Domiciliary care charges: why the variations?

Why can domiciliary care in some areas be free and easily accessible while in others it is costly and restricted? Louise Tickle finds out

Joao Guveia doesn’t go out much. He can’t afford to. At 70 and suffering from arthritis and diabetes, most of his human contact comes from seeing his home care worker, who visits him daily to help him wash, dress, shop and clean his flat. Moreover, it is free of charge.

But Lambeth Council in London, his service provider for the past three years, wants to change the eligibility criteria for home care, downgrading it from those in “substantial” need to those whose need is “critical”. Some older people who now benefit from home care will stop getting any help at all, and those who are still eligible and deemed able to pay will see the cost rise from £7.50 an hour to £17.50.

“I can’t afford it – how can anyone like me afford it?” asks Guveia. “I pay council tax, I pay for my flat. I’ve got my state pension and a private pension, but it is only £64 a month and I even pay tax on that. If I get tested and lose the home care, I have nobody else to help. I can’t clean the house or shave myself. I can’t live at home if I have no care worker, it would be impossible.”

His anxiety is shared by older service users elsewhere. Many local authorities are now setting budgets that severely reduce access to the very home care services that allow them to remain at home.

Charging for the services that older people regard as essential to their continued independence, and introducing or increasing day care charges that support an individual’s social and mental well-being would seem a curious choice. It is known that if this type of support is made difficult to access, older people experience a rapid deterioration in personal circumstances that often results in them needing expensive residential care, the cost of which then must be borne by the local authority.

The challenge is stark. It is estimated that there will be 400,000 more older people by 2011, many of whom will need social care. Council-funded home care hours have increased by about 25 per cent in the past five years. The cost of residential homes for older people continues to rise by nearly 7 per cent a year. As eligibility criteria tighten, based on current trends the 370,000 people with lower levels of need will be excluded from services by 2009.

Local authorities are screaming that they need more central funding. They also point out that as health trusts shift ­responsibility for service provision for older people, councils are having to pick up the pieces.

Lambeth Council says it is not alone in raising charges. And with an entirely different, rural profile, Cumbria Council too is increasing the cost of home care as well as introducing a day care charge of £10 for a service that used to cost nothing.

By contrast, Isle of Wight Council is taking an alternative route. Since 1 April nobody older than 80 has needed to pay anything for their home care needs, irrespective of income or savings. There is no means-testing, a detested process cited as a reason why people choose not to apply for services to which they are entitled.

So why are councils dealing with the needs of their older residents in such different ways? Money, as so often, appears to be the answer. Cardiff Council is now consulting on raising maximum home care charges from £7.95 to £10 an hour to tackle an expected £7m overspend in adult services in 2006-7.

For the Isle of Wight, it’s keenly aware that, because of its “captive market”, private residential home care costs are higher and eat into local authority budgets even more than they do on the mainland. So for this council, it makes financial sense to ensure older people can stay at home for as long as possible. Put bluntly, it’s much cheaper to keep people happy and comfortable at home than it is to let them deteriorate to the point at which they have to be moved.

But this argument applies across the board, so why aren’t other councils doing the same? Lambeth council leader Steve Reed says money from government is urgently needed in order to take the long-term view. He says: “We agree that reducing adult community services is likely to cost more in the long run, and that is why we are actively supporting the Local Government Association in its lobbying of the government for adequate funding of these services.

“We have been faced with some difficult choices this year over care services for older and disabled people. We are investing £1.9m extra in adults’ social services as a result of this budget, but demand is outstripping the funding we receive from central government. This is a national problem that requires national solutions, but Lambeth is one of the first local authorities at the edge of the cliff.”

This doesn’t convince Julia Shelley, chief executive of Lambeth Age Concern. She says: “We’ve told the council that we think the cuts are morally wrong, financially shortsighted and against policy directives for people to live independent lives in their own homes for as long as possible. This is not added value stuff, these are the essentials: help into and out of bed, help to wash, help with meals and with dressing. Without that, you end up in a bad way quickly.”

Shelley estimates that about 750 fewer Lambeth residents will be eligible for free home care after the reassessment exercise is complete. Even for those who can get services, she believes the soaring costs will mean many stop using them. “Some people will end up in dreadful circumstances,” she warns.

But if there’s not enough money, there’s not enough money, surely? “My response to that is that they aren’t making ­similar cuts across all areas of the council,” says Shelley. “They’ll say they’re putting more money into older people’s services, but that’s because they have 800 people in residential care, which speaks for itself – residential care swallows up money very fast. And if they say they did a public consultation, well, they got 800 replies, but we have a petition against these proposals with 7,000 signatures.”

At Age Concern HQ, spokesperson Sam Heath says that, although there needs to be a degree of sympathy for local government, councils are not getting their priorities right. “We know that primary care trusts are not providing some of the preventive services that they should be. And the Wanless report gave a minimum recommendation that funding for adults’ services should be kept at the status quo, but over the past year government hasn’t given the funding to allow that, so the system has faltered.

“But councils cannot wash their hands of this altogether. What they’re doing is very short term, and so we’re seeing ­councils providing care for people with higher and higher needs whereas services should be aimed at people with lower and lower needs. What’s needed is a debate leading to a long-term settlement to make the system fairer.”

Back in Lambeth, it is a telling comment on our treatment of older people that Guveia is hoping he’ll be considered too poor to be charged for his services.

Further information
Age Concern

This article appeared in the 19 April issue under the headline “The great home care divide”

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