Health and social care

Charging and financial eligibility assessment for adult care and support services

This page explains how charging and financial eligibility assessments are carried out for adult care and support services.

Introduction

Our Charging and Financial Eligibility Assessment for Adult Care and Support Services policy has been designed to comply with The Care Act 2014. Its aim is to produce a consistent and fair framework for charging and financial assessment for all customers who receive chargeable care and support services, following an assessment of their individual needs, and their individual financial circumstances.

For the purposes of this policy, an adult is a customer aged 18 and above.

The Care Act 2014 legislates for the provision of care and support in England only. It provides a single legal framework for charging for care and support. It enables local authorities to decide whether to charge a customer when it is arranging to meet a customer’s care and support needs, or a carer’s support needs.

Section 14 of The Care Act 2014 provides local authorities with the power to charge adults in receipt of care and support services, where councils are permitted to charge for the service being provided. We exercise this power within the scope of the Care Act 2014.

Section 14 of The Care Act 2014 provides local authorities with the power to charge for services meeting carer’s needs, by providing services directly to the carer.

Section 17 of The Care Act 2014 permits local authorities to undertake an assessment of financial resources. The financial assessment will determine whether a customer is eligible to receive our funding support, and the amount (if any) which the customer may be likely to be able to pay towards the cost of meeting their needs through care and support services.

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Services that are free of charge

Section 14 of The Care Act 2014 instructs that councils are not permitted to charge for provision of the following types of care and support:

  • Community equipment (aids and minor adaptations): a service which consists of the provision of an aid, or minor adaptation to property, for the purposes of assisting with nursing at home or aiding daily living. An adaptation is minor if the cost of making the adaptation is £1,000 or less.
  • Intermediate care (including reablement support) services for up to 6 weeks.
  • Care and support provided to people with Creutzfeldt-Jacob Disease.
  • Any service or part of service which the NHS is under duty to provide. This includes Continuing Healthcare and the NHS contribution to Registered Nursing Care.
  • After-care services/support provided under Section 117 of the Mental Health Act 1983.
  • Services which the local authorities have a duty to provide through other legislation.
  • Assessment of needs and care planning, including the cost of the financial assessment, as these are part of meeting people's needs.
  • Services provided free of charge under any other legislation.

We will refer to Care and Support Regulations (Statutory Instruments) and Care and Support Statutory Guidance and Annexes issued under The Care Act 2014, in all regards for specific guidance relating to charging and financial assessment, and as such, these statutory regulations form the basis of this policy, except where we exercise our power of discretion as set out within the regulations.

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Diversity and equality

We are fully committed to the broad principles of social justice and are opposed to any form of discrimination and oppression. It therefore accepts not only its legal responsibilities but also wishes to embrace best practice in all areas of its work to secure equality of both treatment and outcome.

We are committed to ensuring that no one is treated in any way less favourably on the grounds of personal differences such as age, race, ethnicity, mobility of lifestyle, religion, marital status, gender, sexual orientation, physical or mental impairment, caring responsibilities and political or other personal beliefs.

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Policy objectives

The principles underpinning this policy are:

  • Where the authority is required to arrange care and support for free, it does so.
  • That customers will only be required to pay what they can afford.
  • That financial eligibility and support towards care costs will be determined through financial assessment.
  • To provide clear and transparent information so customers know what they will be charged, and what they will be charged for.
  • To apply the rules consistently, to avoid variation in the way people are assessed and charged.
  • To promote wellbeing, social inclusion, and support the vision of personalisation, independence, choice, and control.
  • To support carers to look after their own health and wellbeing and to care effectively and safely.
  • To be person-focused, reflecting the variety of care and caring journeys and the variety of options available to meet customer’s needs.
  • To apply charging rules equally so those with similar needs or services are treated the same and to minimise anomalies between different care settings.
  • To ensure that the charge to the customer for services provided is no greater than the cost of that service being delivered to us.
  • To encourage and enable those who wish to stay in or take up employment, education, or training, to plan costs of meeting their needs to do so.
  • To ensure that, where a customer lacks the capacity to undertake a financial assessment, we consult a suitable person who holds an Enduring Power of Attorney (EPA), a Lasting Power of Attorney (LPA) for Property and Financial Affairs, a Lasting Power of Attorney (LPA) for Health and Welfare, a Property and Affairs Deputyship under the Court of Protection, or any other person dealing with the customer's affairs (for example, someone appointed by the Department for Work and Pensions (DWP) to manage their benefit payments).
  • Where a customer lacks capacity and has no one who is able, willing, capable or suitable to act as an appointee or Court Appointed Deputy, we will apply to undertake these duties.
  • Where a person is in receipt of a chargeable care and support service but declines to participate in the financial assessment (having the capacity to make that decision), then they will be charged for the full cost of the chargeable care and support they receive.

