3.1 Charging and Financial Assessment

Audio & Quick Read Summary

1. Introduction

Hull City Council’s Charging and Financial 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 everyone who receives care and support services, following an assessment of their individual needs, and their individual financial circumstances.

Most people will only need to pay a proportion of the cost of their services and some people will not be asked to contribute anything.

This policy will also set out the different ways people can pay and whether they can delay, or defer, payment.

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

2. Diversity and Equality

This policy has been designed with due regard to the public sector equality duty. This means that we must make sure that everyone is treated equally and has the same opportunities as everyone else. It doesn’t mean that we behave in the same way towards everyone because some people may need different things in order to have equal access to services. This might be because of age, disability, race, pregnancy and maternity, religion and belief, gender, gender reassignment or sexual orientation.

3. Legal Basis for Charging and Financial Assessment

The Care Act 2014 provides a single legal framework for charging for care and support. It enables local authorities to decide whether or not it wishes to charge someone when it is arranging to meet their care and support needs. This can either be someone who is in receipt of care and support services or who is the carer for someone who is in receipt of such services.

Section 14 of the Care Act 2014 provides local authorities with the power to charge adults in receipt of care and support services, where the local authority is permitted to charge for the service being provided.

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 or via a third party.

Section 17 of the Care Act 2014 permits local authorities to undertake an assessment of financial resources. The financial assessment will determine the level of someone’s financial resource, and the amount (if any) which they may be likely to be able to pay towards the cost of meeting their needs through care and support services.

Section 14 of the Care Act 2014 instructs that local authorities 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 six 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 (see Continuing Healthcare chapter) and the NHS contribution to Registered Nursing Care;
• 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 constitute ‘meeting needs’.

Hull City Council 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. As such, these statutory regulations form the basis of this policy, except for areas where the council exercises its power of discretion as set out within the regulations.

Please note: An application for judicial review of a Local Government and Social Care Ombudsman decision by Wokingham Borough Council was rejected by the High Court. This related to Wokingham seeking to take into account personal injuries monies recovered for the cost of future care of a disabled woman in her financial assessment. Personal injury awards must be disregarded by local authorities when conducting financial assessments unless the court order includes an undertaking to prevent ‘double recovery’, as set out in Peters v East Midlands SHA of 2009.

4. Policy Objectives

The principles underpinning this policy are:

• where the authority is required to arrange care and support for free, it does so;
• that people will only be required to pay what they can afford;
• that financial support towards care costs will be determined through financial assessment;
• to provide clear and transparent information so people know what they will be charged;
• to apply the rules consistently, to avoid variation in the way people are assessed and charged;
• to promote wellbeing and social inclusion, and to 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 people’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 person for services provided is never more than the cost of that service being delivered to the council;
• to encourage and enable those who wish to stay in or take up employment, education or training, to plan for the future costs of meeting their needs to do so;
• to ensure that where a person lacks capacity to undertake a financial assessment, the local authority consults anyone who has Enduring Power of Attorney (EPA), Lasting Power of Attorney (LPA) for Property and Affairs, Lasting Power of Attorney (LPA) for Health and Welfare, Property and Affairs Deputyship under the Court of Protection or any other person dealing with that person’s affairs (for example someone who has been given Appointeeship by the Department for Work and Pensions (DWP) for the purpose of benefits payments).

5. Care and Support Services which are Subject to a Charge or a Financial Assessment

The council will charge for:

• care and support delivered in a care home on a permanent basis;
• care and support in care homes on a temporary basis;
• care and support in care homes on a respite and short-term basis;
• care and support in other care settings including a person’s own home, this includes:
• personal care;
• medication support services where this is part of a person’s overall care package;
• community support services;
• general home care including crisis and recovery specialised home care;
• non-council services which are provided as part of the overall care and support plan;
• day care services,
• transport;
• housing related support services;
• support services in the home (including supported living and extra care housing schemes);
• adaptations to the home costing more than £1000;
• an administration fee for arranging services for people who fund their own care and support;
• care and support provided to people in prison.

The charges will apply regardless of whether the person takes their personal budget as a direct payment or asks the council to manage it for them.

6. Charging and Financial Assessment for Care and Support in Care Homes on a Permanent Basis

Hull City Council will charge for care and support delivered in a care home on a permanent basis.

A person’s own financial circumstances will determine whether they are eligible for support from the council towards permanent care costs.

People will be made aware at the outset of the maximum amount of funding the council makes available towards care and support provided by private sector care homes. This is known as ‘the Local Authority Rate’. This rate is inclusive of any assessed contribution the person will make, and in the case of nursing care, includes the free nursing care element (FNC) paid by the NHS.

Where a person is eligible to receive local authority funding support, but their assessed needs can only be met in another local authority area, Hull City Council will match the local authority rate for that area.

If, following an assessment, the person chooses a care home in another local authority area for personal reasons, Hull City Council must match the local authority rate for the area where they decide to live. If their assessment does not find that their needs can only be met in residential care, but they choose to move into a care home, the local authority is not responsible for the fees. If they have moved voluntarily and independently to a care home in another local authority area, they become ordinarily resident in that area and would need to negotiate the care home placement and any future support with fees with that local authority.

People who would like to live in accommodation that costs more than the Local Authority Rate, can do so providing they or a third party meets the additional cost. This additional cost (referred to in the Care Act guidance as a ‘top-up’) must be sustainable and the local authority has the right to refuse a person using their assets for this purpose, if the costs cannot be met over a sustained length of time.

Where a person chooses more expensive accommodation than the local authority rate and a top-up is to be paid, the individual responsible for paying must confirm they are able to meet the costs of the top-up for the duration of the agreement, including any price changes that may occur. Both the individual and the person needing care will be made aware of the cost and to whom payment is to be made, together with the frequency, as well as provision for reviewing the agreement on an annual basis, the consequences of failing to maintain payment and the effect changes in any parties’ financial circumstances will have on the agreement. The individual responsible for paying for the top up will be asked to enter into an agreement, covering all of these points. See Annex A: Choice of Accommodation and additional payments.

Someone who own a property or other valuable 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. The council will make deferred payment agreements available under the national ‘Universal Deferred Payment Agreement Scheme’ and ‘The Hull City Council Deferred Payment Agreement Scheme’ providing the eligibility criteria has been met. Details of deferred payment agreements can be found in section 14.

The council will undertake a financial and benefits check for someone entering residential care on a permanent basis. Contributions are payable from the date care commences.

The Financial Assessment will take into account 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 the Charging for Care and Support Statutory Guidance. For more detail on what is included and what is disregarded, please see Annex B – Treatment of Capital , Annex C: Treatment of income and Annex D: Recovery of Debts.

The financial assessment will take into account statutory amounts which the person must retain from their income. These are known as ‘Personal Expenditure Allowance’ (PEA) and ‘Disposable Income Allowance’ (DIA). These amounts are dependent upon the person’s financial circumstances, and are reviewed annually by the Department of Health and Social Care. See Paying for Care and Financial Assessments (Live Well Hull) for more information.

7. Charging and Financial Assessment for Care and Support in Care Homes on a Temporary Basis

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

Following an assessment of someone’s eligible care and support needs, an agreement may be made that they 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 of time and where there is a plan to return home. The person’s stay should be unlikely to exceed 52 weeks, or in exceptional circumstances, 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 the council will assess and charge as a temporary stay.

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

Hull City Council will financially assess all people who are having a temporary stay in a care home, and will charge from the date of admittance. The charging methodology will take into consideration any mandatory disregards of income, capital and property as defined in the Charging for Care and Support Statutory Guidance. See Annex F: Temporary and short-term residents in care homes.

8. Charging and Financial Assessment for Care and Support in Care Homes on a Respite and Short-term Basis

Where a person is a short-term or temporary resident, there is a degree of discretion or modified charging rules to take account of this.

A short term resident is someone provided with accommodation in a care home for a period not exceeding eight weeks, for example where a person is placed in a care home to provide respite care. Where a person is a short term resident, the local authority may choose to assess and charge them based on the rules for care or support arranged other than in a care home.

