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Paying for social care (older people)

What happens when money for care runs out?

This page covers:
• Help from the local council when the money runs out
• Reasons people worry about money running out
• Jacky’s story of her mum’s move to a more expensive area of England

A common worry for people who pay for their own care is about what will happen if their money runs out. Some people we spoke to had been to their local council for a financial assessment. Although they did not get help from their council with funding to begin with, they were told to come back for an assessment when their money got down to near the financial threshold. For more about this, see What is a financial assessment.

If a council starts to contribute towards the costs of care following a financial assessment, this can be organised in a number of ways. For example, the council can manage the care by appointing a care agency without the need for the person receiving care to handle the money. Alternatively, the person needing care can be given the money by the council so that they can manage and pay their own care workers at home. This is what Janine’s mum had. It’s called a ‘direct payment’.

 

When her mum’s money reduced to below the threshold, Janine opened an account to pay the care workers.

When her mum’s money reduced to below the threshold, Janine opened an account to pay the care workers.

Age at interview: 63
Sex: Female
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I had her accounts, that’s it, they gave me an account. So there’s two ways of doing it; you can let the council sort it out or you can ask for money to be put into this account, and that’s right, I had to monitor, I, they had to monitor this account. So I had a separate account which was for my mum’s care, so they told me to open a bank account which was separate for my mum’s care and then they used to have to pay, they used to pay the money into that and then I used to pay the care bills from that, it’s coming back to me now, and then they had to audit it every, every so often; I had to send the bank statements and the bills and stuff to make sure I wasn’t like creaming the money off for something else.

Councils have an upper limit on the weekly amount they will pay for a care home. This is enough to cover the fees of some care homes but not others. Some people were told that they would have to top up the fees if their care home was more expensive than the local council limit. This payment is known as a ‘third party top up’ and must be paid by someone other than the care home resident, for example, their partner or family.

 

Margaret pays a top up for her husband’s care.

Margaret pays a top up for her husband’s care.

Age at interview: 79
Sex: Female
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The assessments, yes, the financial assessment, now Joe’s money was down to the, below, it was well below by this time that, what they suggested. So out of that came the fact that Joe pays, you know, so much from his pensions, I had to sign an agreement, or somebody had to sign an agreement for, to make up the difference from what social services can pay, because they have a set amount, don’t they, that I don’t know whether it’s the same with each council or not, or whether councils work out their own, I’ve not really found that out because I don’t know anybody in care in any other counties, but this was [County] County Council. So there was so much that, a week that they would fund and if you went into one of the homes they would fund it completely but there wasn’t anywhere near here that had a place that I felt he would be happy, because when he first went into the home he could still move about, he could still walk, and like there was a room up a stairs and had to be a lift, he wouldn’t have had his independence, whereas for a few months he could walk still. It soon went because he then had another episode in hospital when he was in for two weeks and, with pneumonia, and they couldn’t get him out of bed, and he never walked again after that, so. He would have been all right in another room but you can’t change, I felt I couldn’t, he’d got, he’d got settled there and I couldn’t change him.

Some families did not feel that it was affordable for them to pay top up fees. This led to worries about whether their loved one might have to move to a different care home or have a different care team coming to their home.

 

Deryck was worried his mum might have to move to a different care home.

Deryck was worried his mum might have to move to a different care home.

Age at interview: 71
Sex: Male
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Finance department of [County B] County Council and they were lenient in the way that they did their calculations. She got around £80,000 for her flat and that, which stayed in a, in an account so she, basically she paid monthly for her care until it dribbled down, and it did, actually three years was about right, till it dribbled down to the £23,500 when we had to have another meeting to see whether she could stay where she was.

But there was a lot of nervous tension when her money got down to the level where she could no longer completely self-fund; and they put you through a few hoops and there was a great deal of anxiety on our behalf that if she couldn’t stay at [town D] where was she going to go, or were we going to pay top-up? And that left a bit of a uncertain feeling in terms of whether, because there’s, I didn’t want to put any timescale on this, I was not looking to, that my mum as being a, oh she’s only going to be here for six months or whatever, as long as she’s able to get some enjoyment out of life that was really the issue. So we thought long and hard, I guess, you know, if we did this, did that, yes, we could, don’t really want to; so that was the conversation I had with them. And I got a phone call one Friday afternoon saying, “She’s got it.” So that was a huge relief, and then from there on her income dwindled down from the £23,500; we never got to the point where I think £11,000, or thereabouts is when you don’t pay anything at all. So she was contributing to her care costs, and in fairness to [name of care provider] the, I saw no difference in the way that they looked after her once the financial situation had changed, and nor would I have expected there to be; for them she was one of their patients and they all deserve the same level of care and I think she got that.

