Deferred Payment Agreement & Care Home fees

[CodLiverOiled]

My aunt (80) is currently has been in respite care for over 3 months, following steroid induced psychosis & a 2nd hospital stay, which is now resolved. She has myeloma, but is currently in remission. She is frail & partially bed-bound. She currently resides in a different county than the rest of her family.
Initial contact with her social worker was patchy & we were informed that she had been dropped from their caseload a while ago - she hadn’t been assigned a new social worker until this week.
This social worker is now pushing for my aunt to be placed in a care home under a DPA. My aunt has 50% of a shared ownership property (which probably would amount to £100k at best) & savings of just under £3k including private pension & Attendance Allowance. Due to her steroid induced psychosis we were only able to get her agreement to POA recently & forms were only received on 10th October so we are waiting for these to be registered. It is fully understood & agreed that all of my aunts assets should be used to fund her care - as with the house she is over the £23,250 limit.
The social worker had just an hour visit to assess my aunt in the care home she currently is in and has decided that my aunt does not meet the criteria for any funded care. My aunt does not want to go home & knowing my mum struggles to visit regularly has stated that she would like to move to a care home near to her. The social worker is now looking for care homes within a 10 mile radius of my mum for my aunt as self funding & with A DPA.
My issue is that (1) I don’t think the assessment was fair, based on one 1 hour visit where my aunt was trying to be positive about her needs and (2) that they seem very keen on moving my aunt to another county. While this is what my aunt has said she would like as she knows my mum is struggling with visiting, I don’t think she understands the possible implications of moving counties & how that would affect her when her money runs out (& that could be quite quickly). Would she lose local resident status?
The social worker has also phoned my mum twice to state that the house should go on Purple Bricks immediately & talking about getting a DPA (also something about taking a loan out in my mum’s name?) which she has said should be agreed, as she has stated that they had forgotten my aunt & in doing so had let her and her family down.
Bear in mind all this has happened in under a week & I feel she is railroading my mum & my aunt - who are vulnerable - into making a decision - and thus offloading their responsibility to my aunt - all due to failures of their own ( the local authority) making.
I have been in touch with Age UK & spoken to the social worker myself ( who then phones my mum) but wondered what else I can do to protect my aunt & my mum before making an informed decision?

Age UK were able to point FIL to an advocate who talked to social services on hos behalf - it was a stage where he was in a sulk with us because DH wouldn't give up work, move an hour away from our home and sleep on an airbed to look after them.

I think you’re confusing the two issues.

if she didn’t meet the criteria for a care home the social worker would be leaving you to it.
it sounds like she does, but she is classed as a self funder. Normally people get 6 weeks funded ‘free’ care from the nhs after hospital and it sounds like this did drift hence why there’s pressure from the social worker.

don’t feel pressured to rush into anything.

Unfortunately though, if she does have care needs but does own her home then she will need to fund her care, either by selling her home, or by entering into a DPA. But the DPA should only be done after independent financial advice and it is your Aunt’s/her POAs decision. Normally it’s simpler to sell the home unless there’s a particular reason not to.

it may be the social worker did a checklist to check for eligibility for fully NHS funded care (ie free) but I’m not surprised she didn’t meet this as it’s a very high threshold.

if I were you I’d ask -
— when did the 12 week property disregard start? (Everyone gets 12 weeks where the property is not taken into account for the financial assessment normally to give time to sell it etc)

I’d also say you need to take independent advice about DPA and ask her to stop pressurising you and your family. Make a note of dates, the gap in contact from the social worker etc.

if you’re still unhappy how it’s being dealt with or still confused, age Uk is a good call.
or ask to speak to the social workers manager.

complaints to local counsellors or MPs also make a lot of difference in social care generally.

as an aside in our area DPA is not automatic and you have to apply for it and you wouldn’t get it for that level of equity.

