Starting the process
The starting points for arranging care can be different. Some individuals make their own plans, others need the support of their family to take the necessary steps, and for some people the process of arranging care is triggered by a medical condition or hospital admission.
In most cases, however, the input of a doctor can be very useful, whether they are the individual’s GP or their hospital consultant. Other professionals might also be involved in the process – social workers, occupational therapists, or physiotherapists, for example.
It is obviously best if the person receiving care can themselves take part in the decision making process. Unfortunately, though, circumstances do not always make this possible, so considering in advance what your wishes would be is a sensible plan. By giving advance thought to whether you wish to remain in your own home or not you can assess what, if any, modifications are going to be needed and plan for these. You can also choose your carers, and build relationships with them over time, building up the level of support incrementally.
Another option is to shop around for an alternative home, whether that is a private bungalow, sheltered accommodation or your pick of care facilities. Part of this process will also include planning your finances appropriately, and we can help you with this.
However, for some the decision on care needs has to be made in different circumstances, with illness or an accident necessitating a speedy decision. In these circumstances, you will need to get information more quickly, and from a variety of sources.
Care at home
There is a huge amount of support available to facilitate an independent life in one’s own home, ranging from a little assistance with dog walking or shopping, to 24 hour nursing care. We can advise on a range of different providers, and on the addition of further levels of care as necessary.
You can arrange assistance privately, access support from a charitable institution or ask for help from your local authority. The Scottish Government continues to fund free personal care for those aged 65 and over who require it. Approval is usually following a referral by the GP (or hospital doctor) to the social work department which carries out the assessment.
However to take advantage of this, the allowance has to be paid through a local authority approved agency. These can provide three or four visits a day to support washing, dressing, mealtimes and so forth, but stop short of overnight care. Help with housework, laundry or shopping, or services out with your own home are also excluded. Some people might also find the lack of continuity in personnel less than satisfactory.
Care in a residential or nursing home
The social work assessment may conclude that an individual is fit to stay in his or her home, perhaps with some of the help already outlined. However, at some point it may become necessary to look for a more comprehensive package of care in a residential home.
You are free to choose your own nursing home privately, and there are a lot to choose from. Here at Morton Fraser we have clients living in a number of local homes, so we may be able to give you some feedback as to our and our clients’ experiences of them. However, what suits one person may not suit another so there is little substitute for visiting as many as you can if time and circumstances allow. All are subject to the National Care Standards, most have websites and you should also be able to get copies of the Care Commission report on individual facilities.
If you intend to privately fund your care, you should be aware that some homes have an admission policy which requires the resident to be able to “self-fund” the costs for a qualifying period, generally of around two years. A rough figure of £30,000 per year would not be far off the mark. What happens after that period depends on an agreement with the home, the individual and the local authority.
If, however, you cannot afford to arrange a home privately, or choose not to, you will need to again involve the local authority from an early stage. The social work department are once again at the heart of the process.
There are effectively three elements to care home costs.
1. Accommodation costs
Accommodation costs are means tested by local authorities. This is based on nationally set rules, which ensure you can retain some money for your personal use. Most of your income, including pensions, will be taken into account when deciding what you should pay. The assessment also looks at capital.
After the social work department have carried out the assessment, they can organise a move to the home, which must be suitable for your needs as they have been assessed. Whilst working with social workers you can express preferences, but there may not be the same element of choice as there would be with a private arrangement. Additionally, if a place is needed urgently you often have to accept what is available, although there may be circumstances where you can be put on a waiting list for your preferred location, which can be anywhere in Great Britain. It is also possible to arrange trial periods and the full financial assessment is not required for the first eight weeks of a temporary stay.
2. Personal care costs
Subject to the assessment you will receive £159 per week to fund your personal care costs. This will be paid directly to your care home.
3. Nursing care costs
The position with nursing costs is the same as for personal care costs, though the amount you will receive each week is £72.
It is important to note however, that if you qualify to receive this free personal care and/or nursing care then you may lose your entitlement to Attendance Allowance or the Care Component of Disability Living Allowance, should you be receiving these.
It is also important to note that when looking at means testing for the accommodation costs, assessments for married couples and civil partners include a half share of any joint assets.
Your existing home is part of the capital which is means tested and, subject to the protection given to your spouse if they continue to live there, you will be expected to use that capital before accessing financial support. There is provision to defer for 12 weeks to allow a sale to be concluded if necessary although in the current market that window may not be long enough. If you find yourself in that situation it is sensible to have good lines of communication with the local authority, although they may choose to go down the route of applying a charging order to the property to protect their position. It may be possible to agree deferred payments too. Again, we are happy to help advise you on this.
If you do not own your home, then this may not be relevant, unless you have gifted it away with a view to avoiding the implications of this assessment. In those circumstances, the local authority can still view the property as being notionally yours. There is not strict time limit beyond which the local authority will not question such gifts although, in practice, the further back in time they were made the less likely they are to cause a difficulty.
Clearly everyone is entitled to make decisions about their property and you may nonetheless decide to gift it to a family member. There are risks attached to this if the family member proves to be unscrupulous or unlucky and there will be potential Capital Gains Tax implications for the recipient of the gift – this option does not work as an Inheritance Tax migration exercise, and precludes the occupier from using the property to raise finance, e.g. for improvements. Instead of gifting it you may consider putting it into a trust, though this may also prevent you from making decisions about your home which you would normally expect to make.
This is a difficult area, not least because some of the issues need to be addressed at a time when other problems or concerns are foremost in the mind. It can be daunting when you are doing it for the first or only time and it is not necessarily clear who has the answers. We are well used to dealing with these issues and have a dedicated team of people to help clients in a variety of ways. Please speak to us if you think we can help. There is helpful information available from the Scottish Government website or available from your local authority.
Our top tips, whether you are planning your own care or arranging for that of a loved one, are:
For further information please contact
Robin Morton - Partner
T: 0131 247 1313