A temporary resident is someone whose stay in a care home is unlikely to exceed 52 weeks or, in exceptional circumstances, is unlikely to substantially exceed 52 weeks. Because a temporary resident is expected to return home, their main or only home is usually disregarded in the assessment of whether and what they can afford to pay. In addition, for example, certain housing related costs are also disregarded in the financial assessment.

Charges for residential short stay placements and respite care will be charged at a single flat rate charge amount.

Short stays and respite provided to other organisations and local authorities by the council will be charged at the council rates for that provision based on the weekly residential general rate.

Short stay and respite provided by external providers to other organisations will be contracted direct with those service providers at a standard residential set rate.

9. Charging and Financial Assessment for Care and Support in other Care Settings including a Person’s Own Home

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

Care and support in someone’s own home or other community setting is the preferred option for most people and where the care assessment shows the person is eligible for formal support, and that it is feasible to deliver it in this way, it will be provided. If this is the case, a financial assessment will be required.

People will have their care and support costs administered through a personal budget. A personal budget sets out the amount of money that is required to meet eligible care and support needs, and the amount the person can contribute towards that cost. The local authority will pay for the difference. Personal budgets may also contain funding towards care and support costs from the NHS.

Where a person has an eligible care and support need, the council will calculate the how much the personal budget might be, using the Resource Allocation System (RAS). Once the indicative budget is known, the care and support planning process, taking into account the person’s desired outcomes, will determine the agreed budget.

People are likely to choose varied forms of care and support to meet the outcomes set out in their care and support plan. Where a person has capital in excess of 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 the council.

People can choose to take a personal budget as council commissioned services or as a direct payment or a combination of both. People 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.

The council will undertake a financial assessment to determine the amount a person can contribute towards their care and support costs. The council will undertake a financial assessment based, as a minimum, on income, capital, housing costs and disability related expenditure (DRE). People with capital in excess of the higher capital limit will be responsible for meeting all of their care and support costs. Evidence will be required to substantiate fully a the person’s financial circumstances. Please see Schedule D.

Where a person has capital in excess of the higher capital limit, they can request a ‘light-touch’ financial assessment. Similarly, where undertaking a full financial assessment may be disproportionate to the cost of care and support services, people can request a ‘light-touch’ financial assessment. The council will take steps to assure that the person is willing and will continue to be willing to pay all charges due.

The council will ensure that people retain at least the ‘Minimum Income Guarantee’ This protected income level is set out in the Care and Support (Charging and Assessment of Resources) Regulations 2014 and is detailed in Schedule C. Additional allowances are also made for disability related expenditure and housing related costs (after taking into account any benefits paid to cover those costs). 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 person is liable for such costs, i.e. holds the tenancy agreement or is party to the mortgage. The ‘Minimum Income Guarantee’ ensures that the person retains income to the equivalent of Income Support or Guaranteed Credit element of Pension Credit, plus a minimum buffer of 25%.

The financial assessment will refer to Care and Support Statutory Guidance for all disregards in respect of income and capital when making a determination of the person’s financial resources.

The council will use its flexibility to disregard 100% of any War Pension when undertaking financial assessments relating to non-residential care, this is in line with the Housing Benefit scheme operated by the council. However for residential care, the Care Act states that only the first £10 of any War Pensions can be disregarded.

Following the financial assessment, the person will be informed of the weekly amount they must contribute towards their care and support costs. People will not be charged more than the amount determined by the financial assessment. Contributions are payable from the date care commences. People who require services to be arranged by the council will either be invoiced on a 4-weekly basis in arrears, pay by payment card or standing order for their care costs. Those receiving their care and support costs through direct payment will receive ‘net’ payments monthly in advance, to which they must then make arrangement pay their contribution.

All financial assessments will be reviewed with the person or their financial representative on an annual basis, and changes applied from the Monday following re-assessment.

10. Charging and Financial 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 in their own right, providing the adult they care for also meets the eligibility criteria for care and support. The support which the council can charge for must not be provided directly to the adult being cared for.

The council decided it will not charge for support for carers, as from April 2015. We want to support carers as much as possible and feel that they should not have to pay for the support they need to continue.

Should the council decide to charge for support to carers in the future, 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.