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Charging and financial eligibility assessment for care and support in care homes on a permanent basis

We will charge for care and support delivered in a care home on a permanent basis.

Customers requiring permanent care and support in a care home must initially satisfy an eligibility assessment for care and support. Only where a customer has an eligible care and support need will a funding application and financial assessment to determine a customer contribution be required.

All customers requiring permanent care and support in a care home must have a financial assessment. Customers’ financial circumstances will determine whether the customer is eligible for support towards permanent care costs from us.

Customers will be made aware at the outset of the maximum amount of funding we make available towards care and support provided by private sector care homes. This is known as the Council or Market Rate. This rate is inclusive of any assessed customer contribution.

Where a customer is eligible to receive our funding support, but decides to reside in another Council area, we will match the Council or Market Rate for the area where the customer decides to live.

Customers who would like to live in accommodation that costs more than the Council or Market Rate can do so providing they or a third party meets the additional cost (Customers can only provide their own top-up in limited circumstances). This additional cost (known as a 'top-up') must be sustainable. We may refuse a request for a customer or third party to use their assets for this purpose if we do not consider the costs to be sustainable over the long term. The third party will be asked to submit details of their financial circumstances to evidence that the top-up commitment is sustainable before entering into any legally binding agreement, covering all these points. The Customer must however have been offered and declined accommodation that meets their needs at a lower cost.

Where a customer chooses more expensive accommodation than that offered by us during any 12-week property disregard period, the customer will be asked to pay a top-up. This can be provided from the customers’ own resources where available or by a third party. The customer will be made aware of the cost. Any customer that has not received an offer of cheaper alternative accommodation that can meet their needs will not be asked to pay a top-up during the 12-week property disregard period.

Customers who own a property or other asset, over which security can be taken, may be eligible to defer care costs against the value of the property/asset. This is known as a Deferred Payment Agreement. We will make deferred payment agreements available under the Universal Deferred Payment Agreement Scheme and The City of York Council Deferred Payment Agreement Scheme providing all eligibility criteria has been met. Details of deferred payment agreements can be found within the Council’s Deferred Payment Agreement Policy. The Council will not make Deferred Payments available to those with second or further properties.

We will undertake a financial and benefits check for customers entering residential care on a permanent basis. This is normally done before the customer starts to receive care. Contributions are payable from the date care commences.

The Financial Assessment will consider income, capital, and the value of any assets. The charging methodology will take into consideration any mandatory disregards of income, capital, and property as defined in Section 9 and Annexes B & C of the Care and Support Statutory Guidance.

The financial assessment process will consider statutory amounts required to be retained by the customer from their income. These are known as ‘Personal Expenditure Allowance’ (PEA) and ‘Disposable Income Allowance’ (DIA). These amounts are dependent upon the customers’ financial circumstances and are reviewed annually by the Department of Health and Social Care. The rates applicable for the relevant financial (April – March) are set out on our website (see Adult care and support fees, charges, allowances and rates).

Where a customer has no income, we are not responsible for providing one. We will provide benefits advice and support, and an advocate (if required) to support the customer to receive any income they are entitled to.

Financial assessments will be updated annually unless the customer is self-funding through a Deferred Payment Agreement. Where a Deferred Payment Agreement is in effect, a review of the customers finances will take place when the equity used to secure the agreement reaches 70%, and within 6 months of the customer being eligible for Council-funded support. If there is a significant change in a persons financial circumstances (such as inheritance, additional or cessation of existing income) then the customer in receipt of a Deferred Payment should request a review of their circumstances. We have a separate policy covering Deferred Payments.