People told us that care home managers also seemed worried about what happens when the money runs out. When choosing a care home, some people were asked to prove that they had enough money to pay for their care for a year or two.

 

Simon’s mum was refused a place at one care home because she couldn’t pay for a full year.

Simon’s mum was refused a place at one care home because she couldn’t pay for a full year.

Age at interview: 60
Sex: Male
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And I went all the way round to just about every home in [Town B], which apparently has the highest concentration of old people’s homes outside of [Town C]; and I only found one that I thought was OK; and when they found out how much mum had in the bank they basically said, “Oh we can’t take you because it’ll be a local authority case.” I notice that they didn’t do that in writing, but anyway.

So, sorry, I don’t understand; so what, because she was below the threshold?

No, they said that she had about five months’ worth of funds and after that she would be local authority and they wouldn’t accept that. I don’t know why; must be some stigma or whatever, but...

So they want to know that you, if you’re going to self-fund they want to know that it’s going to be for as long as it needs to be?

Yeah, no, I got the impression that they didn’t want anything that involved funding from the local authority.

People moving to a care home in another region can find that the fees vary in different parts of the country. Jacky told us about her mum’s move to the south of England and what happened when her money began to run out.

Jacky’s parents lived in a care home in the north of England and after her father died, Jacky wanted to move her mum to be near her in the south of England. She got advice from Age UK about the move and was careful to choose a care home that was not too expensive.

 

Jacky knew the fees would be higher and was worried about what would happen when the money ran out.

Jacky knew the fees would be higher and was worried about what would happen when the money ran out.

Age at interview: 65
Sex: Female
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I think actually I could have rung the Alzheimer’s Society, but I, for some reason I knew that Age UK had got specialist advisors that you could ring that would give you information and they were, they were wonderful. I could not get clarity from either end but what they told me was correct, they sort of said, “No, you must move her now, before her funds run out, because,” they say, “if you move her now there’s no set time period, but if you move her to [name of South county] she will become what’s termed a normal resident, when she becomes a capital depleter she will then apply for a financial assessment from [name of South county] County Council and it will proceed on that ground,” she said, “if you wait until she is becoming a capital depleter in [name of North town], once [name of North town] Council take over responsibility for her payments in her residential care home, if you move her then she will remain [name of North town] responsibility.” [name of North town] are paying £460 a week, I think this is the cheapest room I found which I was happy with but it’s £750 a week, so you’re talking about a big difference.

Jacky talked to the care home managers about her mum’s financial position to make sure she would be able to stay after the local council adult social care department started to contribute towards her care.

 

Jacky looked for a home that could be funded through the local council adult social care department.

Jacky looked for a home that could be funded through the local council adult social care department.

Age at interview: 65
Sex: Female
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But the manager that was there when I was looking at care homes, I actually told him that she would become a capital depleter about six months later, because social services, rightly this time, in [name of county], had told me that when I’m looking at care homes make sure I select one that does accept social services funded residents, which was, again was important to know, because there are one or two, I think, luxury ones here that cost a lot of money and that I think they, they only take self-funders. So, so yes, he knew. He didn’t so I think I think as I remember it I actually said within about six months, which, and it was, it was almost exactly six months, that she would be applying for social services’ financial assessment, because I have heard of other care homes when they yes, they ask for proof that you can self-fund for a year, for example, as a period before they will accept you. So no, that, this particular care home, that wasn’t a problem, no. So they said they had got some residents there that were funded by social services.

And had that not been the case or had you not known to ask that question there could have been a risk that you would have had to move again?

No, definitely, yes, no, definitely. No, that was, that was certainly a question that; did I actually ask it or...? No, when I asked advice from social services on finding an appropriate care home and they actually did volunteer that information, because they sent me to a link on their website, which has got all the care homes and you could see their the reviews, you know, the Care Commission reviews that they’d had on that and everything; and she actually did say that, “Yes, just make sure that when you’re contacting them you check that they do accept social services funding.” So they did, yeah, they did volunteer that information, yes, and it was very important to know that.

