How to pay for carers at home??

[ChristianDior]

My query is about payment options for carers that may be required at home (DM 85 vascular dementia & v well at present but likely to deteriorate) if she is unable/no one else in the family can pay for them?

Does the local authority pay for any care provided for in the person’s home that is then repaid on the sale of the person’s home - like a deferred payment for care home fees? Even if they will be self funding/deferring any care home payment & won’t be eligible for council funded care? Does this exist?

My DF owns her own home & has a generous pension but is living off an overdraft since her cognitive decline & her adult son’s (autism, MH problems) complete enmeshment in her finances & their mutual codependency (since DF died & DM became more dependent on DB - especially so when she gave up driving & relied on him/he gave up sole use of his own car & took over hers (all at her expense).

IMO cognitively she is not making sound decisions about what & how much she’s spending (mainly on day trips out, petrol, takeaways, food & meals out) but would pass a financial capacity test (having scored 79/82 on her cognitive test at diagnosis & only her CT showing small vessel disease swinging it to a formal diagnosis). An OD is out of character for her but she denies this. She’s resistant to offers to help her budget, online banking or using her solicitor (her POA for finance) or curbing her spending. My brother is in complete denial about her ageing, has lived most his adult life with her & has tried to block moves to getting her diagnosed. He refuses to set any limits on my mother’s spending, daily long trips out, cash withdrawals eg £1000 per month & is completely unable to accept that she will need carers to help her in the future. I’ve pointed out to him that abusing a vulnerable person’s financial position even by failing to limit them when their actions may be of harm to them, is tantamount to financial abuse & this is really serious but he is completely incapable of changing his habits or behaviours. He is almost demand avoidant, avoids all responsibility, does no domestic or gardening help or helping with the mental load & basically only does tasks for her that he likes:can cope with hence the day trips out. He will take her to doctors, hair appointments etc but not supermarkets & so she gets her good at petrol stations mostly & takeaways. She puts him on a pedestal for this & has enabled him most of his life. That she allows him access to her money is the problem as she does not seem to realise it’s not sustainable. Not surprisingly she’s v defensive about this & thinks I’m trying to curb her pleasure & interfering in her private affairs.

I’ve pointed out how excessive her monthly petrol bill is for eg £850 & that my brother is using her account for his own personal (& excessive petrol use. He compulsively drives & is addicted to driving hence v high car maintenance costs all footed by my mother who seems to defend it).

So when the time comes that she needs carers coming in at home how is this paid for if she can’t afford it? This may be needed before any care needs assessment (which I’ve read can take months). She has agreed to having an OT assessment soon for handrails, pull up handles, pendant alarms & getting a key safe installed. So I need to keep her on side to ensure she agrees to all of this without causing too much conflict & argument that happens every time her finances are raised. I’m her POA for Health & feeling v anxious & concerned about this particular issue.

Otherwise she says she’ll sell her home which is too much for her now, to free up money to pay for any care at home, but she’s been saying this for over 10yrs & IMO just not capable of it. She can’t bear pple coming round, my brother hoards & she has executive dysfunction & organisation difficulties even before dementia. And everything is a huge ordeal (always has been before dementia) which is why they both cope with everyday stress with escapism & excessive spending & endless days out.

Or she says she’ll go into care - but if she’s not eligible for care & only in need of support at home surely she won’t be accepted? Especially if she can’t pay for it until on her death??

And to get a care needs assessment - if one is needed down the line - as my brother is living in the home - has mental disability & 59 - a deferred payment arrangement would have to be set up as I imagine he will have to remain in the property? To be sold on her death as he could not afford the bills there. Does this mean you don’t have the same choice of care homes that you would if you were self funding?

My concern is whilst we’ve got a POA set up for finance- she won’t resort to this until she has completely lost financial capacity & yet she may well need carers coming in to help her at home, before that happens.

I’ve got nobody else to really get this off my chest to - I live fairly close by but have several chronic health conditions/disability that make it impossible for me to offer my mother much practical support. And that I’ve expressed to her several times in the 10yr long bid to get her to downsize & get her affairs in order, that I won’t be able to provide the care that ordinarily families would be able to give. But it’s fallen on deaf ears.

