A guide to our residential/nursing care funding

From 1 April 1993 local authorities became able to provide funding for people requiring assistance with the financial costs of residential or nursing care.

The process starts with a care needs assessment by a social worker and if residential or nursing care is deemed appropriate a financial assessment follows. The rules for the assessment of contributions are in accordance with the provisions of part iii of the National Assistance Act 1948, as amended by the NHS and Community Care Act 1990, under Section 22 (5). The Department of Health provides guidelines to Local Authorities on how to assess a service users income. These guidelines are contained in the Charging for Residential Accommodation Guide (C.R.A.G).

Social Services can provide funding towards care if the service user has capital below a set limit (excluding property). This limit is amended in April each year. Please contact the Financial Assessments Team for the current limit. If the service user has above this limit they have to self-fund their residential or nursing placement until their capital reduces to this limit.

Assessment of service user's contribution towards their care

A financial assessment form will be completed and then sent to the Financial Assessments Team. A Financial Assessment Officer will then calculate the service users anticipated weekly income based on the information on the assessment form. They do this by totalling the service users existing income such as state pension, occupational pensions etc and then calculate how much Income Support/Pension Credit the service user will be entitled to should they go into residential/nursing care. The service users contribution is their total weekly income less a statutory amount for their weekly personal expenses. The Financial Assessments Officer will send the service user or their representative a provisional assessment of their likely contribution towards their care.

If the provisional assessment includes an anticipated amount of Income Support/Pension Credit it should be noted that the Department for Work and Pensions have different capital limits and rules to those that Social Services use. The service user or their representative will need to contact the Department for Work and Pensions to either make a new claim or ask them to re-assess an existing claim. This action needs to be taken as soon as the planned admission date for the service user is known.

Assessment of the Social Services contribution towards the service users care

The social worker will use the care needs assessment to determine an amount that Social Services will pay up to, for the service users care needs. This is called the support level and there are different support levels, depending on the care required. These support levels are split in to residential care and nursng care needs.

Social Services can pay the difference between the service user's assessed contribution up to the relevant support level as the departments contribution towards the service users care.

NHS Funding

Service users requiring nursing care will receive an assessment of their nursing care needs organised by the local Primary Care Trust. This assessment will determine the amount the NHS will pay towards the overall cost of the care home. This payment will be taken into account by Social Services when assessing how much the department can pay towards the care home's weekly charge.

Service users who own property

Social Services have to decide whether a property owned by a service user should be included in the service users assessment of charge or not.

Automatic reasons to disregard a property

The C.R.A.G. rules state a property must be disregarded if any of the following conditions apply,

The service user's partner will continue to live in the property.
A relative of the service user is either,
- Aged 60 or over.
- Aged under 16 and is a child the service user is liable to maintain.
- Incapacitated and
- Lives in the property as their main permanent address.

Discretionary disregard of property

Local Authorities can use a discretionary power to disregard a property in exceptional circumstances. To apply for this an application needs to be submitted in writing to the Financial Assessments Manager stating the reason why the property should not be included in the assessment.

If a property is not to be disregarded then the service user or their representative will be asked to sign a form (A67) in which they agree to reimburse Social Services their contribution, from the net proceeds, following the sale of the property.

Disregard of first twelve weeks of permanent funding

Social Services will not seek to reclaim any of its funding from the first twelve weeks of a permanent placement from any service user whose property is taken in to account in their assessment.

Third party top ups

A service user can choose a care home which charges above the Social Services support level as long as a third party agrees to pay the difference between the charge and the support level from their own funds. A service user cannot, except in limited circumstances, pay their own third party contribution from their own funds. Anyone agreeing to pay a third party contribution should be aware that the contribution could increase over time.

Notification of actual contributions

If a service user does enter residential care an actual assessment detailing both the service user's and Social Service's contributions will be issued. This notification also details whether a property is being taken into account or not.

Payments of contributions

Social Services will pay its contribution direct to the residential or nursing home four weekly in arrears. The service user or their representative will need to agree how to pay the resident's contribution with the residential/nursing home, owner or manager.

Appeals

If a service user is unhappy with their contribution, an appeal can be made in writing to the Financial Assessments Manager.

Further information

This information is designed as a guide and is not intended to cover all situations and rules regarding Social Services funding. Further information can be obtained by contacting, the address below.

Contact Details

Social Services

Financial Assessments Team

Upper Studio

Civic Centre 2

Council Offices

Coventry

CV1 5RS

Coventry City Council

Community care services