I used to work doing financial assessments for people going into care and DPs. There are two reasons the SW may have said your aunt did not meet the criteria

1. They don't think she is in actual need of care home care and that her care needs could be managed at home with carers visiting. This would be a good outcome financially as she would only contribute from her actual income is pension and they would allow a fair amount of it to be kept before they bill her for a contribution to her care. Her small amount of savings and house value would not factor in. Or
2. She is not entitled to funded care because she is over the threshold ie because her house value is over £23,250. In this scenario her house would be counted, because if she was in care she would not be living in it. Because it is a shared ownership property I think it would be harder for the council to put a charge against it - each council would have their own criteria for this - as the housing association are the freeholders. (It never came across a shared ownership case, so am not fully sure on this point). Which may be why the SW is pushing for a sale. However the whole point of the Care Act and Deferred Payments (DP) being put as a charge against a property is that nobody should have to sell their home within their lifetime to pay for their care. So I recommend you to check the Care Act online for this point.
   However, the added factor is that shared ownership properties usually don't allow you to have the property and not live in it for more than a year, so that may be an issue.
   Finally, if your aunt is not assessed as needing care home care, but chooses it anyway, the council may not agree a deferred payment (because she is choosing a care home and does not need one). In that scenario she would be choosing to go into a care home just as she can choose to move to another house or into supported living, and the council has no responsibility to fund her by setting up a DP. Also, if she takes this route, when her house funds run down to £23,250 (her weekly care fees could easily be £1,000 per week so it won't take long) they will assess her again. If she still does not meet the criteria for needing a care home they will help her to find a flat to move back out to that would take housing benefit, and that could take a little time as for council flats she might be considered to have made herself homeless by selling her house and moving into a care home. After that, if she needed a care home later, she would not get much choice as she would have no assets at the outset and would be put in a home that accepted the council's (much cheaper) payments.

All in all, if people can stay in their own home and independent it is better all round for them. Also there are volunteer visiting services, I know someone who did this and every person on their list would get a daily phonecall and a weekly visit, she really liked the company of the elderly people she visited and became fond of them. Maybe she could look into this?

A previous poster mentioned AgeUK advocates and this is a good resource

www.ageuk.org.uk/hillingdonharrowandbrent/our-services/brent---what-we-offer/advocacy-brent-gateway/care-act-advocacy/#

Also you can write a letter of complaint to the council and say the outcome you want is for another assessment to be carried out.

Who is the other owner of the house and do they live there?

Your aunt would be entitled to a property disregard as per PP, but only if other capital and assets outside of the house are under £23,250.

If your aunt has lost capacity, the charge will not be able to be put against the property for the DPA until LPoA has been registered with the OPG. The joint owner will also have to agree to the charge being placed against your aunt's share of the property.

It is possible, if there was no cooperation, for the local authority to obtain judgment through the court to have a charge placed against the property, but this takes a long time. The LA I work for would only do this as a last resort.

Your mum can refuse to manage your aunt's finances and she should not be using her own income and savings for your aunt's care. She must use her own funds for visiting your aunt though.

The house does not have to be sold, but under the DPA, arrangements for payment would need to be made within 90 days of your aunt passing away. This means that the house would need to go on the market in this time, or the balance will need to be paid another way.

Thank you all so much, this is so helpful & lots to think about!!,

You’re right though - I think I am confusing the the issues. It’s a lot to look into in such a short time and I’m not appreciating the pressure we’re being put under from the social worker. Am also unhappy with everything being decided after a one hour visit when I don’t think the full implications have been fully explained- I like the idea of getting independent financial advice.

The social worker appears to be saying that a DPA would be agreed due to their failings ( I.e not assigning her another social worker/ forgetting about her / not keeping the family up to date).

All in all, we do agree that her house should be sold to fund her care - and this is also my aunt wants. She has said she doesn’t want to go home (she lives alone) which is understandable- she’s had 2 lengthy stays in hospital and the 6 weeks of NHS funded care package after each hospital stay, ending up in respite care in the care home she is currently living in. Again though, I don’t think it has properly been explained to her the consequences of this option. Obviously once she chooses this option the local authority will then not be responsible for her which is probably why they’re pushing for this scenario.

I’m also a bit wary about her moving counties - would there be any financial implications when it comes to her money running out? She has been a resident in Suffolk for 20 years & would be moving to Norfolk.