Any suggestions/advice gratefully appreciated.

No, that option doesn't exist.

You're either eligible for state-funded care or you're not.

If you are, it's means-tested and your house you live in isn't included in your assets.

When you reach the point of needing enough care that it's more economical to put you in a care home, that's what happens and, unless your spouse lives in your shared house, then it's sold to pay towards your care fees.

If your spouse still lives there when you go into a care home, then a charge is put against your share of the house and the state reclaims what it's owed upon sale of the house when your spouse either dies or goes into a care home themselves (because very elderly people tend not to move home for any other reason. If your spouse did sell up, the state would come knocking for its share and your spouse would only have their own share to buy a new property with).

Sorry I couldn't deal with your post all at once.

Or she says she’ll go into care - but if she’s not eligible for care & only in need of support at home surely she won’t be accepted? Especially if she can’t pay for it until on her death??

Correct. No care home accepts someone self-funding who has no funds! They're businesses, not charities.

And to get a care needs assessment - if one is needed down the line - as my brother is living in the home - has mental disability & 59 - a deferred payment arrangement would have to be set up as I imagine he will have to remain in the property? To be sold on her death as he could not afford the bills there. Does this mean you don’t have the same choice of care homes that you would if you were self funding?

The care needs assessment determines whether she's eligible for state-funded care, whether that's in her own home or a care home is for them to decide. The assessment is free, you contact adult social services in your area or perhaps her GP could make a referral.

Self-funders can live wherever they like so long as they can pay and the place has a vacancy, the prospective resident can choose to wait for a vacancy at their preferred place, if they can manage at home for a while longer.

State-funded care is a fixed rate for the area and the home needs to be willing to accept that rate as well as having a vacancy. There's no waiting for your preferred place, you'll really need a care home by the time you're sent to one and so it needs to happen ASAP, either because it would be unsafe for you to remain at home or you're already in hospital and bed-blocking until a place is found.

I don't know if a brother would count as someone allowed to continue living in the house. Assuming he doesn't own half of it of course. If it's jointly owned then, yes, the state gets its share when it's sold after brother's death.

If he can't afford to stay there, regardless of whether he part owns it, the he's allowed to move out and the house can be sold and the state gets it's cut and your brother, if he's co-owner, gets his.

If he's not co-owner or if he has no right to remain then he can apply to the council as homeless.

As he's disabled, the brother may also need his own care needs assessment, if he doesn't already have a care plan and social worker. If he does, it may need updating so his social worker should be informed of his changed circumstances.

Why can't he afford the bills? If he's the sole adult living there he'd get 25% single adult occupancy council tax discount, possibly council tax benefit too which is means-tested, universal credit which is means-tested and possibly PIP as well. There may be low-income utility bill discounts too. Unless you're going to drip-feed she lives in a castle or ancient 5bed listed country house that's full of drafts, there's no reason he shouldn't be able to afford utility bills.

He can't get a deferred payment for the bills, utility companies don't work like that. The only "deferred payment" is quarterly billing, but the bill must be paid when it lands on the doormat, they usually give a week or two leeway before they start sending reminders, then red letters, then it goes to a debt collection agency.

He'll also be responsible for repairs I guess, even if he doesn't own the house, simply because the owner your mother doesn't have any funds to pay for them. As the person living there he'd be left no choice but to fix the repairs at his own expense if he didn't want to live in something falling down around him. So it could be he's better off renting, so that a landlord is responsible for repairs.

Universal credit would pay towards the rental costs but may not cover them entirely on a private rental. You can find out what the Local Housing Allowance is for your area by looking on the website, as a single person he'd be entitled to a one-bed rate, so if he rents something larger or more expensive than the LHA then he'd have to pay the shortfall from his other benefits.

Means-testing for state-funded care or welfare benefits won't take into account things someone likes to spend on, such as hobbies or bankrolling another relative. There's strict rules set by government about means-testing, a mathematical calculation. Her actual bills or outgoings won't come into it.

If she finds herself unable to pay for her contribution towards the care that she's legally obligated to pay, she can be chased through the courts for it by the local authority just like with any other debt. They can apply for an attachment of earnings and take the debt repayment directly from her pension income.

