Care package costs review risks increase in care home placements

North Somerset council has approved a policy that may leave some people unable to access their "preferred" option of care

Picture: WestEnd61/REX/Shutterstock

A council’s plans to review high cost community care packages could see more disabled people move to residential care if they cannot afford top-up fees for home care.

A ‘fair care policy’ approved by North Somerset council last night promises to review new applications for home care packages that exceed the cost of meeting the same eligible needs through a care home placement. The policy will apply to packages costing the council £500 a week or more.

Where reviews find “insufficient” council funding is available for a person’s “preferred” package, the council will propose an alternative placement or offer the option of paying top-up fees. The council estimates the policy will save £700,000 over the next four years.

An impact assessment suggests the changes could lead to an increase in residential care placements and a reduction in community care packages among the service user group affected, although the council believes this would be “marginal”. The move will also “mitigate” a shortage of local domiciliary care capacity, particularly in rural areas, the report added.

‘Choice and control’

Disability campaigners fear the policy could leave people with no option but to move into care homes if the council deems their support “unaffordable” and they can’t pay top-up fees.

Liz Sayce, chief executive of Disability Rights UK, said: “The wording is subtle – we think it would be helpful to make it clearer – but it does state that the change ‘could lead to insufficient funds being available for the package of support preferred by the individual’ and an alternative being offered.

“If that means only offering residential care when the individual wants support to live at home and be part of the community – that risks contravening human rights. And where in this is the choice and control that should govern social care policy?”

The Care Act statutory guidance says councils should not set “arbitrary upper limits” on the costs they are willing to pay to meet needs through different types of care. Legal experts told Community Care any blanket policy to restrict home care packages in line with residential care costs would expose a council to legal challenge.

‘Not a cap’

A North Somerset council spokesman said the ‘fair care’ proposals were not introducing “a cap or limit” on packages, adding: “It is merely guidance as to when the policy is likely to be applied. The actual value of the award will be determined on an individual basis according to individual circumstances.”

The impact assessment said the council will give due consideration to people’s rights to a private and family life under the European Convention on Human Rights when reviewing packages. The policy will aim to ensure “maximum independence” is achieved for people “within the financial limits of the resources available,” it added.

North Somerset currently provides community care packages offering more than 30 hours of community support a week for 158 disabled people. The group currently receives a total 13,731 hours of care and support a week, an average of 87 hours each.

The ‘fair care’ policy will be applied to new care package applications. The council does not intend to apply it to existing service users unless “significant” changes require their needs to be re-assessed.

The legal view

North Somerset’s ‘fair care’ policy isn’t the first time a council has looked to review community care packages against care home costs. Last year Southampton council shelved proposals to limit personal budgets to the cost of care home placements that could meet needs.

With the funding crisis in adult social care leaving councils under pressure to find cost savings, but the Care Act guidance setting out strict rules around applying “arbritrary” ceilings to certain care options, what are the issues in reviewing home care against residential care costs?

Jamie Burton, a barrister at Doughty Street Chambers, said: “The big question is how these policies will be operationalised in individual circumstances, but there is a real risk here of unlawful decision-making.

“Where a person wants to live at home and critically they have been assessed as having needs that can be met at home, then that is what should happen.

“However, these policies suggest that those people who cannot ‘top-up’ council funds for their preferred package of care are not going to be able to have their care needs met at home. That is a very legally risky strategy.”

Luke Clements, cerebra professor of law at Leeds University, said: “A blanket policy of restricting domiciliary care packages to the cost of residential care would be unlawful. It would conflict with the independent living guiding principle of the Care Act 2014.

“The primary aim must be to promote independent living and a fixed policy that limits the options to the cost of institutional care is making ‘cost’ determinative, not ‘needs’.”

More from Community Care

7 Responses to Care package costs review risks increase in care home placements

  1. A Man Called Horse February 22, 2017 at 3:43 pm #

    A little bit like Quantum on and off at the same time. The Care Act makes clear that limiting care packages in the community to the cost of residential care is unlawful and might infringe the Human Rights Act and be subject to legal challenge. While at the same time Local Authorities are subject to huge cuts in Central Government grants leaving them with less and less money to provide services. Clearly Austerity and cutting the deficit is a much higher priority for this Government than looking after older people. The consequences of bad legislation such as the Care Act is that clearly many will simply end up breaking the law, they are being put in an impossible situation of increased demand and reduced funding. Local Authorities cannot cut demand as that is fuelled by an ageing population. The only thing they can do is cut services, cuts jobs and cut care packages to fit existing budgets. The Tories running the country see the death of older people through their cuts as collateral damage. If you want to change the current position, stop voting for the Tories, it really is that simple.

  2. Sue February 22, 2017 at 5:21 pm #

    Yet again no mention of Extra Care Housing. Have North Somerset considered commissioning Extra Care as an option for those with needs more intensive than can be supported in the wider community, but who wish to remain living independently “behind their own front door”? This can be a cost effective option for social care and importantly also a popular choice for older people.

  3. Caroline February 22, 2017 at 8:18 pm #

    Propaganda is cranking up, work longer, stealing women’s pensions, older people sapping the system and disadvantaging younger people by living in their houses that they bought, with money they earned and paid tax on. Purposefully fuelling tension between young and old. Creeping not so stealthily towards stopping the triple lock. Squeezing social care to intimidate and all the while the real issue of disproportionate distribution of wealth is ignored.

  4. Daniel February 23, 2017 at 7:06 am #

    I agree that there shouldn’t be an arbitrary upper limit as defined in the Care Act, but that doesn’t mean there there is no limit. It just means that it should be considered on an individual basis. Therefore, I would think that the policy above wouldn’t stand up in court, whereas a policy on best value might. I do feel that councils should be able to consider appying the best value principle when care and support planning, as long as they are planning with the person and the personal budget amount agreed is suitable to meet a person in at least one care setting. Without this, it wouldn’t be reasonable to expect councils to fund beyond what they need to. For instance, if it would cost £1500 a week to support someone in their own home with 1:1 support, and residential care would cost £500. It would be reasonable for the council to offer the person the opportunity to move into residential care, or pay the difference. If this wasn’t the case, every local authority in the country would be broke within a week. Whereas, if residential care would cost £500, but a support package in the home was £600, it would be reasonable for the council to fund the home care package.

  5. Gerald February 23, 2017 at 2:10 pm #

    This policy should be welcomed, for years now Councils have been against Care Home Placements most people will benefit from this policy NOT suffer

  6. Kathleen February 23, 2017 at 10:50 pm #

    Of course North Somerset is awash with care home vacancies just waiting to be filled. Not! What about people with learning disabilities who want Independence and security in the community? Are we heading back to the days when care homes were the norm ! I sincerely hope not

    • Gerald March 1, 2017 at 5:21 pm #

      The reason there is now a shortage of Care Homes is that Councils around the Country have been purposely reducing “Contributions” to Fees for many years (since 1996) to encourage the Care at Home schemes. The Care Home Scheme will never work as it does not offer any where near the same value for money service which Residential or Nursing Homes offer. Numerous clients over the years have actually met the difference between the Council funding and the Care Home fees to ensure that their relatives get the service that they wish for them, surely this proves that numerous people actually support Care Homes.