She would be Ordinarily Resident in Suffolk. Therefore, Suffolk County Council would be responsible for the DPA and her funding in Norfolk.

In Norfolk the council continues to commission the care for the duration of the DPA. Some care companies offer their own DPAs, but I have no experience of this.

Look up information about Ordinary Residence in the Care Act 2014, this should explain the responsibilities of the LA when moving 'out of county'

I agree with seeking advice from Age UK. They also have a lot of fact sheets which include information on DPA and ordinary residence.

I would put your concerns in writing to the social worker. Bullet point them. Ask them straight out if she moves counties which Local Authority will be responsible for her and reviewing her care etc.

The social worker should absolutely not be telling your family to list the property or rushing you to do so especially before she has been made permanently resident somewhere but do get independent advice on how best to proceed. As advised above there will be a 12 week property disregard if savings are below the threshold. You do need to know then how they will value her share of the property and make sure they don't overcharge her. Say her share is 100k and she has no capital then they should only charge her full cost until she falls below the threshold but it's not clear as it's not held in the bank so will they review it or will you need to be on top of that? A previous local authority I worked for would have worked out based on income and expenditure when this would happen and then change the assessment without prompting.

https://www.ageuk.org.uk/globalassets/age-ni/documents/factsheets/fs38propertyyandpayinggforresidentiallcarefcs.pdf#page7

The attorney cannot make gifts to themselves or use the donors funds for anything other than necessary expenses on behalf of the donor. You can use their funds to pay for financial advice, to get tax returns done, to pay for phone calls and travel expenses where acting in your role as attorney so checking on her care and welfare and whether she has any needs etc. Family are not supposed to use funds to pay their own travel costs etc BUT whilst a reviewer might flag this I don't believer the court is going to penalise a family for doing so if it's the only way they could visit the donor as the donors quality of life and connections would be adversely affected by not having that. I worked for a LA who were asked to take on a case by the OPG because a daughter was using her fathers funds to pay her travel to visit him (not close by). Everything else was absolutely in order. She was a single parent on income support. She could not afford to visit otherwise and he would have lost out. They wanted to remove her and appoint us the LA. We told the OPG that was ridiculous and not in the clients best interests and said no to taking on the case.

Also @CodLiverOiled , don't be surprised and try not to be annoyed if the social worker doesn't know the answers to a lot of the finance questions. The Care Act is quite convoluted and there are so many variables with each individual they come across. They also can't make it easier for you or cut you any slack, unfortunately. It is the legislation that has to be applied.

There are a few complicating factors in your great aunt's case. The lack of legal representative is one.

The joint owner of the property is another. Typically, the joint owner will either be a living spouse in the property , in which case the property would not be included in the financial assessment. Or a deceased spouse and the property will have become 100% your aunt's.

The third is moving out of county and Ordinary Residence rules.

The SW may not have come across one of these scenarios before, or even been involved in many DPA cases, and may need to get some clarity themselves from finance colleagues or managers.

My point is that if you really push for answers when the SW seems reluctant to give them, you may get incorrect information. Speak to the Financial Assessment Team too.

Good points @Velvian - thank you & thank you to all the other pp ‘s for their input & suggestions.

it’s a minefield, isn’t it?!?

Looks like we could find ourselves in similar position some time this year. MiL currently in rehab unit following surgery, unlikely to walk without help, recently diagnosed dementia and we are told will get 6 weeks care package initially. Then reassessment - she would overstate her abilities to cope so we need to have a family member at assessment who tells the truth. And hope she gets continuing care in the home. She has just under £21000 in savings. We have PoA on finance. So on income alone should get some funded help. I assume IF authorities say she needs care home with nursing care they must fund? This is where I get confused, she owns half the flat on paper, we own the rest but lent her the money to buy and have not charged her rent or any interest etc. Will cross that bridge when we come to it, Age U.K. recommends people to talk to. BUT I assume if family decided she should be in a care home she would have to fund which would mean selling as her pension is tiny!