Customers receiving care and support in a care home on a permanent basis will have their care and support costs administered through personal accounts. Please refer to the section regarding Personal Accounts.

Where a customer is residing at a residential college, no charge will be made to the customer where the placement is prescribed by education.

We will ensure that where a spouse or partner resides in the same residence as the customer before entering a care home, that the spouse/partner will have an income of at least the basic level of income support or pension credit, to which they would be entitled (Minimum Income Guarantee). The partner/spouse will also have entitlement to retain 50% of any occupational income received by the person in care.

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Charging and financial eligibility assessment for care and support in care homes on a temporary basis

We will charge for care and support delivered in a care home on a temporary basis.

Following an assessment of a customer’s eligible care and support needs, a decision may be taken that the customer would benefit from a temporary stay in a care home. A temporary resident is defined as a person whose need to stay in a care home is intended to last for a limited period and where there is a plan to return home. The person’s stay should not exceed 52 weeks, except in exceptional circumstances, when it is unlikely to substantially exceed 52 weeks.

Where a person’s stay is intended to be permanent, but circumstances change and the stay becomes temporary, then we will assess and charge as a temporary stay.

Customers who have a temporary stay that becomes permanent will be assessed for a permanent stay at the date permanency is confirmed and the care plan is amended.

We will financially assess all customers having a temporary stay in a care home and will charge from the date of admittance.

The financial assessment for temporary stays will completely disregard the customer’s main or only home where the customer intends to return to that home.

The financial assessment will treat income and capital in the same way as if the customer was entering a care home on a permanent basis with the following exceptions:

  • Where the customer is in receipt of Disability Living Allowance (Care Component), Attendance Allowance or Daily Living Element of Personal Independence Payment, these are completely disregarded from the financial assessment.
  • Where the customer receives Severe Disability Premium or Enhanced Disability Premium, these benefits cease when Personal Independence Payment, Disability Living Allowance or Attendance Allowance ceases. The financial assessment will be adjusted where the temporary stay extends into this period.

We will ensure that where a spouse or partner resides in the same residence as the customer before entering a care home, that the spouse/partner will have an income of at least the basic level of income support or pension credit, to which they would be entitled (Minimum Income Guarantee). The partner/spouse will also have entitlement to retain 50% of any occupational income received by the person in care.

We will ensure that where housing benefit is received, this is disregarded. Housing Benefit ceases to be paid after 52 weeks, should the temporary care extend beyond this period.

We will ensure that payments made by the customer to keep and maintain their home, such as rent, water rates, insurance premiums, are allowed within the assessment as ongoing expenses. Similarly, expenses that the customer would normally incur and would continue to pay should also be allowed, such as household related Disability Related Expenditure (for example, cleaning, gardening, community alarm services). Contributions are payable from the date care commences. Financial assessments will be uprated for each financial year where a customer requires temporary accommodation in a care home.

Customers receiving care and support in a care home on a temporary basis will have their care and support costs administered through personal accounts.

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Charging and financial eligibility assessment for care and support in other care settings including a person's own home

We will charge for care and support delivered in other care settings including a person’s own home.

Customers requiring care and support in their own home or other care settings must initially satisfy an eligibility assessment for care and support. Only where a customer has an eligible care and support need will a financial assessment be required.

Customers receiving chargeable care and support in the community, including any planned short breaks in a care home, will have their care and support costs administered through personal accounts. Short Breaks are defined as a stay not exceeding 28 consecutive nights, and not more than 56 nights in a rolling 12 month. Excess nights (for example, a single stay exceeding 28 nights) or more than 56 nights per rolling 12 month period will be charged under Temporary Care arrangements (see section 6).

Where a customer has an eligible care and support need, we will calculate how much the personal budget might be, using our Resource Allocation System. Once the indicative budget is known, the care and support planning process, considering the customers desired outcomes, will determine the agreed budget.

