Fair Charging for Domiciliary Care - Consultation Outcome

Approximately 1,000 consultation documents were distributed including over 300 in easy English. These were sent to representative groups of users (including the Disability Equality Forum, WECODP, the Advocacy Project, Action for Pensioners - Older People's Forum, the Care Network, HUG - users of mental health services), voluntary organisations, other partner agencies (PCT, AWP), B&NES staff, some individual users and independent sector providers.

Written Responses

Service Users 52

Carers 2

B&NES staff 21

NHS staff 2

Vol. orgs 9

Representative group 11

Not stated 9

Section 1

Question 1

Currently people who enter residential and nursing care, and have more than £19,000 in savings (excluding their home), pay the full charge. We are proposing that people receiving home care with more than £19,000 in savings (excluding their home) pay up to the full cost of their service so that there is equity between service users. Do you agree?

Yes 48

No 27

Not sure 11

Comments

There were relatively few comments. The selected comments below sum up the main concerns raised.

`Will this apply to both new service users and those already in the system'

`I think there should be equity between service users.'

`This is long overdue'

`It could bar people with savings from accessing services they may need. Therefore you should not be penalised for having services.'

`I have been saving all my life, I don't want to spend it solely just for living.'

`The threshold should be higher since the burden of care will still fall primarily on the permanent carer even if the maximum amount of input is being received.'

`Services received should be based on need not money.'

Question 2

We currently take into account Attendance Allowance and the care element of Disability Living Allowance when financially assessing the charge that should be made. The Council could decide not to take these allowances into account and raised the revenue lost in another way. Do you think we should continue to take these benefits into account?

Yes 56

No 26

Not sure 9

Comments

Most of the comments were with the `No' responses.

`I do feel that if these benefits are taken into account then a full assessment of the disabled persons expenses in connection with their disability should always be made. Quite often the above benefits are essential to a disabled person to cover the extra costs incurred due to their disability.'

`25% of these allowances will be disregarded anyway under this new arrangement.'

`Yes, Agree as attendance allowance was granted to supply the purchase of care needs and help in the home. Presumably Disability Living Allowance purpose is the same.'

`Agree as long as they are left with enough to cover extra costs.'

`Disagree, do not make the poorest people poorer.'

`I need all my benefits to live.'

`Disabled people incur many additional costs we do not therefore think that Attendance Allowance should be taken into account when finally assessing the charge that should be made. Income Support does not even take these allowances into account when assessing income.'

Question 3

We are required to assess for specific additional costs that disabled people may incur. We are proposing to do this by allowing for the following costs in finance assessments.

· Communication needs - personal assistance for people with a visual impairment and those who are deaf e.g. interpreting, (up to 2 hours per week at £8 per hour)

· Mobility needs - personal assistance for getting about (up to 2 hours per week at £8 per hour)

· Personal care needs - incontinence pads if not eligible under the NHS (up to £5 per week)

· General health - special diet, where there is a medical reason (up to £2 per week)

· Domestic health - basic cleaning where this is essential for physical well being

· Safety and summoning help - payment for a community alarm service or similar £3.29 per week

· In exceptional circumstances expenditure on clothing, bedding, heating and equipment will also be considered.

Do you agree?

Yes 70

No 13

Not sure 6

Comments

Comments mainly from the `No' responses.

`It is good that they recognised that there is a need for some financial support in these areas.'

`Amounts do not appear to be realistic and unclear what you mean by exceptional circumstances.'

`Some of this is nonsense, i.e. special diet £2 per week.'

`For personal care and general health should be up to £10 per week.'

`Many people use homeopathic remedies or diet supplements to help with their health and these can be expensive.'

`Either it is proper cleaning or not at all.'

`The additional payments do not cover fully.'

`Two hours a week for communication and mobility needs is insufficient. At least 3 times per week at 2 hours per session should be allowed to enable a person to access work, training, education or social contact.'

`Being able to only go out for two hours would make me depressed, therefore you have not allowed enough hours for mobility and if I need help with my garden I won't get it.'

`It depends what you need as to whether it is enough money, if you need it every day its going to cost you.'

`Would proof of the expense be required?'

`What about those who get the DLA mobility component?'

Question 3a)

We are proposing not to take into account the following costs - transport and gardening. Do you agree?

Yes 39

No 45

Not sure 5

Comments

`Agree that gardening should not be taken into account but transport for some disabled people is essential to maintain their physically and emotional wellbeing.'

`Gardening should be a consideration as elderly would find if quite difficult to maintain a tidy garden.'

Additional costs allowances should be made for gardening on the basis of general well-being in terms of control over the immediate environment and avoiding vulnerability from con-men, burglars etc.'

`Cost of transport and basic gardening (cutting of lawn) should be taken into account.'

`No to transport being excluded, elderly people get not allowance for this in their benefits'

`Some allowance may need to be considered where people have exceptional transport requirements.'

`Transport for shopping and hospital appointments is essential.'

`Transport can be one of the most expensive that can add up to a lot as you may need to get taxis to places.'

`Disabled people need support with transport and gardening to get them out of the home environment, to meet people and take advantage of community life.'

`Transport is one of the hardest things to get, especially if you can't get on a bus. There is not much accessible transport.'

Question 4

We currently do not charge carers if they receive services like home care from the council as carers' service. We are proposing that carers should be charged in future. Do you agree?

Yes 25

No 53

Not sure 11

Comments

`Carers need to be supported so that they continue in their role.'

`Need financial limits imposed for other services'

`This is nit-picking.'

`We need to look after the carers and if they need a little help themselves this should be offered and paid for by the Council.'

