Care Providers and Care Costs

Types of Care Provider

There are a variety of care options available and a Care Needs Assessment can help identify the most appropriate support.

Day Centres   

Day centres can provide an opportunity for people who live independently at home to get out and socialise with others in a safe and supported environment.

Some provide breakfast as well as a meal at lunchtime. Staff are usually available to help with toileting needs but do not generally provide a bath or shower.

Day centres may offer training or work projects for people with disabilities, others may be specifically designed to help adults living with dementia or recovering from illness, such as a stroke.

Homecare

Professional carers providing support to people who still live in their own home is also known as domiciliary care.  The professional carers may support one or more of the following care needs;

  • personal care (washing and dressing),
  • oversee medication,
  • some domestic duties,
  • provide companionship and help to get out
  • support to socialise and take part in activities and hobbies.
  • Some may specialise in particular medical conditions.

Professional carers may work for a care company or not for profit organisation or independently as a Personal Assistant.  Some Care Providers can provide overnight care and/or Live in Care.

Live in care

Live in care may be used as temporary care for example to cover a time when family carers are on holiday or as a longer-term option.  Certain provision must be made for a qualified professional carer to ‘live-in’ the home of the person or people requiring care and support;

  • You will need to provide a private bedroom for the carer.
  • If care is required during the day and night provision must be made for the carer to have necessary breaks (e.g. 2 or 3 live-in carers sharing the care).

Care Homes

Care Homes are communal living residences with 24-hour care provision. Care homes come in all shapes and sizes; purpose built modern buildings or adapted large character houses and ranging in sizes and numbers of residents.

Personal care provided in all care homes includes help with washing, dressing, toileting and mobility. Staff also often help residents with eating and drinking, communicating and joining in social activities.  Some care homes offer day trips or outings.

Nursing Homes

Nursing homes are care homes with registered nurses on duty day and night and are better suited to people who have a condition or illness requiring regular medical attention. They are often better equipped with specialist beds and a range of equipment for moving and handling people. Staff may have specialist training in specific conditions such as dementia.

Sheltered Housing

Accommodation specifically designed for people with some support needs to allow them to live independently. It usually consists of self-contained flats with communal facilities.  A telecare system is usually fitted inside the accommodation and a scheme manager (although not necessarily living on-site) can deal with emergencies and report any care concerns.

Assisted Living Facility (ALF)

Assisted Living Facility is housing for people with disabilities or adults who cannot live independently. It offers more support than sheltered housing. Assistance with daily living activities like bathing, dressing, and eating is provided and there is opportunity to socialize with scheduled activities.

Shared Lives Southend

This is a scheme offering adults with a learning disability or other long term difficulties an alternative and flexible form of accommodation. Individuals, couples or families, in the local community, provide the care and accommodation to help people live independent lives. You can live permanently in the Carers own home or stay for short breaks. Placements can be from one night up to several months. If required you can have a carer providing day support.

Choosing a Care Provider

When family are caring for a ‘loved one’ it can be difficult to start the conversation about future care options should the time come when you can no longer manage the care on your own.  This is best discussed before there is a real need, the more time you have, to make decisions the better; it is always difficult to make a decision under pressure, when family carers are ill themselves or tired and upset.

Care Quality Commission (CQC)

The Care Quality Commission (CQC) is the independent regulator of health and social care in England.  They register care providers and inspect and rate them; the views of family carers and the people who receive care are included in their final reports.  The latest CQC report for each care provider can be viewed on their website.  Care providers may also publish their last CQC report on their own website. Care Quality Commission

Tips on choosing a care provider;

  • Do some research such as reading the last CQC (Care Quality Commission) report for the care provider.
  • Listen to recommendations of those currently using the service
  • If appropriate, visit the care provider to build up your own personal impression of the care and support provided.
  • The organisation Care Choices provide information on choosing care services in your area and provide checklists to help prompt questions you may want to ask care providers when you are looking for support.
  • The Care Choices search tool can be useful to find care providers of all types in your area.
  • If you are paying privately for care, Care Search may be able to help you find a suitable care option and care provider. Care Search
  • The CareCompare website is designed to identify care companies which can meet your care needs allowing you to compare them and then choose the best option for you 

Further information can be found in the Essex and Southend Care Services Directory

Care Costs

When you are considering extra help to meet the care needs of your loved one, a care needs assessment carried out by your local authority can advise you on the level of care required.  If you are considering residential care for example you may be given advice as to whether a care home or nursing home is most appropriate. 