Customers are likely to choose varied forms of care and support to meet their specific outcomes, as defined in their care and support plan. Where a customer has capital more than the higher capital limit and is therefore required to pay the full cost of their care and support, they are still entitled to request services to be arranged by us. We will charge an annual fee for arranging and administering personal accounts for all customers who are self-funders (that is, they have more than the capital limit and therefore are responsible to pay the full cost of their care and support). The annual fee cost is set out along with the relevant higher and lower capital limits, on our website (see Adult care and support fees, charges, allowances and rates).

Customers will have the option to take a personal budget as Council commissioned services, an individual support fund, as a direct payment or a combination of these. Customers who take their personal budget as a direct payment may purchase alternative types of care to meet their care and support needs as defined in Sections 31 to 33 of The Care Act 2014.

We have a specific Direct Payments procedure that sets out the criteria and terms and conditions through which care and support can be purchased by using a Direct Payment.

We will undertake a financial assessment to determine the amount a customer can contribute towards their care and support costs. We will undertake a financial assessment based, as a minimum, on income, capital, housing costs and disability related expenditure (DRE). Customers with capital more than the higher capital limit will be responsible for meeting all their care and support costs. Evidence will be required to substantiate fully a customer’s financial circumstances. Please refer to schedule A of this policy for guidance in relation to DRE.

Where a customer has capital more than the higher capital limit, then a light-touch financial assessment will be carried out. Similarly, where undertaking a full financial assessment may be disproportionate to the cost of care and support services, or where a customer receives income lower than the Minimum Income Guarantee they are entitled to retain, they can request a ‘light-touch’ financial assessment. We will take steps to assure that the customer is willing and will continue to be willing to pay all charges due.

We will ensure that customers retain at least the ‘Minimum Income Guarantee’. This retained income level is designed to promote independence and social inclusion and is intended to cover basic needs such as purchasing food, after housing costs have been taken into consideration. Direct housing costs will only be considered where the customer is liable for such costs, i.e., holds a tenancy agreement or is party to the mortgage of a property. Indirect housing costs will apply where a Lodger or Similar agreement is in place. The ‘Minimum Income Guarantee’ rates are set annually by the Department of Health and Social Care and Social Care.

The financial assessment will refer to Care and Support Statutory Guidance and The Care and Support (Charging and Assessment of Resources) Regulations 2014, for all disregards in respect of income and capital when deciding on the customer’s financial resources.

Following the financial assessment, the customer will be informed of the equivalent weekly amount they must contribute towards their care and support costs. Customers will not be charged more than the amount determined by the financial assessment. Contributions are payable from the date care commences. Customers who require services to be arranged by us will be invoiced monthly in arrears for their care costs.

All financial assessments will be uprated annually with the outcome being issued to the customer before that start of each financial year.

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Personal Accounts

All provision for care and support is paid for through Personal Accounts. A personal account is a combination of the amount of money that is required to meet eligible care and support needs, and the amount a customer can contribute towards that cost. The difference is the amount of funding support that we will provide. Personal accounts may also contain funding towards care and support costs from the NHS. Personal accounts are generally set for a period of 12 months.

Personal Accounts will remain open to meet any contractual obligations required by the care provider in the provision of providing care and support. Personal Accounts will only be closed once all contractual liabilities have been paid. For example, where a customer employs a Personal Assistant, the notice period required under the PA’s Contract of Employment will be paid; where a customer is in receipt of homecare and is admitted to hospital or had a holiday, homecare providers are entitled to claim 5 days payment to cover staffing costs at the full commissioned rate: where a residential care provider requires notice when a customer moves to alternative residential care provision. Planned short breaks will be charged across the duration of the budget. The customer will be charged their assessed contribution until such time as the Personal Account is closed, which may be after care and support provision has ended.

Personal accounts will be reconciled annually, normally on the anniversary of care provision commencing and after the personal account is closed following the payment of all contractual liabilities. The reconciliation will consider the amount charged against the personal account by the care provider and the actual amount the customer has contributed. Any customer that has paid more towards the provision of care and support than the amount charged by the care provider will be entitled to a refund. Customers who have been charged an amount lower than their maximum assessed contribution will be liable for any additional costs up to the maximum amount they have been assessed to contribute.

Self-funders: customers with capital that exceeds £23250 that have entered a care contract through us will be responsible for meeting their care costs in full.

