particular illnesses or disabilities (Headway; Macmillan; Marie Curie; Sue Ryder etc.) can offer advice and support on seeking government funding.
NHS Fully Funded Care
If, care at home is primarily needed because of a health issue such as recovery after a surgical procedure; after receiving treatments such as chemotherapy; palliative care; disability or a complex medical condition as opposed to social care needs, then you may qualify for ‘fully funded care’ which is the direct responsibility of the NHS.
The NHS will pay the full cost of this type of care if your needs are over and above what the local authority must provide. To access NHS funding, you will need to have an NHS assessment before any Local Authority assessment that requires a means test. If you do not have the NHS assessment first, then you may end up paying for local authority services that you entitled to access for free. Talk to your GP or Nurse Practitioner about fully funded care.
Care Funding in UK Areas
Although government allowances throughout the UK are standard, there may be slight discrepancies in financial funding and your contribution to home care, depending on which area of the UK you live.
Care Funding in England
The local authorities generally support people whose needs are very high or assessed as critical.
If the individual who needs help has assets of more than £23,250, then they must pay the full cost of their care, whether that care takes place at home; in a care home or nursing home. From 2020, the assets cap will rise to £72,000. The cap is only in consideration for home care and will not apply to residential care. Living costs (accommodation, food etc.), of £230 a week is an additional charge to the client to be paid for out of their own money. But, for people who are resident in a nursing home, they may be able to have all of their fees paid by the NHS as part of the ‘continuing care’ system. (caretobedifferent.co.uk)
Care Funding in Wales
Everyone has the right to a free care assessment to see if they are eligible for help. Only people who are assessed with needs that are regarded as ‘substantial’ or ‘severe’ will be eligible for help. Weekly home care costs cannot exceed £60. People with an asset value of less than £24,000 (excluding the value of their home) may pay even less.
However, if they are resident in care or nursing home and their asset value is more than £24,000, then they are expected to pay the full cost of their care.
Care Funding in Northern Ireland
The approach to home care in Northern Ireland is far more integrated than anywhere else in the UK. Home care is provided for free to people over the age of 75. Individuals who are under the age of 75 may have to pay towards their care. This is at the discretion of the local social care trust (of which there are five in Northern Ireland).
If home care is not sufficient to meet care needs, a care or nursing home may be deemed as a more suitable option. People who have assets over £23,250 (this may be inclusive of property value) have to pay the full cost of their care. However, everyone gets to keep at least £14,250 of their assets.
Care Funding in Scotland
Anyone over the age of 65, who are in need of help will receive free personal care. The Scottish local authorities will assess who is in need of substantial or critical care.
Within each of the four countries that are in the UK, there may also be variations in support at regional and county level. Look on the Carers UK website to see how the services in your postcode area may differ from the national average.
Wherever you live in the UK, to find out more about accessing grants or benefits for care at home use the following website which will enable you to use the self-assessment tools that will guide you to your next step.
To find out more on which benefits you could be eligible for, here are some useful links: