Care home charges residents for DoLS authorisations

Southfield House's fee policy sparks complaint to CQC but regulator finds it compliant with charging rules

A care home’s decision to charge residents £250 if they require a Deprivation of Liberty Safeguards authorisation has caused controversy, with a leading expert in the field lodging a complaint with the CQC over the move.

The regulator investigated the charging policy at Southfield House, a residential home in Woodford, Stockport, but told Community Care it found the information provided by the home to residents about the fees met the rules concerning registered providers charging for care.

The home, which only works with self-funders, adds an “extra charge” of £250 to residents’ bills if a DoLS authorisation is needed, followed by an £125 annual renewal fee.

Where a resident appears likely to become deprived of their liberty, a care home must submit an application to the local authority requesting an assessment.

The home’s directors said its charges were “fair and competitive” and designed to cover extra costs incurred by individual residents.

Steven Richards, a leading DoLS trainer with Edge Training, wrote to the CQC expressing concern over the £250 charge.

He said: “I’m shocked by the whole idea that you could be a vulnerable adult who lacks capacity and be charged for being deprived of your liberty. The figure they’ve come up with would appear to have no correlation to the burden on a care home when an authorisation is requested.

“I approached the CQC directly to inform them and to see what action they could take under their existing statutory powers. I have since then approached the Law Commission to see what they could do to prevent this re-occurring in any new DoLS legislation.”

The Law Commission is currently reviewing the law in this area for the government and will present its final report to ministers in coming months.

A spokesman for Southfield House said the issues raised about the DoLS charging policy had been “fully discussed” with CQC.

He said: “All our charges are transparent and advertised. All items of expense with regard to care and accommodation are taken into account when setting our fees. We believe that items of cost that are incurred individually should not be encompassed within our standard fees. Doing so would be expecting other residents unfairly to subsidise individuals.

“Residents requiring a DoLS have an appointed advocate or attorney with whom all matters of care and finance are discussed on an ongoing basis.

“The social care sector in general is currently under huge financial pressure. All tasks from care to admin to facility carry a cost and the introduction of additional requirements bring with it additional cost. The job has to be done.”

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22 Responses to Care home charges residents for DoLS authorisations

  1. Sara-Jayne Williams February 2, 2017 at 12:16 pm #

    I am dismayed that a provider considers it appropriate to financially take advantage of the most vulnerable people in society. The safeguards are there to protect people and to ensure their rights are upheld!

    • Stuart February 2, 2017 at 6:12 pm #

      I am more dismayed that care homes have been asked to provide safe care for less money than safe care costs. Additional tasks like this consume care staff time and need to be paid for or else corners are cut elsewhere. The homes are not taking financial advantage of anyone: they themselves have been taken advantage of by local authorities for years as they struggle to make ends meet, deal with the constant threat of closure and try to retain their staff. I think it s brave and, should I find myself in residential home in the future, I hope my care home manager charges properly for the support and administration my living there costs.

      • Andy February 2, 2017 at 8:17 pm #

        But this isn’t a home that takes local authority funding. The authorisation process is not something to be profited from and the cost is extortionate for very little work for the home. It’s an outrageous abuse. I wonder what would happen if people refused to pay the fee. Would be keen to know the view from a safeguarding Adults perspective. Do they charge for other referrals they make? Because that’s all it is. A dols authorisation also isn’t a duty to then deprive but a power do so when needed. Therefore do fees scale depending upon when, how and duration of restrictions? Given that it is not the home authorising or renewing I wonder what trading standards would think.

      • Social Worker February 3, 2017 at 12:33 pm #

        Or even better, we stop using care homes & build a model for the future that enables us all to stay in our own home with support when needed.

        • chrissie February 7, 2017 at 11:24 am #

          I do so agree with this or extra care/flexicare housing available to everyone – everyone prefers to remain in their own home and have care when needed an access to activities if they are unable to go out. Some local authorities restrict their extra care housing to those who are in rented accommodation but it should be strictly based on need with sliding scales of charging.

          The DoLS charging is outrageous – perhaps this home also charge for butter on the toast!

          • Lesley February 8, 2017 at 12:55 am #

            People can still be subject to DoLs in their own homes if they meet the Acid test

        • Andrew Makin February 10, 2017 at 8:29 am #

          Good luck with that one.

          15 years ago I was at a Yorkshire Region (as it then was) workforce planning meeting. One of the facts put forward was that in order to maintain the current (2001) level of service for a growing elderly population, every school-leaver would have to go into health and social care.

          Giving adequate home care (including combating loneliness, or had you forgotten that?) for highly dependent people would have to treble, at least, the current workforce.