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Charging and financial eligibility assessment for support for carers

The Care Act 2014 provides councils with the power to charge for support for carers, where they have an eligible support need, providing the adult they care for also meets the eligibility criteria for care and support.

The support which we can charge for must not be provided directly to the adult being cared for under any circumstance.

Where we decide to charge for support to carers, the financial assessment will follow the same calculation methodology as those receiving care and support outside of a care home. This will normally be a light-touch financial assessment; however, the carer can request a full financial assessment if they so wish.

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Funding and financial assessment considerations

Deprivation of income and/or assets is the disposal of income and capital (savings, property, and investments) to avoid or reduce care charges. Disposal can take the form of transfer of ownership or conversion into a disregarded form. In all cases, it is up to the customer to prove to us that they no longer possess an income or an asset. We will determine whether to investigate if deprivation of income or assets has occurred. Where an investigation is conducted, this will be conducted under guidance contained within the Regulation of Investigatory Powers Act 2000. Following the investigation, where we decide that a customer has deprived themselves of an asset or income to reduce a charge for care and support, we will initially charge the customer as though they still owned the asset or income, or the beneficiary of any income/asset transfer, as set out in Section 70 of The Care Act 2014.

Property other than the customer’s main or only home will be included within the financial assessment as a capital asset. The only exception to this rule is where the customer is taking steps to occupy other premises as their home. In this case the asset value will be disregarded for a maximum of 26 weeks. Any further disregard is discretionary after that time.

The Care Act 2014 requires that financial assessments are completed for customers as individuals. Where capital is held and income is received on a joint basis, then it is assumed that each person is entitled to 50% of that income. A couple is defined (for administration of their financial affairs) as two people living together as spouses or partners.

Allowable housing costs (for example, rent, mortgage or council tax) will only be allowed in the financial assessment where the customer is liable to pay these costs. Where the customer is not liable for these costs but contributes towards these through a private board agreement or similar, then the council will allow reasonable costs linked to housing only.

Where funds are held in trust, the financial assessment will seek to determine whether income received, or capital held in trust should be included or disregarded. Copies of trust documents (for example, Trust Deed, Will Settlement etc) are required to be produced as part of the financial assessment.

Where the customer receiving care and support has capital at or below the higher capital limit, but more than the lower capital limit, they will be charged £1 per week for every £250 in capital between the two amounts. This is called 'tariff income'. For example, if a person has £4,000 above the lower capital limit, they are charged a tariff income of £16 per week.

We will automatically increase state benefits and allowances within all financial assessments before the start of each financial year, using information provided by the DWP. Expenditure will be increased in line with locally set increases (for example, council tax) or in line with the CPI figures published by the Office of National Statistics (ONS) for the previous November.

Where a benefit or income is received and has been backdated, we may re-assess the customer contribution from the date payment commenced, where the customer has not notified the Council, but was aware that any increase in income would increase any contribution due.

Where a benefit or income ceases and a customer had not notified us, the customer contribution will be re-assessed and backdated to when payment stopped. Consideration will however be given to income deprivation therefore circumstances surrounding the cessation of any payment will be investigated before the contribution is reassessed.

We will not charge for Job Coaching.

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Ability to pay

The purpose of the financial assessment is to ensure that the level of financial contribution calculated is within customers’ means and leaves the customer in receipt of the guaranteed minimum level of income set by the Government, plus any disregarded income, determined by the type of care they are to receive.

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Recovery of debt

The Care Act 2014 consolidates our powers to recover money owed for arranging care and support for a customer. These powers can be exercised where a customer refuses to pay the amount they have been assessed as being able to pay or have been asked to pay (where the cost of care and support is less than their assessed contribution).

The powers granted to us for the recovery of debt also extends to the customer or their representative, where they have misrepresented or have failed to disclose (whether fraudulently or otherwise), information relevant to the financial assessment of what they can afford to pay.

We will approach the recovery of debt reasonably and sensitively and will only take Court action as a last resort.

The initial stage of debt recovery will involve discussing the debt with the customer or their representative. Social workers will be advised of the debt and will become involved as appropriate. In all cases the desired outcome is to prevent debt escalating and for the customer to make affordable repayments of the debt as well as being able to pay ongoing costs as they arise.

