Elder Care Bill

A new survey shows tens of thousands of families are paying extra ‘top-up’ charges to care homes looking after their older relatives

(The Guardian – David Brindle)— What links the Isles of Scilly, Tameside in Greater Manchester and Tower Hamlets in east London? Not much, except that they emerge from a survey as the only councils in England in that families of older people in residential care don’t have to pay a top-up fee to supplement means-tested council funding.

Elsewhere, the practice of care home top-up payments – a “secret subsidy” in the words of the charity Independent Age – is rife. Best estimates suggest that 56,000 families are paying an extra sum to the care home looking after their loved one. Such payments are supposed to be voluntary, typically to enable the resident to have a bigger room or a nice view, but the reality is that many are not.

In one case, in which Independent Age advised a man required to pay a top-up fee for his wife’s care, the council involved agreed to repay him more than £20,000 after he threatened to seek a judicial review.

Today’s survey exposes a woeful picture of confusion among councils and widespread ignorance of their legal duties. Of 129 authorities that responded to a freedom of information request by Independent Age (86% of all English councils responsible for social care), only 36 said they knew about all top-up payments in their area and so were able to be sure that families were – or at least had been – “able and willing” to pay them, as legislation stipulates. Just one in four councils said they directed families to independent advice before agreeing top-up fees, while only one in five carried out annual checks to ensure they were still able to afford to pay. Should families default, the council is liable.

Most alarmingly, 36 councils, or almost a third, said they had no information about top-up fees. Some of these, such as Bury and Cheshire West and Chester, claimed the fees were nothing to do with the council and were entirely an arrangement between the family and the care home. But councils such as Camden in north London, Norfolk and Worcestershire said that top-ups should be arranged only between the care home and the council, on behalf of the family, and never between the family and care home. Independent Age says the correct interpretation of official guidance is that while families may in specific circumstances deal direct with a care home, any arrangement should be monitored by the council, which must anyway contract with the home for the full fee.

There is no prospect of an end to top-up payments under the care bill reforms currently in committee stage in the House of Lords. The bill preserves families’ right to make such a payment to supplement “the reasonable cost of securing the provision of the service concerned in the local area” which would be included in an eligible older person’s personal budget allocated by the council. However, there is nothing in the bill as it stands to enable the older person or their family to challenge the reasonableness of that cost by independent review. Ministers rejected a call by the scrutiny committee on the draft bill for the creation of a care and support tribunal. But officials have talked of adding “an independent element” to councils’ own appeals procedures. In the light of today’s survey findings, that is surely the minimum necessary.

The survey offers a timely reminder that the bill is no at-a-stroke solution to the problems of care funding. The plans it includes for a £72,000 cap on lifetime care costs would not stop families shelling out for top-up fees and/or non-care “hotel” costs. As Labour peer and care costs expert Lord Lipsey warned in a debate last week, that could amount to £37,000 a year even after the cap was reached. Many people are going to be shocked.