11. Charging for Care and Support for People in Prison

The council will charge for care and support services provided to people who are in prison.

A light-touch financial assessment will be carried out to establish if any contribution can be made by the person towards their care costs.

12. People who Lack Capacity or are Losing Capacity

If a person lacks capacity and no other person has been authorised to act on their behalf, then the council will act in their best interests (see Assessing Mental Capacity: Guidance and Best Interests Decision Making).

Where a person lacks mental capacity, they will be financially assessed to determine their ability to contribute towards the cost of their care. If the person does not have any family or friends to support them through this process the council will engage an independent advocate (see Advocacy chapter).

As far as possible, the council will consult with and engage with family members when a person lacks mental capacity to give consent to a financial assessment. However, if someone lacks the mental capacity to consent to a financial assessment, they may also lack the capacity to consent to their information being shared between the family and the local authority. When family members do not have the legal right to access the person’s bank accounts, the council will work with the person who has the legal authority to make financial decisions on the person’s behalf. If there is no such person, then the council or family member must approach the Court of Protection to appoint a deputy to make financial decisions and access the person’s bank accounts.

There will be an administration charge made where the council takes responsibility for managing a person’s affairs to cover the cost of providing that service.

13. Financial Assessment Considerations

The purpose of the financial assessment is to ensure that people are not asked to contribute more than they can afford or is fair and that they keep the guaranteed minimum level of income set by the Government.

Deprivation of income and / or assets is the disposal of income and capital (property and investments) in order 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 person to prove to the council that they no longer possess an income or an asset. The council will determine whether to conduct an investigation into whether 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 the council decides that a person has deliberately deprived themselves of an asset or income in order to reduce a charge for care and support, the local authority will include the asset in the financial assessment as if the person still owned the asset or income.

Property other than the person’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 person is taking steps to occupy premises as their home. In this case the asset value will be disregarded for a maximum of 26 weeks.

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

As part of the Armed Forces Covenant, the government has committed to making sure veterans are not disadvantaged by their service and when appropriate receive special consideration. To support veterans injured on active service, payments to veterans under the War Pension Scheme, with the exception of Constant Attendance Allowance which is specifically intended to pay for care, must be disregarded in the assessment of what a veteran can pay for care from 10 April 2017. This brings payments to veterans under the War Pension Scheme into line with Guaranteed Income Payments under the Armed Forces Compensation Scheme which have been disregarded since October 2012.

The council will undertake a financial assessment for people in the Shared Lives Scheme. The person’s contribution will be calculated on the costs incurred for the care and support element of the placement. People will be advised of the amount they will need to pay their carer for rent and household charges which is separate to the contribution calculated for the care and support element of the placement. The Shared Lives Scheme supports people to claim eligible welfare benefits and housing benefit so that they can meet this part of the cost. The person will be expected to meet the costs of the household charges from their guaranteed income.

Allowable housing costs (for example rent / mortgage / council tax) will only be allowed in the financial assessment where the person is liable to pay these costs. Where the person is not liable for these costs, but contributes towards these through a private board agreement or similar, then they will be expected to meet this expenditure from their guaranteed income.

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 person receiving care and support has capital at or below the higher capital limit, but more than the lower capital limit, a ‘tariff income’ will be calculated at a rate of £1 per week for every £250 in capital between the two amounts. For example, if a person has £4,000 above the lower capital limit, £16 will be added to their weekly income for the purpose of their financial assessment.

14. Deferred Payments Policy

The policy is in line with the Care and Support (Deferred Payment) Regulations 2014, sections 34-36 of the Care Act 2014 and Chapter 9 of the Care and Support Statutory Guidance issued by the Department of Health and Social Care and will be updated in line with any subsequent changes to the legislation.

The policy will apply to people who have been assessed as being eligible for residential or nursing care who have a property. The council has determined that the deferred payments they enter into are not regulated credit agreements in line with the Consumer Credit Act 1974 and Financial Services and Markets Act 2000.

The policy will only apply to people who meet the eligibility criteria set below and who are able to provide adequate security:

• someone is assessed as having eligible needs which the local authority agrees can only be met through residential or nursing care;
• who has less than the upper capital limit (currently £23,250) in assets excluding the value of their home (i.e. in savings and other non-housing assets); and
• whose home is not occupied by a spouse or dependent relative as defined in regulations on charging for care and support.

