3.2 Third Party Contributions

1. Policy

1.1 Introduction

When someone is assessed as requiring care in a residential or nursing home, the person has the right to choose the particular provider or location. Subject to the fees and charges set out in the charging policy, the local authority is responsible for funding such a placement up to the level of the usual cost of care (for people over 65) or the local value based tariff (for people under 65) for the type of placement which has been agreed. If the person chooses a provider or setting which charges more than the usual cost of care or value based tariff, a third party contribution may be required. This policy sets out when a third party contribution may be requested, who can pay this and the factors to consider before entering into an agreement that a third party contribution will be paid.

1.2 Agreeing Provision of Residential Care

If the assessment shows that someone’s needs will best be met in a residential care setting, a financial assessment must be carried out. The process for this is set out in the charging policy. The financial assessment will determine what the individual can afford to contribute towards the cost of their care and the local authority will fund the balance, up to the usual cost of care, or the local value based tariff for the type of placement specified. The usual cost of care and the local value based tariff are set out in Appendix 3a of the residential contract which is updated annually by the Commissioning team. The sum of the individual’s and the local authority’s contributions is the personal budget. The person must be informed in writing about the level of their personal budget.

The person must be offered at least one placement, and preferably more than one which is:

• Suitable to their needs;
• Available;
• Within the amount specified in the personal budget for the accommodation of that type.

If there is no placement available within the personal budget when the person needs it, the local authority must offer a placement in a more expensive setting and adjust the personal budget accordingly. A third party contribution cannot be requested for a more expensive placement which has to be made because of a lack of availability within the market.

Everyone entering residential care has a statutory right of choice which is not limited to the providers with whom the local authority normally contracts, or to the local authority area. If someone chooses a placement which is outside the local authority area, we must arrange for their preferred care and in doing so must have regard to the usual cost of care in that area and adjust the personal budget accordingly.

If the person does not wish to enter a suitable placement which is available within the amount identified for the provision of accommodation within the personal budget and chooses a more expensive setting, a third party contribution can be requested. The amount of the third party contribution must be the difference between what the personal budget is at the time the agreement is made (having due regard to the issues set out above) and the actual cost of the placement chosen.

1.3 Agreeing Third Party Contribution

Before entering into a third party contribution agreement, the local authority must take all reasonable steps to ensure the person making the contribution understands the full implications of their choice. These are:

• That they will be responsible for meeting the additional cost for the full duration of the person’s stay;
• That the contribution may increase annually if the provider increases its fees;
• That if the third party contribution cannot be sustained, the person may need to move to an alternative setting.

If the person understands the implications and wishes to proceed, then a written agreement must be made which sets out:

• The amount specified in the person’s personal budget;
• The additional amount to be paid;
• The frequency of the payments;
• The process of making payments;
• A statement on the effect of any increases in the charges the provider may make;
• A statement on the effect of a change in the financial circumstances of the person making the third party contribution;
• A statement on the consequences of ceasing to make the third party contribution.

When entering into a third party contribution agreement, it is preferable to arrange for the contribution to be paid directly to the provider, but any interruption or cessation of payment must be quickly recognised and acted upon. Arrangements must be made whereby the local authority is immediately notified of any non-payment.

1.4 Ceasing to Pay Third Party Contribution

There will be circumstances where someone becomes unable to continue to pay a third party contribution, and it is essential that the local authority becomes aware of any interruption or cessation of payments as soon as possible because it is ultimately responsible to the provider for meeting the full cost of the placement for the duration of the placement if the third party contribution ceases. If someone has ceased to make a third party contribution, the local authority must decide whether to arrange the person’s move to a placement which can be funded within the personal budget or whether to make the additional payments itself. It is responsible for any outstanding sum owed to the provider under the third party contribution agreement and although it may recover these costs from the person who agreed to make the contribution, this may not always be feasible. Timely recognition of non-payment and an immediate response to this are therefore vital.

If a move to a placement which can be funded within the personal budget is being considered, this can only be acted upon following a new assessment of the person’s needs and must have regard to their wellbeing.

1.5 Additional First Party Contributions

In some circumstances, the person themselves may decide to make an additional contribution in order to move to a more expensive setting. This can only take place where the person is subject to a 12 week property disregard and is likely to become a self-funder, or where they have a deferred payment agreement in place. In these situations, the deferred payment agreement must reflect this and the debt accrued under the deferred payment agreement will include the amount of the first party contribution.

1.6 Self-funders who ask the Local Authority to arrange their Care

The Care Act enables someone who can afford to pay the full cost of their care to ask the local authority to arrange it for them. To ensure long term clarity over liability for costs, Hull City Council will broker contracts between the provider and the person but should not enter into a contract on behalf of the person and recharge. If someone who can afford to pay the full cost of their care lacks capacity and has no Attorney in place, the Court of Protection should be approached to appoint a deputy and the City Council will broker contracts between the provider and the deputy if asked to do so.

1.7 Third Party Contributions and Section 117 Aftercare

If someone is assessed as needing residential care to meet their needs under section 117 of the Mental Health Act, the local authority is responsible for fully funding the placement up to the level of the usual cost of care or the local value based tariff for a placement of the type needed. The person’s needs will be assessed and a care and support plan drawn up using the Care Programme Approach. This care and support plan should specify the type of accommodation needed and the local authority should work out what the level of the personal budget would be if it were providing a personal budget.

The person has the right to choose their placement provided that the accommodation is:

• The same type as the accommodation assessed as being needed;
• Suitable;
• Available;
• Within the level at which the personal budget would be.

If the person chooses a placement which is more expensive than what the personal budget would be if a personal budget were being provided, then either they or a third party would need to pay a third party contribution. The process outlined above for agreeing an additional contribution must be followed.

2. Procedure for Agreeing Third Party Contributions to Residential Care Home Fees (Top up Payments)

2.1 Scope

When someone is assessed as requiring care in a residential or nursing home, the person has the right to choose the particular provider or location. If the placement they choose cannot be paid for within their personal budget, a third party contribution (top up fee) may be needed. This procedure sets out the steps to take if someone is considering entering into an agreement to make a third party contribution.

2.2 Principles

Everyone must be offered at least one and preferably more than one choice within their personal budget. If there is no placement available within the personal budget at the time it is needed, the City Council must offer a more expensive placement and must amend the personal budget accordingly.

People have the right to choose a provider with whom Hull City Council does not currently contract or who is outside the Hull City Council area.

Entering into an agreement to pay a third party contribution is a legally binding and potentially long term commitment and Hull City Council has a duty to make sure people fully understand the nature of the commitment before making it.

2.3 Procedure steps