Guide to Personal Budgets in Adult Social Care

Transcription

1 Guide to Personal Budgets in Adult Social Care The care you deserve in the home you love Guide to Personal Budgets 1

2 If you want to know how a personal budget can help you get the care you need, then this guide is for you. You ll find out what a personal budget is, how it works and the options you ll have for choosing your care. We are regulated by the Care Quality Commission (CQC) in England, the Care and Social Work Improvement in Scotland (CSWIS) and the Care and Social Work Inspectorate in Wales (CSSIW). If you would prefer a different format or language or you would like any further information please contact your local branch. 2

3 Contents 4 What is a personal budget? 4 What are the advantages of a personal budget? 5 How do I get my personal budget? 6 How much will I receive and how is it calculated? 6 What can I do with my personal budget? 8 How is my support planned? 9 What happens if the council ask me to pay towards my care? 10 What happens is my needs change? 10 How do I arrange my own services? 12 Be clear about what you re contracting for 13 Dealing with issues 15 Other sources of information 3

4 What is a personal budget? If you need care, then your local council will assess your needs and work out how much it will contribute towards the costs of your care. Once an assessment has been completed and eligibility is approved, your council will provide you with a personal budget. This is an amount of money you can use to buy your care. You can receive this as a direct payment to your bank account, for you to spend with a care provider or on employing your own carer. Or you can decide to use the council s services. Each approach has its advantages. You choose what s best for you, depending on your situation and what you want to get from your care. There s more information about your options later in this guide. What are the advantages of a personal budget? With a personal budget, you take control: You ll know right from the start how much the council will pay to meet your social care needs you can decide how you would like to be supported and by whom you can produce your own support plan, and you can fund your support plan through your personal budget. Having a personal budget can make a big difference. In a recent survey, people who received direct payments said it improved their physical and mental health, their independence and their control over their lives and care. They also said they were supported with dignity and that they felt safer inside and outside their homes. Source: POET Survey 2013 Think personal act local Guide to Personal Budgets 4

5 How do I get my personal budget? The first step is for your council to assess your care needs. This is called an Outcome Based Supported Assessment. An outcome is something that you want to achieve in your life - a goal or something to aim for. The assessment will ask about what you need help with. It usually covers: 1. Meeting your personal care needs 2. Keeping yourself safe 3. Eating and drinking 4. Making decisions and organising your life 5. Being a part of your community 6. Your role as a parent or carer 7. Running and maintaining your home 8. Having work and learning opportunities 9. Managing your actions 10. Family carers and informal support Councils use a range of different ways to assess your needs. You may be asked to complete the assessment questionnaire yourself. Self-assessment is becoming more common, as it helps put you at the heart of the process. Once you ve gone through the questions, your council will work out how much money you re likely to get towards your support needs. It does this by awarding points based on your answers. These points are converted into pounds, to make up your indicative personal budget. This is a guide to how much your support should cost. Your council will also ask you about your income and savings, and tell you how much if anything you need to pay towards your support. 5

6 How much will I receive and how is it calculated? Your direct payment must be enough to pay for a service of a reasonable standard, which meets your needs and your council s legal obligations. It should include any urgent care that you may need, for example because you have a chronic medical condition that fluctuates over time. It should also include any other costs of paying for your care, such as VAT on services you buy or holiday pay for a carer you employ directly. If your choice for receiving care costs more than your council thinks it should, you may have to pay the difference. However, you can appeal if you think your council isn t paying you enough. Your personal budget may change over time, even if your care needs stay the same. This is because your council s budget may go up or down - for example, due to inflation or changes in its policy. What can I do with my personal budget? This section of the guide looks at how you can use your personal budget. Your options include: 1. Managed council budgets 2. Individual Service Funds 3. Direct payments 4. A combination of managed budget and direct payment. Each has advantages and disadvantages, which we explain below. 1. Managed Council Budgets With this option, you ask your council to arrange the care you need. If you currently receive council services, then they re likely to continue. This can be the simplest option for many people. Guide to Personal Budgets 6