Local authorities aren't known for going above and beyond to do their jobs properly and comply with the laws regarding care needs, preferring to fob people off where they can and pay for the minimum they can get away with. So if they have to chase through the courts for payment I can image they'll be even less helpful than usual.

An OD is out of character for her but she denies this.

Please clarify what this means in the current context. To me, OD is overdose.

I’ve pointed out to him that abusing a vulnerable person’s financial position even by failing to limit them when their actions may be of harm to them, is tantamount to financial abuse & this is really serious but he is completely incapable of changing his habits or behaviours.

This is unfair to the brother and incorrect. Your mother has the right to make decisions, however unwise or harmful they may be to hers, so long as she's judged to have capacity. The brother has no rights to limit her spending. To do so would be financial abuse. Not doing so isn't. If she's bankrolled him willingly and without coercion all his life, it's not financial abuse for him to carry on with the situation now, even with her cognitive decline.

If brother isn't working and has no income or savings, why is he not claiming benefits? He's eligible, even if it turns out to be eligible for jobs-seeking benefits, if he's judged for for work by DWP. It's unlikely he needs her income, one way or another he can obtain his own.

He's entitled to his thoughts. If he wants to stick his head in the sand about her aging and cognitive decline, that's upto him. Let it go and stop trying to convince him, he doesn't have to think like you.

If he obstructs the house sale when she wants to sell, that's financial abuse. He can't legally block the sale, even if he's co-owner she could take him to court to force sale if she wants her share liquidated.

If he prevents her carers doing their job when the time comes, that's elder abuse.

She is now diagnosed, so that's a moot point. Though worth mentioning to mother's social worker, in case she needs a doctor in future if there's a chance he won't take her.

If he's doing these things he should be reported to your mother's social worker and the police. You can't expect social workers to accept he's doing a crime if you won't report it. They certainly can't act on your say-so, especially if your mother has capacity, but if crime is reported police may be able to have him removed from the house and social services can take the abusive relationship into account when forming your mother's care plan.

...avoids all responsibility, does no domestic or gardening help or helping with the mental load & basically only does tasks for her that he likes:can cope with hence the day trips out. He will take her to doctors, hair appointments etc but not supermarkets & so she gets her good at petrol stations mostly & takeaways.

Brother is not obligated to care for her in any way or to do things he can't cope with. Her bankrolling him has nothing to do with this, it's a separate issue. Both issues are between him and your mother.

It is his personal choice what he does and doesn't help with, both domestically and in terms of care. It's literally none of your business, beyond ensuring mother's social worker is informed of what he is/isn't willing to do so they can see where the gaps in her care needs are.

Not surprisingly she’s v defensive about this & thinks I’m trying to curb her pleasure & interfering in her private affairs

You are. I appreciate you want what you think is best for her, but it's her decision, not yours.

I’ve pointed out how excessive her monthly petrol bill is for eg £850 & that my brother is using her account for his own personal (& excessive petrol use. He compulsively drives & is addicted to driving hence v high car maintenance costs all footed by my mother who seems to defend it).

No harm in having your say, but as always when offering unsolicited advice, one has to be prepared to be told to sod off! You have said your peace and now you need to back off. Otherwise you'll end up being the one carrying out financial abuse via coercive control. That you think it's for her own good is neither here nor there. Your opinion isn't law.

Nobody can step in until she loses capacity. At that point her POA can step in to ensure her care bills and other needs for herself are paid and if there's nothing left for brother then tough luck. However, given that she's been happy to bankroll him for a long time, it's possible he would be given a monthly monetary gift if there's funds available for it simply because that's what mother would have chosen to do if she could still choose and POA must act in her best wishes.

So when the time comes that she needs carers coming in at home how is this paid for if she can’t afford it? This may be needed before any care needs assessment (which I’ve read can take months).

I’m her POA for Health & feeling v anxious & concerned about this particular issue.

