If you need care and support, the best place to start is your local authority.
This is because your local authority may pay for some or all of your support if your needs meet the eligibility criteria and you have a limited ability to pay for the services yourself.
There are some services the local authority provides that it cannot charge for. But for many services, the local authority may carry out a financial assessment to see if you should pay for, or contribute to, the cost of your care services.
Local authorities are not required to charge for care services, but they must abide by legal guidance if they do.
If your local authority will pay for some or all of your care, you will be given a personal budget, and it could:
- provide the care directly to you, either through its own staff or through an organisation it has contracted to do so
- give you direct payments that enable you to buy the services directly with money given to you by the local authority
For more information, see Choosing care.
Services local authorities must provide free of charge
There are some items the local authority must provide for free if you are assessed as needing them. These are:
"Community equipment" means items specifically designed to make daily life easier for you. For example:
- equipment to help with zips or buttons
- telephones with large buttons or flashing lights
- communication aids
- telecare equipment
The need for this type of equipment will come out of an assessment of your needs. However, your local authority may claim the equipment you need could be used by anyone.
For example, an electric tin opener might be helpful, but your local authority may regard it as "ordinary equipment" that it will not fund. You could argue it would be reasonable and sensible to provide equipment that will help with assessed needs.
A local authority may have set rules about the type of equipment it will consider supplying, or the level of costs it will meet. If this is the case, you could argue they shouldn't have blanket policies about the equipment they will provide and should make decisions depending on individual circumstances.
If you disagree with a decision about community equipment, use the local authority's complaints procedure.
Minor adaptations costing less than £1,000 are provided by local authorities at no charge. Minor adaptations include:
- grab rails to make it safer to get in and out of a bath
- blocks to make beds higher
- raised toilet seats and bath seats
In some cases you may be asked to pay associated costs, such as maintenance charges. If you disagree with the decision about a minor adaptation, use the complaints procedure.
If the adaptation will cost more than £1,000, you may be eligible for a disabled facilities grant.
Reablement services are meant to help people adapt to a recent illness or disability by learning or relearning the skills necessary for independent daily living at home.
Reablement services may be offered to someone who has recently come out of hospital. It can include:
- helping you practise daily activities such as cooking and bathing to help you regain skills and get your confidence back
- helping you find new ways to do some things so you feel safer and more confident
- looking at what else might help, such as whether you need support to go out, or whether you could benefit from a personal alarm or telecare
- involving your relatives or carers in helping you live more independently, and discussing any support they might need
Reablement should be provided free of charge by the local authority for up to six weeks. In some cases the support may be expected to last longer than six weeks – for instance, if someone has recently become sight impaired – and the local authority should consider the benefits of this, including the reduced risk of hospital readmissions.
Financial assessment for care and support services
If you have been assessed as needing care services, your local authority will carry out a financial assessment (a means test) to see if you should pay something towards the cost of your care.
This assessment looks at your income, including tax credits and some benefits after disability-related expenses (if it is including disability benefits). Disability-related expenditure can include items such as laundry, maintenance, respite care, and extra bedding.
If you need to go into a care home, the local authority must ensure you have enough money to spend on any personal items you might need, such as clothes and toiletries. This is known as a personal expenses allowance (PEA).
A local authority has the discretion to allow a larger personal expenses allowance – for example, if you have dependent children, or you are a temporary resident and also need to meet the costs of your own property. If you'd experience hardship if the allowance was not increased, you should complain about this to the local authority.
If you are receiving care in your own home, the local authority must ensure you have enough money left after charges to meet your living costs, such as rent and food. This is known as the minimum income guarantee (MIG). The levels are the equivalent of Income Support plus 25%, and the amounts are set out in regulations.
Capital, deprivation of capital and notional capital
The local authority will also look at your capital, such as savings and property. Currently, local authorities won't contribute to the cost of your care if you have more than £23,250 in savings and property (known as "capital"). From April 2020, this threshold will rise alongside the introduction of the cap on care costs, so more people will be eligible for help sooner.
Support is means-tested, which means the local authority will carry out a financial assessment to work out what you can afford to contribute towards the cost of your care.
If you have more than this capital limit because of the value of your home, but you have a low income, the local authority may allow you to defer payment while you arrange to sell your home.
If the local authority thinks someone has deliberately got rid of capital to get financial assistance, it will treat that person as if they still had that capital. This could apply if you:
- spent money on a non-essential or luxury item
- gave money away
- gave away property or a share of property
The local authority will look at the reason why the money has been spent. Repaying a debt, for example, may justify your action, but it will depend on the individual circumstances.
The timing of the expenditure or disposal of capital is also important. If you didn't know you needed care or you were likely to need care in the immediate future, the less likely it is that the local authority will view it as deliberate deprivation of capital.
If the local authority decides there has been deliberate deprivation of capital, you will be treated as if you still had the capital. This is known as notional capital. Notional capital is treated as gradually reducing over time to a point where you qualify for full help.
You can use the local authority complaints system to dispute a decision. If you disagree with the local authority's assessment of your needs or your finances, you can take steps to challenge the decision.
Contact your local authority to discuss how to do this. If the situation is complicated – for example, around deprivation of capital – it may be best to get specialist legal advice.
Top-ups and choice of services
If you are receiving local authority support with the cost of your care and you need to live in a certain place to receive that care, such as a care home, you have the right to choose where you live (choice of accommodation).
The local authority must ensure you have at least one choice that is affordable from the amount identified in your personal budget, and ideally more than one. Some local authorities will have a list of preferred providers that they will usually recommend.
If you do not like the provider suggested, or you or the person you care for has a particular service in mind, you can ask the local authority to arrange it.
The local authority has a duty to explain this right of choice to you. This free choice is subject to conditions:
- the preferred accommodation must be available
- the preferred accommodation must be suitable to meet your assessed needs
- it will not cost more than the amount set out in your personal budget
- the provider is willing to enter into a contract
You may choose a care home that is more expensive than the amount set out in your personal budget. If you do, a third party such as a relative or friend must be willing and able to pay the difference in cost for the likely duration of your stay. This is known as a top-up payment.
Where a person agrees to enter into a top-up payment, they will need to sign a written agreement with the local authority. This will set out what the costs are, how often they have to be paid, and what will happen if the person is no longer able to make the payment.
In some limited circumstances you can make this payment. This is if you enter into a deferred payment scheme, or you benefit from the value of your property being disregarded for the first 12 weeks of your care.
The restrictions on paying this additional cost yourself will be lifted from April 2020, when the point at which means-tested support for care costs is increased.
The local authority can never require you to pay a top-up payment and must ensure there is at least one choice available within the amount set in your personal budget. Any arrangements to pay a top-up must involve your local authority, and should not be directly between you and your provider.