`It depends on their financial circumstances - the whole picture.'

`Agree provided it does not lower the standard of living for the person involved, remembering most people are on a fixed income.'

`The Carers are saving the Council money by being a carer as the person they are helping doesn't need so much outside help.'

Section 2

The Fairer Charging changes will result in loss of income for the Council. It is therefore proposed that we increase the current charges for some services. Some of these charges have not been reviewed for sometime. The proposals are as follows: -

· Increase the hourly home care charge to £7.20 per hour (currently £5.12 per hour)

· Increase the maximum home care charge for people with less than £19,000 to £56.25 per week (currently £37 per week).

· Increase the home care charges for people with more than £19,000 in savings to £12 per hour with a maximum charge of £248 per week (currently £8 per hour with a maximum charge of £56.25 per week)

· Increase the community meals charges to £2 per meal (currently £1.75 per meal)

· Increase day care charges to £2 per day (currently £1 per day)

· Include the Severe Disability Premium in financial assessments. This is currently disregarded.

Agree 29

Disagree 34

Comments

`It is an admirable target to try to keep people in their own homes for as long as possible but there are a great many things we can no longer do safely. Why is Council spending £23m to render the Spa a tourist attraction? What about reasonable charges and transport for local residents?'

`£248 max for people with more than £19k may not be equitable with gross cost of residential care because people living in the community still have to maintain their home. Day care charges could be increased to a more realistic rate.'

`For clients with more than £19,000, there should not be a maximum. They should pay actual cost of the service.'

`For people with £19,000 and over I do not feel we should provide services, only in exceptional circumstances. People should then be charged for every hour received.'

`Should there be a ceiling amount for services users who have more than £19,000. If they were to choose Res/NH care they would meet the full costs and this would be significantly higher.'

`To a person required a large amount of support and with over £19,000, finding the maximum charge would well be impossible. The outcome could be person not getting the amount of support they need, as they cannot afford the charges. It is a huge jump in finding £248 as compared to the current maximum charge. A situation like this could result in a family member or partner having to give up their work to provide the care needed.'

`I support the proposals for charge increases. However, I wonder whether we should consider phasing increases for those clients who will be affected by the removal of the ceiling.'

`Agree to increases.'

`These increases are needed to provide equity in service provision.'

`Again it seems that people who have saved all their lives are being targeted. It does not give any incentive to couples or people to save for their old age. I agree on some of the increased but others are quite a significant jump.'

`Some people may need extra help and might not be able to afford extra charges.'

`Agree with community meals and day care charges being increased but not the others.' (SEVERAL STATED THIS)

`Day care charges should be increased further.'

`I think £2 for day care is a good rate for what you get, money well spent.'

`Quite happy for meals on wheels to go up. I can't cook for myself. Quite happy for day care charges to go up, I wouldn't get out otherwise.'

Increase in maximum home care charge seems a very big increase, is this in line with increase in pensions. Increase in home care charges to £12 per hour is too big. Concerned about people who refuse to have services due to the costs and yet services are deemed necessary.'

`Home care charges increased by 50% are exorbitant. Need to cut overheads first.'

`This appears to be allowing some expenses but charging more on the other hand, so we are just back to where we started but created a huge amount of work in the meanwhile.'

`The increase in home care charge plus the huge rise in the maximum charge will make people try to economise and this unfortunately will put Carers under extra pressure.'

`The Council will have to try to save elsewhere for example on office equipment and staff.'

`It is very well putting all charges going up but if the benefit stay the same we are going to be a lot worst off.'

`They cost too much already.'

`I feel that £7.20 per hour too large an increase and many people find it difficult to pay.'

`The Government wants to encourage care in the community then adequate funds should be provided to ensure people's needs are met.'

`Why two increased at day centres, i.e. meals and day care charges.'

Perhaps try £1.50 per day for day care charges so not so expensive, as I have to pay dinner on top.'

`Day care charge too much, I am happy with what I pay now.'

`Service users will experience this as a tremendous increase on what they currently pay. Even though this might seen `fair' within the context of low rises over the years, it might have an adverse effect on service users/parent-carers budgets.'

`Increase in hourly rate to £7.20 and £2 seems rather steep'.

`Disagree with increases'

`Disagree, I believe to raise all the cost of all the services is very unfair.'

`The charges are going up too much. The home care service is not worth £7.20 an hour as there are a lot of things they won't do or help with.'

`The increase in charges will not leave people with very much money, especially as they are counting attendance allowance and Disability Living Allowance and want to include Severe Disability Premium.'

`Severe Disability Premium should not be counted in financial assessment.'

`I think the Severe Disability Premium should continue to be disregarded.'

`Only part of the Severe Disability Premium should be taken into account, say £20 max.'

Response from West of England Coalition of Disabled People

Their response was that although they welcomed the process used to develop the consultation document they were disappointed with the final document. They felt that the document could have more fully explained why the consultation was being carried out. WECODP are fundamentally opposed to charges. They feel that disability related benefits should not be taken into account and that the proposed disability related expenditure assessment is too restrictive. WECODP have asked for a deferment of the decision to allow further consultation with more evidence to justify the charging increases.

Response from the Carer Network

The main comment was that charges for carers should not be introduced. Carers already provide a huge value to local health and social services. They were divided in their opinion but mostly felt that AA/DLA should be taken into account as it was given to provide an element of care irrespective of income.

They felt that transport and gardening should be allowed for because of the isolation and rural issues of this area.

They felt the section on increased charges was confusing and the level of increases were well above the inflation rate.