@Juneday

*we are told will get 6 weeks care package initially. Then reassessment
*
We got the reablement package a bit longer as they were late doing the reassessment. If MIL stays in her own home and doesn't receive full NHS funding then she will be means tested for her contribution. The assessments I've seen are quite in depth in comparison to one needed for residential care. They take into account her normal expenditure and there are increased disregards for disability related expenditure eg a lot of laundry due to accidents.

*I assume IF authorities say she needs care home with nursing care they must fund?
*
Not necessarily. It could be that she has some needs which should be met by the NHS so would receive NHS funding for that part of her care and the remainder is paid by MiL if she has assets or the LA with your MIL paying a contribution.

Property is disregarded from the financial assessment for 12 weeks. MiL's share of the property would be taken into account in her assessment if she is not going to return there and has no spouse or dependants living there. I believe you can ask for a deferred payment arrangement but the council can refuse. I think that if the joint owner lives in the property as their home then the council cannot force a sale (don't know how they recover the money). If the joint owner does not live in the property as their home I think they can push for sale.

I think that if the joint owner lives in the property as their home then the council cannot force a sale (don't know how they recover the money). If the joint owner does not live in the property as their home I think they can push for sale. - that’s if the joint owner isn’t a spouse or dependent. If a spouse,the property is disregarded

The social worker had just an hour visit to assess my aunt in the care home she currently is in and has decided that my aunt does not meet the criteria for any funded care My experience (with applying for CHC) is that the assessor doesn’t directly assess, they take evidence and then decide. So an hour would be enough to take evidence from the care home as to what support was needed. The issue is that your aunt will have been feeding her duff info. Are you able to appeal the decision?

Social services, I discovered, feel it is acceptable to leave someone immobile in a single room with a commode and people popping in for 30 mins four times a day. So what seems to us “she needs to be in a care home” doesn’t necessarily seem so to Social Services. Elderly people are considered to need feeding and washing, they’re not, apparently, considered to need social interaction or mental stimulation.

Thank you, this is a difficult area to get to grips with, MiL has savings less than £20,000 and a very small income, state pension and tiny extra, still in rehab hospital who have said they are looking at continuing healthcare package; the hospital bed and equipment have been in her lounge for 3 weeks, organised by previous hospital, with her paying out for storage of her furniture at reduced rate for first 8 weeks, after than it will cost her £40 to store the furniture that had to be moved for the hospital bed, chair etc.

We don't have PoA on health and as she has been diagnosed with dementia I imagine we are too late.

We are tenants in common but don't live in the property, so I believe care in the home will be assessed on needs first and then if she does need it, they will take from her income up to an amount which leaves her with enough for her bills and food - that seems to be how it works, but different areas seem to have slightly different cut off points - I think her area, borough of Richmond, Hounslow/Chelsea and Westminster for health, are not very generous.

Where it could get complex is if there is talk of a care home, can she be forced into one and the authority force her to pay, i.e. sell half a house because we can't be forced to sell? I know of people who are fighting this for their very frail parents, the criteria for continuing care is tough - so we hope the 4 visits a day that we have been told to expect come into effect - we have no names of people involved in the decision making, we have had no contact from the GP, although they have a letter giving permission to talk to DH, her son.

No one is giving an idea of a return to home date, although the department that organised the delivery of the hospital bed etc. were in a real hurry to get the delivery done. Still waiting for a hand rail that was promised 6 months ago, the guy turned up and said he had the wrong drill bit?! MiL knows the surgery, metal rod inserted to stabilise her ankle, mean she will not be able to walk normally again, at the moment walking is very painful and with help and a walker, she also knows she forgets things and gets confused, she seems to have lost the ability to read, but can sound quite sensible and together when not over tired.

She hasn't been out on her own for over 2 years, we do her shopping and take her to appointments.

I am sure there are many others in this position and charities such as Age Uk are a great source of information, but the communication between the experts involved excludes family unless you have PoA on Health ... luckily my parents organised theirs years ago!!

So sorry to hear this and this is my fear, I have heard stories like this before, it seems so cruel and undignified, I do understand the pressure on staff too.

*We don't have PoA on health and as she has been diagnosed with dementia I imagine we are too late.

