Care home top-up fees

[veryfondoftea]

We are starting to look at care options for my mother who has dementia.
Costs for this are outrageously expensive in our area. Around £1700 a week. If we sell her house we can self fund this for 3 years.
She has no other savings, so as I understand it, once the money from the house sale runs out she will be entitled to council funding.
What I cannot work out is how much this will before?
I am presuming it will not cover the £1700 and I see that there is usually an option for a third party ( this would be me) to pay a top up fee to keep her in the nicer/ more expensive care home.
Is anyone able to give me an idea of how much this top up fee is likely to be? I realise it will vary but anyone who can give an example from their own experience would be helpful.
Thanks in advance

Don't know the answer, but I'll hop on and watch with interest because we've been wondering exactly the same.

My understanding is that homes generally charge lower fees for council-funded places. But I don't know whether in a top up situation the family pays the difference between the council rate and the standard rate, or between the council rate set by the home and what the council will actually fund.

Does your mother no longer have Capacity? If she does retain Capacity this puts a different slant on things ie Does she want go sell her house and move into a Nursing Home. if she still has a degree of Capacity I would strongly advise obtaining Power of Attorney for both Health and Welfare and Financial Matters if you have already done this. Also is your mother in receipt of Attendance Allowance? This benefit is NOT means tested and she should most definitely be entitled. This could help to pay for some care in her home if she would be manageable with this level of support.
You could contact the Health team in your area and request a Health Needs Assessment Decision Support Tool be completed. This will determine if your mother has high health support needs and entitled to NHS funding. I doubt she will meet the criteria to be funded by health but she should be entitled to Nursing Care Element of funding. This used to be called FMC - Free Nursing Care. This is a small contribution weekly or no for the nursing element of her care. Would it be possible for your mother to remain in her home with carer visits. These can be organised by Social Services and although not free are a whole lot less than Nursing Home fees.
Hope you can get the support our mother needs.

I wouldn't worry about it at this stage. Most care home residents suffering from dementia have a life expectancy of around 1.5 years. My FIL only lasted 6 months in the care home.

Thanks for sharing your thoughts. It would be great to hear from anyone who has an example of the actual costs they've paid.

To answer some of the questions,

Yes she has some capacity. Already receiving attendance allowance. We had hoped to keep her in her own home with carers but she's become terrified of being on her own so we're now wondering if residential care is more appropriate.

I suspect she has several years left on the basis of my experience with other family members with the same condition

We have power of attorney

I would ask the question direct of the care home(s) that you are looking at. For my MIL, her three kids paid about £500-£600 top up between them a month, but I don't know what the base cost was (not dementia but loss of speech and movement after a stroke)

The care home my mother moved to a couple of years ago only asked her to be able to self fund for 3 years. After that, they have a charitable foundation that tops up the local authority funding, so they have guaranteed her to end of life. I guess they make make the offer based on age and health? She is 92 with dementia and mobility issues but still fairly with it.

They are part of the Elizabeth Finn Homes group

Your mum doesn't have to be completely out of savings before being funded by the council. Check with the local council adult social care team when she would become eligible for council funding. Don't run down the savings completely first.

Don't forget she will still have her state pension and any other pension she collects to go towards the costs.

If in Scotland there will also be other contributions, I'm not sure about Wales. And nothing in England.

Also don't assume a more expensive home is better. Often you end up paying for facilities that the elderly person is no longer able to access.

When I was a care home manager 10 years ago if a client ran out of money that would bring it into the hands of social services because the family would tell social services that they have run out of money.

What happened next was that a social worker would visit the person in my home and carry out an assessment to see if they needed care (they did, obviously, because they were already in a home, it's just an assessment that social services have to do). Once thats established they then ask you if you would accept the social services payment which is, what, about £400 a week? Our answer to that was always no, and so social services paid the full amount. No-one was ever moved to a cheaper home.

To conclude, when you are 12 weeks away from running out of funds, contact adult social services and tell them. It then becomes their problem as well, if that makes sense.