The POA takes effect when she loses capacity. Until that point you can't decide she needs carers, it simply isn't your decision. If she'd prefer to spend the money on brother that's upto her. If she doesn't get on with selling the house and doesn't let you arrange it either, that's upto her. As frustrating as this is for you, she has the right to make her own decisions. If she refuses to pay for private carers or refuses to have them, the agency will stop sending them. As with care homes, they're a business not a charity.

One last thing. If she's getting private carers and between those and the brother and you, she's getting all her needs met then she won't qualify for state-funded care. They don't fund care because someone else would like to stop paying for it or stop doing it. They fund care where there is a need only, not a want. Anyone who wants to stop caring/paying for care needs to cease doing so prior to the care needs assessment, otherwise they'll say all her needs are being met.

@Eastertidingsthankyou for such a comprehensive reply & for confirming there is no provision for care at home where the payment for which could be deferred - in the same way care home costs are (as in when the person goes into care & the costs are deferred until their home is sold).

My mother fully intends to pay for any care home costs with the sale of her property. I had just read that dependants or relatives aged 60 or over & /or with a disability may remain in the home if the owner goes into care. But if this is not the case then my brother will need to seek his own accommodation, so your suggestion re a social care assessment for him is helpful. Any benefits he may receive will not cover the running costs of the property that is indeed a large, rural, listed, oil run, money pit in an expensive council tax bracket. (No drip feed intended just too much to get across in the first instance & not relevant if as you say it will be put up for sale as she will not qualify for any state care & he has no interest in the property).

If you know that you won’t be eligible for state funding is a care needs assessment necessary then? Her pension & value of her home will mean she is not eligible. I’m confused.

I wasn’t asking if bills & running costs for my brother could be deferred in any way but my post is confusing I agree.

The main issue remains: how does she pay for any carers coming in as she may need them, but cannot pay for them because her pension is being so mismanaged & misspent (by her & my brother)? She can fund external care but has to be severe enough to be accepted for it. She is incapable of selling her home ATM & resisting any help to do so. I suppose it will have to get to the point that her financial capacity can no longer be demonstrated allowing for her POA for finance to step in. I am sadly not in a position to pay for any carers due to being on a low income myself.

If anyone else has been in a similar position I’d be grateful for any thoughts.

Okay a few questions… would DB be classed as a “dependent” of your mother do you know? If so that changes what can happen about the house.

Is DB in receipt of carers allowance for looking after your mother?

Does your mother receive attendance allowance?

Re the petrol, is your brother receiving the petrol for his own personal use, or is he using it to drive her around?

Who is on the financial POA- is it just you or is it DB as well?

Oh and does your brother receive any form of disability benefit? PIP etc

@Eastertidings OD is overdraft abbreviated from earlier description of her being overdrawn.
Appreciate the further reply & advice. Re financial abuse - I’m surprised that enabling an elderly person with a known neuro cognitive disability to get into debt, that will prevent them from being able to pay for their own care - is not financial abuse.
I’m surprised that you do not think it reasonable for me to be concerned about this.

Re my brother’s limited ability & refusal to help my mother with housework/chores/gardening - it was to illustrate that despite living with someone, they are unable to provide any care for her other than driving. Hence she will need private support a lot sooner than if that family member could help her (with for eg taking medication, preparing meals, help getting in & out of shower). And I read that the council or social workers tend to perceive that if you have family living with you, you are considered to have sufficient support. The reality is my DM has limited family support.

I think the decision to get carers to help one’s parent is one made jointly by both the person & their concerned family member. My mother is already talking about the need for external support & is receptive to it. She has always maintained she does not want to burden her children with her care also. So again I don’t think my concern is misplaced.

My brother does receive benefits & is in debt. My mother’s OD arose when he became her driver (coincided with her being unable to drive any more & him not being able to afford his own car any longer due to the high maintenance costs as a result of his driving addiction & debts). She tells me she now keeps her bank card in her purse after their outings, & takes it to bed with her, so that he cannot spend any more on it while she’s in bed. But her petrol spend this month remains the same, so she’s either just saying this to me, or he’s using it without her knowledge while in her company. Which would be easy to do. Prior to this my mother was extremely anti-debt, preached as a parent about the perils of getting into debt & both her & my father feared “getting into the red” like it was a moral affliction, so this is uncharacteristic & out of character for her.