A care needs assessment and carer’s assessment can be requested no matter the level of savings or income you have.

If  there are eligible care needs, a financial assessment will be required to identify whether the cost of care will be met partially or entirely by the local authority or whether the person requiring care services will be ‘self-funding’ i.e. required to pay the full cost of the care provision themselves.

If the local authority is helping to pay the cost of care, they will allocate a personal budget for your care needs and the local authority will then find a care provider with the capacity to provide the care.  An alternative is to ask to receive the personal budget as a Direct Payment (Self Directed Support) so you are able to choose and manage the care yourself. 

Advocacy services can help explain options and if needed, can help you express your concerns or complaints to the local authority or care agency. Contact Southend Essex Advocacy Service for further information; Telephone 01702 340566 ;  South Essex Advocacy Service

Local Authority Financial Assessment

The Social Care Finance team at Southend Borough council can help with enquiries on care charges and can be contacted on;

Non-residential care charges 01702 215008 ext. 4062 or 4651 or 4542

Residential care charges and third party top-ups 01702 215008 ext. 4629 or 4312 or 4636

Guidelines on financial assessment and care charges;

If there are care needs identified during the care needs assessment which are eligible for support, the local authority will complete a financial assessment also called a ‘means test’ of the income and assets of the person with care needs.

If a financial assessment is not completed the local authority will not make a financial contribution towards the care provision.

The Care provider may start providing services before the financial assessment has been processed.  You will receive a statement of how the required financial contribution has been calculated and fees payable will be backdated to when the care provision started.

The financial assessment works on upper and lower saving limits which are set nationally by the Government. These limits can change each year. In 2019/20 the upper saving limit is £23,250 and the lower limit £14,250.

If the person with care needs has savings and income more than the upper limit you will be asked to pay the full cost of your care.

  • This does not include the income of a spouse or partner.
  • In the case of savings held jointly only a percentage will be taken into account.
  • If care is provided within the home the value of their home is not included.

If your savings are less than the lower limit they will be disregarded although other income such as benefits and pension are still counted.

If the local authority makes a financial contribution to the care costs, the choice of care provider will be limited to those that accept the local authority’s funding level.

If the local authority is making a financial contribution to the care costs, the local authority can organise the care package or you can ask for a direct payment (Self Directed Support) and organise the care yourself. 

If the cared for has capital and savings between the upper and lower limit they will be expected to contribute £1 per week for every £250 they have above the lower limit.

To ensure you have enough money to live on, the local authority has to leave you with a protected amount; for non residential care this amount is called the Minimum Income Guarantee (MIG) and for residential care the amount is called the Personal Expenses Allowance (PEA).  2019/20 Rates for MIG and PEA

You cannot give money or property away to reduce the contribution you are asked to make towards the cost of care and support.  This is called Deprivation of Assets.  You may still be charged as if you still had those assets.

More information including a virtual assistant to answer queries can be found on the Age UK website https://www.ageuk.org.uk/information-advice/care/paying-for-care/

Direct Payments or Self Directed Support (SDS)

In most cases the personal budget which the local authority has allocated, to meet care and support needs, can be paid as a Direct Payment.  

The person with care needs or their carer (if they have permission) can request a Direct Payment to arrange their own care and support services instead of receiving them directly from the local authority.  This is called Self Directed Support or SDS.

Details regarding Self Directed Support can be found on the Southend Council website;

Setting Up a Direct Payment

Employing a Personal assistant

Records must be kept and accounts submitted to the local authority to show how the Direct Payment has been used to meet the care needs. 

Direct Payments may be used to pay a care agency of your choice or to choose your own support workers or Personal Assistant (PA). 

In some cases, the Direct Payment could be used to pay a family member to provide the care but not usually your partner/spouse or someone who lives with you.

If the Direct Payment is used to employ individual PAs, there are additional responsibilities.  More information and support is available from the charity Vibrance.  The following websites provide further information on finding and employing Personal Assistants;

Vibrance and Skills For Care Information

Is the value of my home included?