In a similar situation we rented out my mum's house to provide an income, added in pensions and attendance allowance and were able to pay for a care home at a much lower level than the nursing care she now needs - £650 a week in comparison to £1200 a week for nursing care.
Look at places with dual registration for care and nursing so as her needs change you can increase the level of care.

Check out the CQC reports for homes as a starter for ten.

You can ask for an adult social care assessment for your mum and they can advise on funding - I think she can have up to £26,000 in savings and be funded. Best of luck - PM if it's any help

Depending on her needs she may qualify for chc funding. You would need to prove that her needs are medicamedical not social, and they would fund home care or residential based on assessed needs. Its worth exploring as this isn't subject to means testing

I suggest you talk to the care home you’re considering. When we were looking for MiL I spoke to one care home manager who said that provided we could prove we had funds for 3 years he would take her on and deal with the local authority when the time came but he would never force a resident to leave. We didn’t use that home in the end for location reasons but I was reassured by his approach. It was a BUPA home although I don’t know if it was a firm wide approach or just that manager.

Thank you all this is very useful.
We have only spoken directly to one home and they said that they would negotiate fees with the council at the end of the 3 years and had never had a case of not being able to reach an agreement.
It seems like this kind of situation is quite common then and we want to be asking about it when looking at potential homes.
I could afford a top up fee of some sort if necessary but not more than a few hundred a month.
It's hard to know what the right kind of home is for her at the moment. She can still take care of her self and the house to a level but is in a very bad state with her fear of being alone on a daily basis. She is also terrified of going into a care home and begs us not to put her in one.

I think she may be better with a live in carer if this could be arranged. Maybe go along the lines of her Mental Health being a big issue - fear of being alone.

Most people would never willingly choose to go into a home, but sadly as we all live longer, what they need eventually outweighs what they want.
Especially with dementia, remember, today is the best she will ever be. Very difficult.

She has no savings at all so I'm not sure how we'd fund a live in carer. Although absolutely this would be the best option for sure.
We'd thought about both of us selling up in order to buy a bigger place together but from what I can understand this then causes complications when we need funding for a care home later on down the road and we may be required to sell the house. If anyone has any advice on this then I'd be very grateful

Would extra care housing be a better option where she retains her own apartment but there are carers based on site and facilities she could access to prevent loneliness?

Usually the council threshold is £50k savings for care home. So you would need to inform the LA if funds drop to around £60k and require LA assessment. The LA will then assessment and most likely say they won't fund a care home with such a significant top up amount each week, unless detrimental to clients health and well-being. Our councils standard rate for care home is £950ish per week.
If she has no savings though, are you intending to fund the fees until the house is sold and then reimburse yourself?
I expect she will be visited by a DoLs assessor at any care home to determine capacity and then she would have an RPR to ensure they are not objecting placement and there is no alternative care options which have been overlooked as part of best interest decisions. You can always ring the LA to enquire their financial thresholds for care homes and advice etc.

@MrsMiagi
Yes that would be ideal but I'm struggling to find anywhere like this which takes dementia patients. Do they exist?

@helloyoutoo8
I hadn't really thought about how we'd fund it initially. I'd read something about a 12 week grace period which implied that the council might pay.
But yes we could cover fees until the house is sold if necessary.

Just to add, I would ring LA and ask for an assessment. If they agree she has eligible needs the LA can assist with capacity assessments, best interest decisions and if a placements needed - deferred payments if a property case ( funding placement and the LA being reimbursed from estate.

Good luck

I think what I'm struggling with is that she really doesn't seem bad enough to be in a care home. She still takes care of herself to an ok standard etc. However this fear of being alone is not something we can deal with. We have to go to work. We cannot be with her all day and night.
Also the system doesn't seem to allow us to buy a house together so we can care for her ourselves

Extra care often refuse dementia patients because as they deteriorate it becomes very difficult to keep them (and the other residents)safe