Penalty charge

Pauline Thompson is the care (finance) policy officer at
Age Concern England. She spent many years working in local
government, first as a social worker and latterly in the field of
welfare rights. She co-authored the CPAG Paying for Care
Handbook and contributes to the Disability Rights
Handbook.  

“They call it fairer charging but it’s not fairer,” was the
comment of a carer whose mother had just had her charges doubled by
the local authority. The reason? Because the local authority had
changed its policy in line with the Department of Health’s
Fairer Charging Policies for Home Care and Other
Non-residential Social Services.

This guidance has sent home care charges soaring for older people
who depend on help getting out of bed, dressing and eating. In one
area the highest increase was £261 a week. Even those on
means-tested benefits have suffered.

When the DoH Guidance on Fairer Charging Policies was
issued in November 2001, Jacqui Smith, then health minister, said:
“There are huge variations between councils and this new statutory
guidance allows us to put an end to this. The main aim of this
guidance is to make sure we get a fairer service all round.”

Age Concern commissioned research to find out whether or how far
this aim had been achieved.

The research (see panel, below) shows there is undoubtedly more
consistency and fairness for those on low incomes. Charges should
not now take a single older person below a weekly income of
£131.81 and some people have seen their charges fall. But
there was little evidence of fairness for those on middle incomes
or those who have some capital.

This is shown by the responses to our hypothetical case study.
Sixty-three authorities calculated what they would charge a woman
receiving 10 hours’ home care a week and a day at a day centre. She
had an income of £230 a week and capital of £17,100.
Depending on where she lived the responses showed this person could
be charged between nothing and £103 a week for care.

Cross-boundary discrepancy
To compound the seeming injustice of this, in some areas, a council
with one of the lowest charges bordered an authority with one of
the highest. This represents little improvement on the findings of
the Audit Commission, which four years ago reported charges ranging
from nothing to £120 for 12 hours’ care.

Local authorities received no extra funding to implement the new
fairer charging policies. They have been expected to do complex
means testing, take into account disability-related expenses, give
benefits advice and help with benefit claims – all of which are
essential for many older people.

For many local authorities. the changes have involved new IT
systems, changes to forms, the cost of a consultation exercise and
providing new information about charges to service users.

Thirty-one authorities gave estimates of the changes to their
income as a result of this extra work. Sixteen reported that their
income would fall, five said it would be little affected and 10
that it would rise. Of the 20 that gave estimates of the costs of
administering charges, all but one reported an increase and half
estimated the cost had more than doubled, with the largest increase
in administration costs being 400 per cent. Only one-third gave any
transitional protection to current users against increases in their
charge.

Faced with higher costs and a loss of income from not charging
poorer users, some authorities have shifted the burden of payment
to older people with middling incomes or some capital. The service
users interviewed had strong views about being penalised for
saving. A typical response was: “You save for your old age and when
you get there you get a bit sick when you get penalised.”

Given that most councils now charge by the hour, those with the
most needs are likely to pay substantial sums for their care at
home. One of the service users interviewed found her charge had
increased from £35 to £182 a week as she now had to pay
for each of the two carers needed to lift her. In effect, this is a
tax on disability.

Postcode lottery
So the postcode lottery is still with us. Local authorities are
having to ask intrusive questions about older people’s finances
because they are disabled. And many people have faced a large hike
in their charges. On the positive side service users are getting
their entitlement to money benefits checked. Depending on the local
policy, they might actually receive some of the extra benefit they
have gained. And, of course, the poorest service users are no
longer charged for their care.

In all the discussions about charging for residential care, charges
for home care tend to get lost. Yet the costs can be high and
subject to changes that the service user cannot foresee. Our
research found that, as result of the increases, some service users
dropped out of using care services or reduced use. The changes
caused a great deal of anxiety to some service users, especially in
those authorities which delayed sending bills for some time. Bills
in excess of £500 were cited.

This research reinforces Age Concern’s belief that “fairness” can
only be achieved by abolishing charges for personal care. Soon
England will be the only nation in the UK charging older and
disabled people for their personal care at home. Is this a
situation that we want to continue?

Research findings

• 71 per cent of responding authorities set a maximum weekly
  charge, some charged the full cost and others had a banding system.
  The range of the maximum weekly charge was £23.50 to
  £400. Two authorities did not charge.  
• Hourly charges varied from £3.50 to £15.50 an hour;
  35 per cent did not have any subsidy for hourly charges. For those
  that did, the subsidy varied from 4 per cent to 72 per cent. Some
  authorities had a variable hourly charge. 
• Most followed the capital limits suggested in the guidance. Ten
  did not have an upper capital limit and four had a higher capital
  limit. Some offered more generous tariff income rates. 
• Most counted the severe disability premium and attendance
  allowance or disability living allowance (care) as assessable
  income. 
• A minority allowed extra additions or only charged against a
  percentage of income on top of the sum below which they could not
  charge (£131.81 in the case of older people).  
• 60 per cent undertook individual assessments of
  disability-related expenditure; 9 per cent ignored part or all of
  disability benefits instead; 18 per cent gave a standard allowance
  ranging from £10 to £40 a week.

Abstract

This article looks at the findings of research into the
implementation of Department of Health guidance on charging for
home care. Using the responses from 86 authorities in England, the
research found there are still large variations in charges around
the country. Authorities which calculated the charge of a
hypothetical service user charged from nothing to £103 a
week. The research has reinforced Age Concern’s view that it is
fairer to abolish charges for home care.

About the research

Eighty-six English local authorities responded (57 per cent) to
a postal survey and Age Concern also interviewed finance officers,
service users and their carers, and their own offices which had
information and advice services.

Further information

• Fair Enough?, Pauline Thompson and Dinah Mathew, Age
  Concern England, 2004, price £10, from policy@ace.org.uk
• Charging with Care,Audit Commission, 2000
• Fairer Charging for Home Care and Other Non-residential
  Services, Policy Guidance November 2001, Practice Guidance
  August 2002, from www.publications.
  doh.gov.uk
• Coalition on Charging – an umbrella organisation campaigning on
  charges for care. Go to www.mencap.org.uk   

Contact details

Contact the author on thompsp@ace.org.uk