What the State Provides...

Since implementation of the Community Care Act in 1993 the provision of state care has been split between National Health Service who are responsible for medical care and Local Social Services who are responsible for assessing and providing social/persona

This division is continuing to cause concern over the definition and distinction between what is medical need and what is personal care. The following is Advice on Care’s current understanding of the situation:

Any initial medical attention needed will still be paid for and provided under the National Health Service. However once the medical condition has improved or at least stabilised, the hospital will want to discharge the patient to avoid “Bed Blocking”. Before this can be done, a Community Care Assessment (needs Assessment) is carried out, by a Doctor or Registered Nurse and a Care Manager from the Local Authority’s Social Services. This assessment decides what help the patient will require and where this could be provided.

This could be either:

Continuing NHS Health Care, in which case it will continue to be free – this can apply continually even in a Nursing Home if the NHS deem that such ongoing care is required primarily for medical reasons and not principally because of frailty.

However from October 1st 2007 a new National Framework for NHS Continuing Care is being introduced in England and with it a new Decision Support Tool to try and more fairly assess peoples entitlement to free NHS continuing care based on their own needs and to try and prevent inconsistencies of decisions around the country. For more information click on National Framework for NHS Continuing Care or Decision Support Tool.

Intermediate Care is treatment designed to help rehabilitate the patient to living back at home. It is only provided free of charge by the NHS for a short period often lasting no more than 6 weeks.

Domiciliary Care, which is where care continues in your own home. This will be most people’s preferred option, but may only be deemed practical if you are still capable of living on your own or have a spouse/partner or other family member prepared to care for you . Dependent on your needs the Local Authority’s Social Services may be able to provide a range of services including home help, meals on wheels, day centre visits, equipment to help retain Independence – known as Assistive devices, or even modifications to your home. They may charge for these services after carrying out a financial means test based on your capital and income. The NHS will also be able to provide primary care services such home visits by GP’s/District Nurses, Chiropody, Physiotherapy, transport to and from outpatients and prescriptions free of charge. However if you fail the means test or require greater help than Social services are able to offer the only answer may lie in using your own money.

Residential Care Should more full time care be necessary and other family members are not able to provide the level of care required, the only option may be care in a home. This can either be in a home offering Residential Care or one offering Nursing Care. Once such care is require the Local Authority must assess your ability to pay for it yourself, by performing a means test. Only If your savings and income are less than currently £13,000 (England and N Ireland) £12,500 (Scotland) or £17,250(Wales) (2007/8) will you qualify for the maximum help.

There are no national set limits as to how much will be paid for each type of care. Normally after the assessment, the local authority will give you a list of homes and advise you on the maximum level they will fund. So even this may not be enough to meet the full cost of your preferred home, in which case you would either have to choose a cheaper home or your family may need to pay a top up.

Should a nursing home be recommended you may then qualify for NHS funding contributions towards nursing needs only (defined as that which requires the planning of /provision by or delegation /supervision by a member of NHS staff, not towards personal care (defined as help with daily activities including washing, dressing, feeding, toileting, or mobility) or residency costs.

The level of assistance in England and N. Ireland are from 1st October 2007 is £101 per week (2007/8):

If you live in Wales everyone receives a flat fee of £114.90 per week. (2007/8)
If you live in Scotland you receive £65.00 per week towards Nursing Needs, and up to £145.00 per week towards personal care either for help in your own home or in a care home. Please note however, that in Scotland if you receive help towards your personal care then any Attendance Allowance being received will stop after 4 weeks. These contributions are paid directly to the home and will help reduce the cost, but with average costs of nursing care in England during 2005 being £27,500 (Source: FSA guide Paying for Care) and with some homes in some areas costing considerably more, there will be a considerable bill to meet.

So whilst some support is provided by the State clearly it is limited and subject in many cases to a strict means test. Once care is deemed necessary, a Means Test will also be carried out if the patient's capital is less than 21,500 England and N. Ireland, £22,000 in Wales and £20,750 in Scotland (2007/8) and you wish to apply for Local Authority funding.