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Care & carers

Top up fees

(71 Posts)
GracesGranMK2 Wed 17-Jan-18 22:37:48

We are having to take on top-up fees for my mother's care in her home. Currently she can afford them but if she needs additional care we may have to try and find the money from the family or change carers or the way she receives care. These top-ups come because local authorities keep the amount they will pay below the actual amounts charged locally. They currently only have one company they can use and they did not have any spaces at the time needed for mum. Two other companies they used to use have gone out of business. It can mean that even someone with so little they should be paying nothing may well have to "top-up".

This is much the same as top-up fees when relatives have to go into a care-home. I thought that this article "To Pay or not to Pay - Care Home Top Up Fees", might be of use to anyone in the position of finding a home at the moment.

It is interesting to read that "This means that at least one Care Home must be offered that does not require a Top-up Payment." I just wonder how long you might be waiting for that little unicorn?

Curly63 Wed 17-Jan-18 22:55:09

Top ups a rip off. I know of one of our local homes charges £100 + top up per week for LA funded residents. Not easy to find when your a pensioner yourself and an only child.

GracesGranMK2 Thu 18-Jan-18 10:40:03

I agree Curly63 but I don't know what you do about it. The article at least tells you what questions to ask so may be helpful.

Curly63 Thu 18-Jan-18 15:53:26

If you ever get to the care home stage visit all the homes in your local area gather as much information that you can check them out online and see what their last CQC rating is. Ask about staffing level, and if they have a top up what does it cover? Even if mums finances get to the £23,250.00 threshold they still have to contribute £4.00 per £1000 until it gets to around £14,000 and then it's calculated again I think they are allowed to get to either £8000 or £6000 and basically that's to cover funeral costs. Even when their pensions go up the fees are recalculated again and the amount they get is added onto their contribution so less for the LA to pay.

humptydumpty Thu 18-Jan-18 15:58:49

If top-up fees can't be paid some homes make the person move to a cheaper one - and some of those are horrible; be warned...

Curly63 Thu 18-Jan-18 17:16:09

True. Bend over backwards for you when you're a private paying resident but totally change when you become a LA resident.

Eglantine21 Thu 18-Jan-18 17:38:13

I'm not quite sure why families who are just scraping by with nothing to spare should support anyone who has thousands in the bank.
If I had over £23,000 I would expect to use some of it to pay for my care.

Jane10 Thu 18-Jan-18 17:44:28

I expect to have to cough up too. However, all this business of visiting lots of care homes and reading their CQC reports becomes academic. Waiting lists can be so long that you just have to take whatever becomes available. Act quickly if offered as spaces are snapped up very fast. Sad but true.

GracesGranMK2 Thu 18-Jan-18 18:45:50

Eglantine this is not about the amount you have to pay because of your income and savings. This is about the so called "Top-up" because local councils are not paying the going rate so that people have to have care - either at home or in a care home - that they have to "top-up" to the going rate. There is often no choice of home or care that is as low as the councils threshold. Even those on and income and with savings low enough that the law and the government say they should not be paying have to pay this 'top-up' because there is no alternative.

Whether or not the level at which you pay is right or wrong the councils are using this to get round the law.

You and Jane10 both say you would expect to pay. I would expect to pay if my income says I should be paying but what happens when that money runs out and you are still expected to pay. I'm afraid being virtuous will not keep the care there for you! I am currently juggling with this for my mother. When you are having to go through it I would love to know how you manage the minefield that is care these days . All I wanted was to give some information to those who might be in a similar position.

Eglantine21 Thu 18-Jan-18 19:01:24

I think I was responding to Curly rather than your original post. Sorry.

I would still expect someone to pay for their own care if they had thousands in the bank.

Maybe then there would be enough for the people who don't have very much. But as long as wealthy people expect the not so wealthy to support them there will never be enough.

On another tack I think the decision to devolve this to councils was wrong. Councils in poorer areas don't have the income to support their poorer people. Councils in rich areas have greater income but don't have to support as many people. It's a national issue not a local one.

GracesGranMK2 Thu 18-Jan-18 19:40:02

I would still expect someone to pay for their own care if they had thousands in the bank.

They do! Do you actually have any idea how the system works? I really can't work out why you appear to be being so judgemental. I am sorry, I really don't understand where you are coming from.

Yet again I have no idea why you are saying that social care has been "devolved to councils". I don't know all the history of this but it has always been with the local authority (councils). Way back when it was with the Parish - that's when we had the workhouse and Parish Relief I believe, but to my knowledge it has never been provided by central government. The issue for the councils is that the money they have received from central government to help provide care has been cut, and cut.

I agree it should be a national issue. I feel it should be paid for by a National Insurance which combines Public Health, NHS and Social Care but this is SO not what this thread was about. What it is about is the reality of care. It is under the Care and Carers heading not Politics. The cuts that government has inflicted on the LAs which means they are passing costs on to all including the very poor, by going round the rules and regulations.

Eglantine21 Thu 18-Jan-18 19:54:58

Oh well, seems to be my day for getting things wrong.

Lazigirl Thu 18-Jan-18 20:15:58

I haven't heard of having to pay top up for home care and I am shocked. I know that if you have over £23,000 savings you have to pay all care fees, but under that it is means tested surely? How could a person afford to eat, heat their house etc if having to pay top up or am I missing something?