Kind thanks for your reply.

Hi thanks for yr reply- really quickly as I have to rush - DB would be classed as a dependant IMO - no carers or attendance allowance - yet - DM wld not qualify for it yet.

DB does receive PIP. Petrol is completely enmeshed -mutual use. DB suggests where they could go & DM agrees. Or DM suggests a day trip to….Brother uses the car outside of these trips/errands for her. POA for Finance is Solicitor. I have POA for Health.
Thank you.

If your DH is living in the house and is over 60, then the house would be disregarded in a financial assessment.
Your DM would need an assessment of need to determine what care she would qualify for. If it is deemed she meets the criteria for care visits at home, her income would be taken into account to contribute towards it. Once she reaches a point where 4 carer visits daily are not enough, she would be eligible for a care home place. Again, her income would be assessed - basically she would be left with £30 a week for personal spending.
Is your DH in a position to afford to live in their house without any financial support from your DM?

@Soontobe60this is really helpful thankyou. So my DB will likely be over 60 (is 59) so that’s what I’d read about being allowed to stay in the house. He can’t however afford to without any financial support from my DM (& with benefits). And my DM’s intention is for it to pay for her care shld she need it. I assumed the council wld allow him to live there & then defer payment til it’s sold on her death?

You say that if DM meets criteria for care at home this is assessed against her income - at which point then perhaps her POA for Finance could get involved. I am just worried there won’t be any income in her account to pay for care at home due to the mismanagement & debt - but if there’s a formal look at her finances, maybe then my DB will have to make every effort not to spend on it. That’s my main fear - that she will be in need - but there be no means to pay for it. And I get upset bcos she worked hard all her life & I can’t stand the thought of her suffering. She does have the means to - on paper but not when she is overdrawn. Many thanks.

She can fund external care but has to be severe enough to be accepted for it.

No, if she's self funding there's no 'severe enough to be accepted'. If you want care, you get as much as little as you pay for. - just as any adult can pay for a cleaner, housekeeper, private chef, chauffeur, gardener, food delivery service etc if they want to.

Need only comes into it if the local authority is paying.

Thank you this is really good to know. If we k or she won’t be eligible for funding will a care needs assessment be necessary?

Shld read If we know

Does she have savings of 23.5k?

Ignore the house for now, if what she needs is care in the home.

If she doesn't, she needs a care assessment. If she does, she will need to pay for the care until her savings fall below the threshold.

But she may have to contribute to the cost if she has a lot of pension coming in. This would be determined by a financial assessment.

Ask for both of these NOW so she is on the list. It can take months.

PS If self funding do care homes accept deferred payments as regardless of DB’s living situation there it could take time for the property sell??

Thanks @SilverBlue56no savings & cld pay for care at home if wasn’t overdrawn & pension being misspent. She’s not in need enough yet I’m trying to anticipate what to expect. She’s having an OT assessment soon though which will be really helpful. But this confirms it then - to ask for a care assessment & financial one thanks again.

Deferred payments while the house sells would need to be individually negotiated with the care home. I think most will have a system for it.

Ok thats good to know - thanks.

Deferred payment agreements are arranged with the local authority and the care home, not privately (as far as I've found anyway) this will still require the care and finance assessments and won't be available for all. Definitely do not rely on being able to make a a private arrangement like this with a care home.

@SilverBlue56thanks for this. It’s actually what I read about initially. So going round in circles! What I read re this was that you are limited to care homes that the local authority is affiliated to. But that’s not a criticism more an observation/consideration. Obviously there no ideal places or processes just v uncertain & complex ones.
All the info’s been helpful though.

Yes, this is because the DPA is between the home and the LA and therefore has to be agreed by them to be the appropriate course of action following a care and finance assessment..you can't just ask for this and they'll say oh ok. If you see what I mean!

@SilverBlue56- I think so - so it’s only at their discretion following due assessment & only if the person can no longer remain safely at home even with all the respective packages of care tried to date?

Contact adult social care and mencap for their advice. From what you have said your brother is going to probably need help once your mum is home and it’s a thousand times easier if things are in place before you get to that point.