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      

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