Where the council cannot secure a first legal charge on the property it will exercise its discretion on a case by case basis and will need to be satisfied there is adequate security.

The person must have capacity to enter into a deferred payment agreement, or must have a Deputy or Attorney to act on their behalf.

The council may refuse a deferred payment agreement where for example:

• it is unable to secure a charge on the property;
• the property is uninsurable;
• where someone wants to defer more than they can provide adequate security for.

In such circumstances the council will notify the applicant or their representative in writing setting out the grounds for refusal and provide appeal rights.

Property valuations will be sought to obtain the limit of the deferred payment agreement.

When assessing applications the council will consider the following:

• the likely duration of the deferred payment;
• equity available in the property;
• contributions which may be made from a person’s income and savings;
• any top up payments to be deferred; and
• the period of time a person would likely be able to defer weekly care costs.

If a person decides to rent out their property during the course of the deferred payment agreement, the council will expect to be paid 100% of the rental income to offset the accruing debt.

Once a person is approaching or has reached the agreed limit the council will make a decision, based on the financial circumstances of the individual, as to whether to cease further deferrals or to extend the limit. Advance notice will be sent along with an indication of how the person’s care costs will need to be met in the future.

The council will charge an administrative fee for arranging the deferred payment which will cover the actual costs including:

• the costs of registering a charge with the Land Registry, including any Land Registry searches;
• costs of valuing and any revaluation of the property; and
• staffing, management and legal costs.

The deferred payment agreement will stipulate that the property must be maintained to a reasonable standard of repair and condition with an appropriate level of buildings insurance cover.

Administration fees will be charged for setting up the Deferred Payment and for annual administration. These will be reviewed annually as part of the council’s budget setting process.

Interest will be calculated daily and added to the accrued debt. The rate of interest charged will be set by the Economic and Fiscal Outlook Report, and updated twice yearly. The market gilt rate is currently published in the Economic and Fiscal Outlook, which is usually published twice yearly alongside the Budget and Autumn Statement on the OBR website.

15. Recovery of Debt

The Care Act 2014 consolidates the council’s powers to recover money owed for arranging care and support for a person. These powers can be exercised where a person 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 the council for the recovery of debt also extends to the person 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.

The council will approach the recovery of debt in line with its Corporate Debt Policy which sets out the approach to debt recovery for all council debts.

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

The council will give regard to the level of debt and the cost of recovery and will not proceed with recovery action where it is uneconomic to do so. The council will also give due consideration to financial hardship and the person’s ability to repay the debt.

The council will only proceed with Court action through the County Court where all alternatives have been exhausted.

All debt that arises from 1st April 2015 must be recovered within 6 years from when the sum became due to the council.

Schedule A: Treatment of Income

Click here to view Schedule A: Treatment of Income

Schedule B: Treatment of Capital

Click here to view Schedule B: Treatment of Capital

Schedule C: Minimum Income Guarantee

Click here to view Schedule C: Minimum Income Guarantee

Schedule D: Disability Related Expenditure

Click here to view Schedule D: Disability Related Expenditure

Schedule E: Complaints

1. A person may wish to make a complaint about any aspect of the financial assessment or how a local authority has chosen to charge. The first stage is to ensure that the assessment has been conducted and calculated correctly. Disagreements in relation to financial assessments, should be emailed to: ASCFA@hullcc.gov.uk.

2. An officer, independent of the disputed assessment will reassess the information provided by the person at the time of assessment. Any information omitted from the initial assessment will be considered upon submission; however the council is 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 person’s prior knowledge.

3. Where the assessment is correct, but a person still wishes to complain, they can do so in the following ways:

• by telephoning the contact centre on 01482 300 300;
• by writing to Contact Co-ordinator, ​​​​Adult Social Care, ​​​​Strategic Service Development Team, ​​​​Warehouse, Guildhall Road, Hull, HU1 1HJ;
• online at: https://www.hull.gov.uk/consultation-complaints-feedback/adult-social-care-feedback.