          Care homes are the Plan B. There is no alternative.

      • Nikki February 3, 2017 at 3:57 pm #

        This home isn’t local authority funded though Stuart. Residents pay the bill themselves. All the Care Home are doing is requesting an assessment and charging £250 for the privilege.

  2. Clare February 2, 2017 at 8:13 pm #

    As a professional I am appalled at the care home for taking advantage of vulnerable people in this way. Is that figure justified by filling in a form?! The LA doesn’t charge so why charge the individual. Isn’t the high weekly cost enough to cover that!
    It’s appalling.

    • Andrew Makin February 10, 2017 at 8:51 am #

      Not everyone will need an authorisation, so it is unfair to subsume the cost under the general fee. There is a cost to processing Authorisations and somebody has to pay. Should the care home owner pay for it himself, out of his own pocket? The charging principle is reasonable; £250, however, is I agree disproportionate.

      Local Authority care homes may not charge for DOLS, I don’t know, but the fees they pay themselves are higher than what they give to the private sector, anyway, and if you go into LA accommodation, and have over £23000, you will pay that higher fee. Is that fair?

      As to families or LPAs being reluctant to consent to DOL requests, that’s like saying you are reluctant to consent to driving on the left. The law is the law and consent doesn’t come into it. Not putting in a DOL request would also be a violation of Article 5 of the Human Rights Act 1998.

      And even when they had the money, not one Local Authority since 1993, when they took over the funding, has raised care home payments in line with inflation. In the days of the SSA my own LA (Bradford), was pleased to announce one year that it had underspent its elderly care budget by £1,000,000. North Yorkshire, which is next door to me, had a policy of increasing fees for existing care home residents by less than they would pay for new residents, and still below inflation. It’s the LA’s fault.

  3. Stuart Turner February 3, 2017 at 9:49 am #

    Sara, I agree. I am also concerned that there may be a reluctance for families/LPAs/Deputies to consent to DoLS requests being submitted if there is an associated charge. Equally might some unscrupulous service providers increase the number of requests?

    Central Government have capped or reduced funding to Local Authorities year on year. Local Authorities have little opportunity to increase their revenue significantly (business rates, council tax, using local assets etc), so to some degree Local Authorities have much fewer options when prioritising budgets.

    These are very difficult times, and they will be much more difficult is society is completely divided.

  4. John Plimsoll February 3, 2017 at 10:27 am #

    I believe charging vulnerable residents for DOLS to be an outrage and entirely unacceptable. One of the positive aspects of the DOLS procedure is that they ensure at least a minimal level of protection against unlawful detention for self-funding residents, for whom there was previously no safeguard. We are reportedly told that, “Residents requiring a DOLS have an appointed advocate with whom all matters of care and finance are discussed on an ongoing basis”. Surely a well run care home will be ensuring that ongoing discussions like this are taking place with relatives or another advocate for all their residents, unless the resident has said they do not want this? The advocacy and discussions required through DOLS are surely a mechanism for formalising good practice. DOLS presents additional costs on the local authority who must provide assessors and there may be some additional cost on the care home, but it seems to me this will be minimal in care homes that already operate best practice for residents who lack, or may lack mental capacity to make some decisions. Is the care home going to charge the resident even more if the court of protection becomes involved?

    I accept that providing high quality care is expensive and that there is wide spread under funding, which makes things extremely challenging for care providers. That is a different matter however, the answer cannot be additional charges of this nature.

    • Pearl Baker February 12, 2017 at 8:02 am #

      I am a RPR under DoLS, and the Deputy under the COP for ‘Property and Finance’ i see my role as an important part of their ‘Care Plan’ any problems they will contact me and likewise. No extra charging for this, but at £1450 a week you would not expect any. I will be reducing this cost by £156 a week, because it is a Nursing Home. CHC has been applied for, but slow.

      It a self funder you still receive your State Pension, and Higher Rate of Care under AA about £87 per week. (if you applied for it).

      This reduces your actual cost by £393 per week ( dependent on your State Pension.)

      Amount payable £1063 a week.£55276 Annually

      As a Deputy (family) i take no expenses for the work undertaken by me, (which is substantial) if the LA hold this position your SAVINGS will diminish substantially.

  5. Danny Ryan February 3, 2017 at 5:16 pm #

    First – it appears that this particular home ‘only works with self-funders’ – so the issue of there being ‘underfunding’ &c is hardly like to apply here. I’m sure profit-margins are as protected now as they ever have been.