If the person with care needs owns their own home the value of the home is not included in the financial assessment while they are still living there or they are in a care home temporarily.

If a care home is chosen as the permanent care option  the value of the residence will not be taken into account if  the home is also occupied by any one of the following;

  • a spouse or partner
  • a relative over 60 years of age
  • a relative who is disabled
  • a lone parent who is their estranged or divorced partner
  • a child who is under 16, who is their child or their responsibility

Note: If a relative gave up their own home to live with the cared for to be their unpaid carer they may also be allowed to remain in the home.

Deprivation of assets

Deprivation of assets is when a person has intentionally given some of their money, property or other assets away, to reduce the contribution they are asked to make towards the cost of their care and support.  If the local authority believes they have evidence of deprivation of assets they may still charge the person as if they still had those assets or ask for payment from the person/s who received those assets as a ‘gift’.

More information including a virtual assistant to answer queries can be found on the Age UK website https://www.ageuk.org.uk/information-advice/care/paying-for-care/

Schemes and benefits to help

The local authority finance department can explain statutory regulations.  Care Act 2014 Advocacy services can also help explain options; South Essex Advocacy Service

There are various schemes available to help pay for care home fees such as;

Top up fees – If the care home charges are above the local authority threshold a relative, friend or charity may top up the local authority contribution so the family member can go to the care home of their choice.

Deferred Payment Scheme if you have savings less than £23,250 and all your money is tied up in your property. The council may pay your care home fees and you repay it later when you choose to sell your home, or after your death.

12 week disregard  – If you own your own home, are in a care home permanently and you have less than £23,250 in savings, the council must disregard the value of your property in your financial assessment for 12 weeks.  The council will pay the care home fees for these 12 weeks, or until your property sells, if sooner.  If your property does not sell after the 12 weeks you may be able to have a deferred payment.

Further information about these and other aspects of paying for care can be found on the following websites;

Money Advice Service-  Help with Care Costs

Planning ahead for long term care costs

Financial Advisers specialising in Later Life

Southend Borough Council Guidance on Paying for your Care

Charges Payable for Adult Social Care – Southend Borough Council

Benefits to help pay care fees

NHS Continuing Health Care – If the person’s care needs are primarily health care needs they may be eligible for NHS funding.

NHS Nursing Care Contribution – If care is in a nursing home they may receive a NHS contribution to the care fees.

Mental health Section 117 After care– If the cared for person has a mental health condition and were admitted to hospital under certain sections of the Mental Health Act 1983, care home fees could be fully funded under Section 117 After care.

Disability Benefits

When a person is permanently resident in a care home any disability benefit they receive (DLA, PIP or Attendance Allowance) may continue or stop depending on who is paying the care home fees.

NHS Continuing Healthcare

If the primary care needs are ‘health needs’, the NHS may have the responsibility of providing and funding the care.

Most people with long term care needs will not be eligible for full NHS Continuing Healthcare; it depends on your assessed needs, and not on any particular diagnosis or condition.

There is an initial checklist and where appropriate the full Continuing Healthcare Assessment would be completed.  Your GP or social worker can advise and organise for the assessment to be carried out.

You can choose to receive funding for your care as a direct payment, known as a personal health budget. A personal health budget gives you more choice and control over how you plan and pay for your healthcare and wellbeing needs.

NHS Funded Nursing Care

If you are not eligible for NHS Continuing healthcare and you need care from a registered nurse in a nursing home you might get NHS funded nursing care.  This is a non-means tested contribution towards your nursing costs and is paid directly to the nursing home.

Case study

Rohit’s sister was not remembering to take her medication and eat regular meals. As a result of a care needs assessment a support plan was put in place and a care provider agreed to do the required four visits a day. This support plan was only partially successful. Rohit talked to the social worker and discussed reorganising the care visits. Rohit agreed to manage Direct Payments for his sister’s care. He found two people to work as Personal Assistant to meet his sister’s care needs.  Having received advice from the GP and pharmacist the time the medication was taken was changed. The same two carers now carry out two longer visits each day which is proving more successful in encouraging Rohit’s sister to socialise and eat healthily as well as take her medication correctly.