Jacky said that a top up would not be affordable and she knew that the local council adult social care department must offer a place that would meet her mum’s physical, emotional and social needs.

 

Jacky did not want her mum to be moved and refused to pay top up fees.

Jacky did not want her mum to be moved and refused to pay top up fees.

Age at interview: 65
Sex: Female
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And, and this was exactly what the social worker said, right at the end of this interview she sort of she said and these were her exact words, she said, “So the social services pay £615 a week so that would leave £135 a week top-up.” As though that was, that was it, you know. So then I sort of brought up my- I challenged it on the basis of the 2014 Care Act and, and I said, and I said, “I was very careful to look at other care homes, I’d disregarded some,” I said, “I don’t think you’ll find a cheaper room in [name of town A].” And she immediately said, “No, you’re probably right but we can get a cheaper room in [name of town B].” [name of town B], I don’t even know [name of town B], it’s down, it’s, I think it’s a more deprived area actually; but it wasn’t so much that, because if you’re in a care home she’s not really going out, but it’s like, for example, every Friday I take my three year old granddaughter and we call on the way back from her ballet class every Friday, I wouldn’t be able to do things like that if she was down in [name of town B]. So, so I sort of said this, and so I said to her that I knew that they had to give at least one option that met this needs and moving her to [name of town B] would not meet those needs, because it’s a bit like, well she’s a parcel we can just move her to [name of town B] because it’ll save us X amount of money, and so, and again it’s like the bullying thing. I said to her, “And so if you don’t agree to her staying here I will be appealing on that basis and,” I said, “make no mistake I will appeal.” And I think she knew I meant it, you know, I was, and I would have done. So that was that, and that’s just what I’m saying about it’s the system, not the individual. Because then we went up to see the manager, because she wanted to ask the manager whether there would be any negotiation, would, whether they would reduce the fees, because she’s then backed off from me, and she said, “Oh well we’ll go and talk to the manager and see if they’ll reduce the fees.” And as I said to her, “But why would they because, you know, they’ve got to make ends meet, why are they just going to suddenly say oh now social services are paying we’ll make it cheaper?” “Oh sometimes they do,” she said. And so we went up there. Anyway they wouldn’t because I’d already, I think it was quite a good rate compared to other care homes, a lot of care homes you are paying £1,000 and I think some of the newer rooms there they’re £1,000 as well. And so the, I remember the social worker then said to her, “Oh when I took this job I didn’t expect it to be all this about fighting about money.” So that’s why I don’t blame that individual social worker because it’s probably a horrible part of her job, but that she is obviously told to put it that families think this is it, we’ve got to top up and families feel guilty because they think OK, my parent’s going to get moved somewhere if I don’t agree to pay this, but that’s not actually the case. They don’t tell you that the Care Act is actually in legislation that they’ve got to offer at least one option that meets physical, social and emotional needs, and if you can make a case on that they’ve got to prove otherwise.

Jacky and other people’s stories show that there can be some difficult negotiations about paying for care as money is running out. Some people told us they wanted to avoid the worry and so decided take financial advice from a specialist later life adviser about buying an immediate needs annuity which would pay for care for the rest of their life. For more information, see the summary What is an Immediate Needs Annuity?

 

Mark says that buying the annuity meant they knew dad could stay in the home where he was happy.

Mark says that buying the annuity meant they knew dad could stay in the home where he was happy.

Age at interview: 58
Sex: Male
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Well what we, what we thought was that this money was my dad, it’s my dad’s money obviously, and the only, he has no, he has nothing to spend it on other than his care, so we were totally happy for all of his money to be spent on his care, which would be better for him in that it would mean that the annuity would need to fund less of his total care package. But we had quite we had quite a specific, we, yeah, it was a very specific amount we wanted to cover, so we had a, we had that goal in mind when we set it up; then there wasn’t a lot of, well you could do this or you could do that, we knew exactly what we wanted. Because I think our, as I said before, our biggest fear was that we wouldn’t be able to afford to keep him at the care home if his money ran out. The care home were quite helpful explaining that that might not necessarily happen, that the mechanism might be that they would have to go to the local council to try and get them to help fund it, and this is often what happens, but it can be quite a long process and it can be quite what was the word they used? You know, it can get a bit heated; and actually we didn’t, we just didn’t fancy that, we didn’t want to get into a situation where we were sort of having to haggle over dad’s you know, staying in his care home, basically, so yeah.

 

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