    Secondly, the referral needs to be made to the Local Authority – it’s that LA that will bear any related cost except for the admin required to make the initial referral – £250 then £150 annually is nothing more than cynical greed and opportunism.

    Ssdly, this is nothing more than any of us should expect in such a vile climate of ‘money-first.’

    • Pearl Baker February 12, 2017 at 7:49 am #

      If someone subject to DoLS and COP Order for Property and Finance settled in a Nursing/Care home,why would you want to renew it after one year? if their conditions deteriorates request CHC assessment.

      In my opinion the Care Home has a duty under ‘Safeguarding’ anyway, all Dementia Wards are Locked.

  6. Jack Skinner February 6, 2017 at 11:06 pm #

    For £250 it better be the most magnificent form 1 in history… printed in gold leaf embossed cartridge paper!

  7. GERALD February 8, 2017 at 1:45 pm #

    What a load of hypocrites, what Public Sector doesn’t charge nowadays for any service it carries out, all backed up by the law of course, CqC are normally very fair and I do not see that they have not been so in this instant.

    One rule for the Private Sector and another for the Public Sector as usual.

  8. Jason M February 8, 2017 at 2:19 pm #

    What next, charging extra when people are ill? When they need medication? DoLS is clearly seen as an admin burden and a burden on staff not a core part of their duties. Shameful.

    If a local authority was to do it, surely it would be incompatible with the positive duty to protect Article 5(1) – but care homes are NOT a public authority in the meaning of the HRA so they can be this dismissive and grudging.

  9. Mike February 9, 2017 at 5:46 pm #

    I don’t understand what care homes are charging for. They are only required to notify the supervisory body if and why they believe a person meets the acid test and why they need to deprive a person of their liberty. The responsibility is the states e.g. if the are imputable to the state then it is either Health Boards ior Local Authority depending on who is providing or commissioning the care. The funding for this in terms of Section 12 doctors and BIA’s falls on Health or LA’s. These costs are not passed on to the providers so how can they charge.

  10. Pearl Baker February 12, 2017 at 7:37 am #

    As a DoLS RPR i fail to see the necessity to have this in place on an Acute Dementia Ward in Hospital? when admitted under section 2 for assessment and treatment, this was replaced with DoLS before the 28 days, despite the continued assessment and medication changes. It is all about money. Section 3 was the next step (costs money)

    I constantly requested a ‘Care Plan’ meeting, (this did not happen) and was so concerned with the drug regime of administering a drug NOT licensed for Dementia that i contacted the HOSPITAL. It was stopped.

    ‘Article 5 of the Human Rights Act requires that no one should be deprived of their liberty except in certain, pre-defined, circumstances: there must also be an appropriate, legally based procedure in place to protect the individual’s rights..

    This is why DoLS in it’s present form will cease.

    DoLS is an inhuman way of treating people, incarcerated, drugged against their will, often just to keep them quiet.

    Dols in it’s current for (my opinion) is the responsibility of Health and Social Care! but do they Inspect those implementing DoLS under ‘Safeguarding’? no they do NOT.

    The CQC are supposed to be there to protect, but how can this be done, unless they actually look at patients notes?

    The CQC did NOT contact me regarding no CARE PLAN, inappropriate treatment with an un-licensed drug. Lips and mouth so SORE he could not eat or drink?

    I suggest that Private Guardianship is the way forward, it puts the POWER back to those who really care for the ‘safeguarding’ treatment of their loved one’s.

    DoLS charging cannot be lawful if it is part of Health & Social Care, particularly if they are subject to Continuing Health Care.

    DoLS is being replaced.

  11. Stuart Turner February 21, 2017 at 11:25 am #

    surely there is a very simple bottom line: The Managing Authority has a statutory role to make a DoLS request where it believes the arrangements is has made for a resident’s care and treatment amount to deprivation of that resident’s liberty.

    If CQC, or better, a Judge during a hearing, ask why the MA did not make a request to the Supervisory Body they state ‘because they wouldn’t pay the £250 fee we charge them’…I really don’t think the case would be dismissed on those grounds! they may find themselves being required to pay damages for the negligence and also losing any local authority contract that they might hold on adult safeguarding grounds.

    Would said home also require a resident to pay for an adult safeguarding enquiry alert? I think not.

  12. Lavern Newell February 28, 2017 at 5:16 pm #

    I would assume the care needs are the same as those identified when the person was placed. Until additional support is identified as a consequence of the DoL how can you charge for this. I would expect the home to review the care needs and discuss this with the family.

    I find this extremely unpleasant and would hope the residents and the families look into this and act as they are the people who will change this.