*
Not necessarily, a diagnosis of dementia does not mean that the person can not make any decisions for themselves at all but you will know better where she is at now.

If MIL can understand the authority she is giving the attorney then it's ok to go ahead. If she doesn't understand what it means then it shouldn't be done.
Mental capacity has to be decision and time specific.

What I would say is that it is very isolating to be at home if you do not live with anyone and have no visitors. My mother is bedbound and I would say still isolated even though she lives with my sister and dad. Think about how many hours of the day she will be alone and what her days will look like. You may have befriending services in your area.

In our area there is a carers group on Facebook so check for something like that as it may contain people who have been in your shoes in your LA. Like you we felt very much at sea. There's nothing from the GP, discharged from the memory service and no involvement from social services for a number of years after diagnosis (prior to her being hospitalised and bed-bound). This was in part due to having family who were able to do quite a lot.

Mum has double handed care 4x a day. A few of the carers are fantastic, very knowledgeable, caring and hardworking. Others are very dishonest and quite lazy. I know someone will say something about pay but this doesn't help when it's your loved one that isn't being cared for properly or whose funds are paying for a 30/45 minute visit and they were here for 8 minutes when they could have slowed down and done a better job. This can be stressful to deal with and we have done everything they do in cleaning, washing changing pads etc.

just catching up as things change every couple of days, MiL in Kingston following another fall, not physical damage by delirium and NHS have concluded she currently does not have capacity, OT wanted to send her home and see if this helped! Told DH she would be home that afternoon, he was only home because of train strike and dashed round to sort things out and buy food in-between working. She didn't come home, next day Social Services rang and said she needs temporary nursing care and after that would discuss care home options. I think care would be preferable and safer, she had two falls in 5 days after discharge 3 weeks ago. So the first big question is how is the 50% property with 84 year lease and two other tenants in common, get valued for a DPA and is this an amount that is then stated on charge documents? Can a DPA be agreed if she does not have capacity? We have PoA on finance not health. I assume they cannot take the final £23,250 and could leave that in the value of the property in effect. She has as stated approx £21,000 in savings - unless she wins the premium bonds big time! I assume we can use those savings after the 12 week period and start DPA after that? Assuming she doesn't qualify for CHC, (atm anyway), if we refused to agree to a charge, but social services say a care home is best - is this stale mate... in which case they would go back to 4 2 person care visits, district nurse visits, physio visits in the home, that arguably are at a similar cost to some care homes?

I rang age UK near me and they were quite off with me and said it wasn't their area?

EUFF - feel for you. The 5 days of carers were interesting, really kind positive young women, who had to risk a parking fine because of resident's only, I have since found I can buy a carers permit for £120 for each carer - but would happily do so to prevent a £40 fine each visit! She broke the rules and actually cooked something for MiL, usually only allowed to heat up in a microwave! After one email and two letters handed in to GP a young very keen and helpful GP rang DH and offered some help and said he would chase the hospital for news etc. Can't organise her second hearing aid whilst in hospital though (she only has one - long story). 6 week wait for physio. Missed her follow up post op appointment because hospital forgot to take her to the other hospital, District Nurse turned up the day we had to call an ambulance again, fall alarm didn't work and GP surgery said they had no doctors available to come and check on her, prescription for suspected UTI hadn't turned up at pharmacist..... and on it goes. Luckily is after 6 days in side area of A&E in a dementia ward, colourful and designed with dementia in mind, big clock with time and date etc. (which MiL insists in wrong) and nurses who understand dementia and elderly care and are kind a incredibly patient. One little lady keeps screaming and trying to escape home - so sad - but for a tiny lady she can look quite scary - takes two nurses to get her back to safety of her chair or bed. Sadly the nicely done little lounge area is always empty. MiL 90 this weekend and her worse nightmare was to be in Hospital - but at least ward sister said NHS caterers will send up a little cake. SiL spoke to nurse on last visit and mentioned her broken ankle, and they knew nothing about it, despite us telling another nurse, the frailty doctor being informed, the physio and two OTs, and my writing to them when I realised another nurse thought the wound form her break was a pressure sore.... perhaps we had better put a great big label on her leg. 😯.