Jane10 Thu 18-Jan-18 20:18:47

I'm not sure why you are being so harsh in your responses GGM2. Eglantine and I contributed in good faith. I have had to navigate through all this quagmire of care on two occasions so far so do have experience of it. Our experience may be different from yours but is just as valid in its way.

durhamjen Thu 18-Jan-18 20:28:46

I think GracesGran is talking about care for her mother in her mother's own home, not care homes.
She is having to sort it all out at the moment for her mother.

My mother in law was in the same situation a few years ago, then had to go into a care home. Every time she went into hospital she was sent out to a new and cheaper care home.
Rules have changed since then, though.

Lazigirl Thu 18-Jan-18 20:34:51

I am talking about care in own home. My mother/or we haven't been asked to pay top up.

Eglantine21 Thu 18-Jan-18 20:51:57

I have also been involved in arranging care for several elderly relatives and some not so elderly.
Different authorities, different provision, different experiences.
It's impossible to use experience of one local authority to make a blanket statement about local authorities in general such as " local authorities will keep the amount they pay below the actual amount charged locally."
It varies from authority to authority.

durhamjen Thu 18-Jan-18 20:53:52

It depends what's wrong.
When my husband was dying, the first week we were told his care would be paid for by the NHS, because he was on the Liverpool care pathway.
The second week he rallied, so we had a social worker who came to ask about finance.I lost count of the number of times I said I don't know, why don't you ask him?
He couldn't talk, eat or drink, give his own insulin injections, etc.
She went away and said she would let us know how much we would have to pay.
The next week he died. I never got a demand for the middle week.
That was six years ago this weekend.
Things might have changed since then.

Lazigirl Thu 18-Jan-18 21:01:51

If someone meets the criteria for NHS care they should be eligible for something called Continuing Health Care, but many people are not informed of this, and if they do apply they may be refused because goal posts are moved due to lack of funding. It's a national disgrace really and legal advice need to be obtained before it can be successfully claimed, often then only on appeal. Same old story really - no money for adequate health care.

Lazigirl Thu 18-Jan-18 21:06:00

You should never have been asked to pay dj. Awful at such a stressful time.

MissAdventure Thu 18-Jan-18 21:21:14

I've never, ever seen private paying residents treated differently to those whose fees are covered by benefits.

Eglantine21 Thu 18-Jan-18 21:39:12

At the home where my aunt is at the moment, the care staff have no idea who is paying privately and who is funded by the local authority. I have never seen any difference in care either.

Likewise with my father-in-law who has home carers. The carers are paid by the agency. His carers don't know where the money comes from.

MissAdventure Thu 18-Jan-18 21:45:36

Neither do they care, I should imagine. It makes absolutely no difference to them, and they haven't the time to sit scrolling through reams of financial paperwork. Too busy doing their job, (hopefully!)

GracesGranMK2 Thu 18-Jan-18 22:09:42

OK. This will not be definitive but I will try and explain.

Firstly, most of us have an impression of how Social Care is paid for. I will try and explain 'top-up' for home care but it does apply to care in a Care Home too.

So, there you are trying to sort out the provision of care for a parent. This post was not about what you have to pay because the government says that it will be £xxx if you have more than £14,250 in savings and an income over £189. This will be worked out and you will have to contribute whatever that figure is.

There is, however a maximum the council will pay per hour and multiples are worked out by the hour even if you are having fractions of an hour at some times. Still with me?

So for every hours of care (at home) they will explain they will pay £x. The first thing is that they will go to their preferred providers who they can put in at this figure - they have agreed this with them. However, this figure is not what any other care provider in the area is charging. This is because they cannot run their business on this amount. Because it is too low for businesses to survive they may come back and say their one surviving care provider (they did have three but two went out of business) doesn't have anyone at the moment - would you like to use direct payments and find your own carers.

Sounds like a good idea. You ring round and find no one charges this amount. Not only do they charge more for an hour, they also, not unreasonably, charge even more than half that for a half hour (often used for meal provision). In addition they may charge more per hour (and per half hour) at the weekend and they also charge a travel fee for each visit over a certain mileage. So, the SS are offering to 'put care in' and will pay a certain amount. If you go down the road of direct provision you will have to pay the "top-up" to meet the fees I have just described.

What do you do? You could wait for the preferred provider to have someone free - knowing that a) they may be working on a tighter schedule to make the hour's pay work for them and b) the last two went out of business - what if these do too.

So you may decide you will "top-up". All this is before you pay anything the government has decided you need to contribute. You will probably think it is a good idea at first - after all you need the care urgently and the figure plus the amount you need to contribute is one you can afford, even though the person needing care is on a low income.

The government has worked it so that you pay the maximum you have to on a low amount of care but this does not increase so you know you can cover that. However, every time more care is needed so is 'top-up'. You may have to move to a cheaper carer, forgo some care, or what ...?

This is top-up and for anyone dealing with it, it can be a worry and I thought the article might help.

durhamjen Thu 18-Jan-18 22:28:05

Not definitive?
You mean there can be more ways for the care system to screw people who need care at home?
I suppose my husband's was different because he had cancer and we had the carers from hospice at home get in touch with us having been alerted by the oncologist. I wouldn't have known who to get in touch with otherwise, or even if care was available, having looked after him on my own until then.
Like lazigirl said, most people do not know about continuing health care. It should kick in automatically, but I've heard so many tales about people not knowing until it's too late.
It's a good reason for health and social care to be looked at together. In fact, the latest healthcare act is the Health and Social Care Act(2012).
So why are they separate? Wasn't Hunt always in charge of them both?
Sorry, no help for those struggling with the situation at the moment.