We will give regard to the level of debt and the cost of recovery and will not proceed with recovery action where the cost of recovery would be disproportionate.

We will only proceed with Court action where all alternatives have been exhausted. At this stage we will proceed with action through the County Court.

All debt that arises from 1 April 2015 must be recovered within 6 years from when the sum became due to us, unless legal proceedings are under way, the debt is subject to a deferred payment or other legally binding agreement, or a repayment arrangement is in place.

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Schedules

Customers who are in receipt of care in all settings apart from permanent care in a care home and are in receipt of disability benefits (Attendance Allowance/Disability Living Allowance or Personal Independence Payment) will be asked about additional costs incurred as a direct result of their disability. Allowances will be made where costs are not and cannot be met by us.

Only costs incurred by the customer will be considered as part of the assessment as allowable expenditure.

We have the right not to allow costs that should be met by other agencies, such as the NHS. This applies to therapies such as physiotherapy, chiropody and incontinence pads which may be provided free of charge.

We will include the following disability related expenditure within the financial assessment

  • Payment for any community alarm system
  • Costs of any privately arranged care services required that we cannot provide
  • Costs of any specialist items needed to meet the person’s disability needs:
    • day or night care for which the customer has an eligible need but is not being provided by us.
    • specialist washing powders or laundry exceeding 4 loads per week.
    • additional costs for dietary needs due to illness or disability (evidence from the customers GP may be required).
    • special clothing or footwear where this needs to be specially made or altered, or due to additional wear and tear due to the disability.
    • additional costs of bedding, for example, due to incontinence, occasioned by age, medical condition, or disability.
    • any heating or water costs, above average levels for the area and housing type,
    • occasioned by age, medical condition, or disability.
    • reasonable costs of basic garden maintenance, cleaning, or domestic help, if necessitated by the customer’s disability and is not met by social services.
    • personal assistance costs, including any household or other necessary costs arising for the customer.
    • purchase, maintenance, and repair of disability-related equipment, including equipment or transport needed to enter or remain in work; this may include IT costs, where necessitated by the disability; reasonable hire costs of equipment may also be included, if due to the waiting of supply of equipment from us.
    • we will not make allowances at a higher rate where a reasonable alternative is available at a lower cost, for example where incontinence pads are available on the NHS, but the customer decided to purchase them privately.
    • internet access for blind and partially sighted people.
    • other transport costs necessitated by illness or disability, including costs of transport to day centres, over and above the mobility component of DLA or PIP, if in payment and available for these costs. Where we provide transport and the customer wishes to use alternative transport at a higher cost, the cost our provision will be used to determine any allowance.
  • All other expenditure will be assessed as either an everyday living cost or will be reviewed as a specific need against the customers’ care and support plan.

Schedule B - Complaints

A customer may wish to make a complaint about any aspect of the financial assessment or how a council has chosen to charge.

The first stage is to ensure that the assessment has been conducted and calculated correctly. Requests for a financial reassessment should be directed to:

The Income Services Manager
Income Services Team
City of York Council
West Offices
Station Rise
YORK
YO1 6GA

Or email: incomeservices@york.gov.uk

An officer, independent of the disputed assessment will reassess the information provided by the customer at the time of assessment. Any information omitted from the initial assessment will be considered upon submission; however, we are under no obligation to backdate the outcome to the date of the original assessment. The only exception to this is where benefit income has stopped without the prior knowledge of the customer.

Where the assessment is correct, complaints about the level of charge are subject to the Care and Support Complaints Procedure as set out in The Local Authority Social Services and NHS Complaints Regulations 2009. Complaints should be addressed to:

Have Your Say
Customer Feedback Team
City of York Council
West Offices
Station Rise
YORK
YO1 6GA

Or email: haveyoursay@york.gov.uk

Schedule C – Summary of publications

The following publications have been referred to in the compilation of this policy:

  • The Care Act 2014
  • The Care Act 2014 Regulations Part 1
  • The Care Act 2014 Care and Support Statutory Guidance
  • Mental Health Act 1983
  • The Council Social Services and NHS Complaints Regulations 2009

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