Councils are ignoring the needs of older people who fund their own care. But as the number of self-funders increases, campaigners are pushing for change, writes Corin Williams
(Graphic: Matthew Daley/Three in a Box)
A growing “us and them” situation is developing between vulnerable adults who qualify for council services and those who own enough assets to be deemed capable of paying for their own care. As cash-strapped councils prioritise their limited resources to those who pass the means test, self-funders are often being left to fend for themselves.
This lack of support particularly affects older people as they move into residential care, many of whom enter into deferred payment schemes as they sell their homes to pay for fees. There are all too many stories of social workers just handing self-funders a list of local care homes and precious little else.
The trouble is that everyone is entitled to support, information and advice from their local authority, no matter how much money they have managed to save for their retirement years. Even millionaires should in theory be offered a care assessment and help in deciding what services they need.
Currently, anyone with more than £23,000 in savings or investments counts as a self-funder, and according to Age Concern there are about 115,000 self-funders in care homes, accounting for 27% of all residents. In 2007 a report by the Commission for Social Care Inspection, A fair contract for older people?, found that many self-funders were not being given the chance to discuss their care options with social services. Half of those surveyed said they had not received a care assessment. Some had even been put in a care home when they didn’t need to be. In all, a shocking four out of 10 councils acknowledged that people who fund their own care received less support than other older people.
It was also discovered that self-funders were often paying over the odds for the same care home places as publicly-funded clients because local authorities were able to drive down prices through purchasing block contracts. In effect, self-funders were found to be subsidising publicly-funded residents, something that Age Concern is still campaigning vigorously against.
From every angle, self-funders are not getting a fair deal at all, and although their numbers are expected to rise over the next decade not much has been done to address the situation since the CSCI report. Now at long last national director for social care transformation Jeff Jerome has brought the subject up again. He admitted at a recent personalisation conference that “we do not understand the self-funded market” and clearly realises where the shortcomings are.
“The problem that we’ve got, given that Putting People First is asking us to concentrate on the whole community, is that we have a lot more understanding of people coming through the council system than those who don’t,” he says. “We know that in certain parts of the country the proportion of self-funders in care homes is very high, but we don’t know how they got there, where they originate from, what sort of support they’ve had in thinking out their options or what their choices and preferences have been.”
The first step, as Jerome sees it, is to pull together existing research and set up specific projects to find out more about the situation. But is it not down to councils to get their act together? “Some authorities have made some inroads, but they are a small minority,” he says. “We’re having a look at that at the moment and I am trying to commission some work around this. It’s quite clear that unless something dramatically changes, the amount of private money that’s going in to the care and support system will perhaps become the majority in the not-too-distant future.”
Sarah Pickup, co-chair of the Association of Directors of Adult Social Service’s resources network, has a similar prognosis. “When I talk to other directors, they are clear that this is an area for improvement,” she says. “My expectation is that with Putting People First and the provision of the social care reform grant, authorities will be placing a greater emphasis on the need to offer support to self-funders.”
So what does the situation look like from the independent sector side fence, and can the personalisation agenda really provide all the solutions? According to Alex Edmans, a care funding adviser for Saga Personal Finance, more than 4,000 people contacted her service in 2008 for information on how to pay for their care. Many of these inquiries were from people who were entitled to social services funding.
“Unfortunately, all too often, we still receive calls from those who have received little guidance, or indeed, incorrect information,” she says. “This would suggest that the situation has not changed over the last few years.”
Pauline Thompson, policy adviser for Age Concern, has been concerned about self-funders for a number of years, not just in care homes but also those who need domestic help for independent living. “A care package at home can be very complex, because you’ve got different people in at different times of day to do the various services that you need,” she says. “If any one of those fails to turn up, then you really need some help. The care manager role is there to help sort it out and organise it.
Self-funders to a large extent are in a worse position because they haven’t got that structure of help around them if their care package isn’t working that day. “Also people who have direct payments often get access to advice and payroll organisations, whereas a self-funder – who is technically the same as somebody who receives a direct payment – is often left to their own devices. There is a huge issue around this and it does need to be resolved.”
Not all councils have ignored self-funders, however. Keith Hinkley, director of adult social care at East Sussex Council, set up the Support to Access Care Service specifically for self-funders in the wake of the Fair contract report. Currently four practitioners work on the project, which has seen take-up increase from 374 clients when it first launched in 2007 to more than 550 and the numbers are expected to increase year-on-year. All clients are offered care assessments as well as information on care home fee levels in order to help tackle the problem of cross-subsidy between private and public residents.
There is still a long way to go in order to reach out to self-funders who have shied away from council services, Hinkley warns. “In common with every local authority in the country with Putting People First, we’re changing how we assess and deliver support to people,” he says. “One of the clear points about the service transformation is that we need to get better at developing choice in the market. Because we’re not having as much contact with self-funders we’re not necessarily getting the information from them about what sorts of services they need.”
This brings matters neatly back to Jerome’s original point – it’s an area we just don’t know enough about. What we do know is that all councils will eventually have to ensure that self-funders receive the same level of service as their own clients.
But councils may not end up that providing the service themselves, says Jerome. “Perhaps we also need to think about whether organisations other than local government is the best way to deal with this,” he says. “Quite a lot of people don’t want to approach their council. We need to think about best access points and mediums to receive information, but it doesn’t have to be delivered by the local authority. We will be talking with organisations such as Age Concern, Counsel and Care and others about that sort of partnership approach.”
East Sussex Council helps self funders