DH consults on cap on care costs and new appeals system under Care Act 2014

Practical Law UK Legal Update 4-599-7825 (Approx. 5 pages)

DH consults on cap on care costs and new appeals system under Care Act 2014

The cap on care costs

On 4 February 2015, the Department of Health published a consultation on draft regulations and guidance on the cap on care costs contained in the Care Act 2014.

The draft Care and Support (Cap on Care Costs, etc.) Regulations 2015 provide for a cap of £72,000 in respect of the costs that each individual is obliged to pay to meet their eligible support needs. Costs exceeding the cap will be borne by the local authority.

Under the current rules, if a person has less than £23,250 in assets, they will receive means-tested help and if their assets are below £14,250 they will contribute only what they can afford from their income.

How the cap on care costs will work

Under the new proposals, when a person reaches the £72,000 cap, the local authority becomes responsible for meeting costs of the person’s eligible care and support needs. The person will remain responsible for meeting their daily living costs and any top-up payments they have chosen to make, for example in respect of a specific type of accommodation.

The following thresholds apply:

People in a care home with less than £118,000 in assets will qualify for means-tested local authority help with their care costs.
People in a care home with less than £17,000 in assets will contribute only what they can afford from their income.
Once people in a care home reach the £72,000 cap, the same means-test will apply to determine what proportion of £230 a week they can afford to contribute towards their daily living costs.
The authority’s means-tested contributions will count towards the cap (so that people who benefit from means-tested support will pay less than £72,000 of their own money).
Those who develop eligible care and support needs under the age of 25 will have a zero cap for life.

Local authorities will start a care account which will monitor a person’s progress towards the cap and will provide an annual statement setting out the person’s progress towards the cap. Before the cap comes into effect, local authorities will begin work to identify people who currently meet their own eligible needs to ensure they can begin progressing towards the cap when it comes into effect on 1 April 2016. Costs accrued before 1 April 2016 will not count towards the cap.

For each person with eligible needs, the local authority will provide either:

A personal budget where the local authority is going to meet the person’s needs.
An independent personal budget (IPB) where the person is meeting their own eligible needs.

Both budgets will set out the costs of meeting the person’s eligible needs that will count towards the cap. The local authority is responsible for informing a person that they have reached their cap.

Daily living costs

The cap is intended to apply to the costs of care. Daily living costs are excluded. However, local authorities and providers are not required to calculate actual daily living costs. Instead, the draft regulations set a notional amount set nationally of £230 a week. People in care homes will remain responsible for meeting this amount including after they reach the cap. Local authority financial support will be available to people who cannot meet some or all of their daily living costs.

Which costs count towards the cap?

The following costs count towards the cap:

The cost, or in the case of self-funders what the cost would be, to the local authority to meet a person’s eligible care and support needs.
- For a person receiving local authority financial support to meet their eligible needs this is the cost of meeting the person’s eligible needs specified in their personal budget, less daily living costs if included.
- For a self-funder meeting their own eligible needs this is the cost of meeting the person’s eligible needs specified in their IPB, less daily living costs if included.

The DH seeks views on how local authorities should determine what the costs of self-funders’ care would be to the local authority, suggesting that the fairest approach is for local authorities to set IPBs by taking an average of the personal budgets the local authority has given people in that area with similar levels or types of needs.

The guidance sets out the principles which should underpin the calculation of any IPB.

The following costs are excluded:

Costs of meeting eligible care and support needs incurred before 1 April 2016.
Costs of meeting non-eligible needs, even where the local authority has chosen to meet those needs.
For people who receive care in a care home, daily living costs at the level set in the regulations.
For people receiving local authority financial support, top-up payments the person or a third party chooses to make for a preferred choice of accommodation.
Costs of any service provided to the person which is not included in the personal budget or IPB, such as prevention and reablement services.
Interest or fees charged under a deferred payment agreement.
NHS-funded nursing care for people in care homes and Continuing Health Care.

The draft regulations will come into force in April 2016.

Appeals against local authority decisions under Part 1 of the Care Act

The government is also consulting on the need for an appeals system against specific care and support decisions in relation to part 1 of the Care Act 2014.

Currently, individuals can only challenge decisions about their care and support through the local authority’s complaints system and, if they are unhappy with the outcome, through the Local Government Ombudsman.

The government proposes a three stage process:

The early resolution stage, where the local authority facilitates open and constructive dialogue with the person to attempt to resolve the issue locally and early.
The independent review stage where the local authority appoints an Independent Reviewer to review the local authority’s original decision and make a recommendation.
The local authority makes a decision considering the Independent Reviewer’s recommendation.

The government proposes the following areas should be subject to the appeals process:

Assessment (section 9): the local authority’s decision as to the format of the needs or carers assessment.
Eligibility (section 13): a decision by the local authority as to whether the person’s needs are eligible for care and support or whether a carer’s needs are eligible for support.
Care planning (section 25): the needs that the local authority is going to meet and how it is going to meet them.
Direct payments (section 31): decisions by the local authority for direct payments to the person or nominated/authorised person.
Personal budgets (section 26): the amount that the local authority deems is appropriate to meet eligible needs.
Independent personal budgets and care accounts (section 28): the costs which count towards the cap for a person meeting their own needs.
Deferred payment agreements (section 34): decisions about how much local authorities allow people to defer.
Transition for children to adult care and support (section 58): the local authority’s decision to refuse a transition assessment to a child, young carer, or child’s carer.
Independent advocacy support (section 67): decisions by the local authority as to whether a person should have an independent advocate.

The consultation closes on 30 March 2015 and responses should be emailed to: [email protected].

Source

DH: Consultation on cap on care costs and appeals (4 February 2015), Factsheet 6 Funding reform, and Factsheet 13 Appeals policy proposals.

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Also Found In

Resource ID 4-599-7825

Published on 11-Feb-2015

Resource Type Legal update: archive

Jurisdiction

England