7 However, the service you get could change every few years if your council signs up with a new care provider. This might also mean your care staff change. Some councils will give you more choice. They may have a list of care providers you can choose from or even allow you to choose any care provider you like, with the council managing all the paperwork and payments. You ll need to speak to your council to find out what services they provide and how much choice you would have. 2. Individual Service Funds This is a more flexible managed budget. The organisation providing your care also manages your personal budget for you, through a contract with your council. Your provider has to be clear about how it s spending the money and make sure it s only spent on you, as directed by your support plan. If your council agrees, your provider can also organise other services for you. 3. Direct Payments With a direct payment, your council pays the money straight into your bank account. You can then buy care services from an agency, employ your own carer, or a mix of both. Direct payments give you the most control over your care. However, they also come with responsibilities. You must make sure you use the money appropriately. If you employ your own carer, you ll also have the legal responsibilities of being an employer. If you want, someone else can manage your direct payment for you. A community organisation or a provider like Allied Healthcare can do this. This makes your life easier but you still keep the responsibilities. If you can t manage your direct payment yourself, you can have it paid to a suitable person. This can be a family member or friend, who then takes on your responsibilities for you. Your council will have to follow a process to appoint this person and must make sure your best interests come first. 7

8 An independent living trust is another option. This is usually set up by your family and friends, to share the responsibility of managing your personal budget. This was a popular choice before the law allowed you to appoint a suitable person. Equipment and adaptions If you need equipment or small adaptations to your home (under 1,000) your council may provide these free of charge and may give you a direct payment to pay for them. Take advice to ensure that the equipment you re buying is safe, appropriate and cost effective. The occupational therapy department at your local social services can help you. You should also find out whether you or your council will own the equipment and who will be responsible for looking after it. There are about 40 Disability Living Centres across the UK, which display a wide range of equipment and have staff to give advice. You can visit one if you re unsure about a piece of equipment and would like to try it out. 4. A mixed package You can opt for a mixed package, by choosing to have some of your services provided or arranged directly by social services, and using direct payments to arrange the rest for yourself. This can be a useful way of trying out direct payments. How is my support planned? A support or care plan sets out the support you need and the cost of it. Your plan is a formal document and your council must agree it with you in writing and give you a copy of it. Your support plan will include a range of information, such as the care needs your council identified during your assessment, any amount you ll need to pay towards your care, and support that carers and others can give you. Guide to Personal Budgets 8

9 Your support plan will also show: 1. What s important to you 2. What you want to achieve or do differently 3. How you ll be supported 4. How you ll use your personal budget 5. How you ll manage your support 6. How you ll stay in control of your life 7. How you re going to make your plan happen You can get help with support planning from your council s care manager, voluntary and other organisations, or family and friends. You should be able to choose how you wish to proceed. Allied Healthcare can also help with support planning, so you can benefit from our expertise in designing care plans. Soon after your care service starts, your council will check your support plan is working for you. This includes making sure the plan is meeting your needs as well as regular reviews to take account of any changes and how they might affect your support plan and funding. What happens if the council asks me to pay towards my care? If you need to contribute, it s likely that your council will reduce your direct payment by the amount it asks you to pay. It s also possible that you ll receive a direct payment for the full amount, in which case you ll need to repay your contribution to the council. If you disagree with the amount you re being charged, you can appeal. If you re in dispute with your council about the amount you re expected to pay, you should ask to be paid the full amount until the dispute is settled. This will put you in the same position as someone who receives services from the council, while the amount they contribute is being resolved. 9

10 Your council should give you as much notice as possible before the direct payment starts or the amount is changed, to give you enough time to sort out disputes. What happens if my needs change? Life is full of surprises and no support plan can cover every eventuality. That s why personal budgets are designed to be flexible. As a general rule, as long as the outcome is still being met and it s within your personal budget, you should be able to make changes without needing your council to agree to them. For example, your support plan may show that you ll go swimming once a week. If you have a cold you can choose to do something different, such as a relaxation session. However, there will be some things that change your support plan so much that your council will need to agree to them. For example, as a result of a fall your mobility may be significantly impeded and you need more services to support you in your home. How do I arrange my own services? If you opt for a direct payment, you can arrange your care in a number of ways. These are: 1. employing your own care workers or personal assistants 2. using the services of an agency 3. using the services of someone who is self-employed 1. Employing your own care workers or personal assistants Many people find this a successful way of arranging their services but you will have to manage the responsibilities of being an employer. Guide to Personal Budgets 10

11 Before you can recruit a care worker, you ll need to: 1. write job adverts and job descriptions, making sure you ve covered all the tasks you ll want doing 2. find out where to advertise 3. work out what to ask at interviews 4. decide how much to pay 5. draw up an employment contract which meets legal requirements, and 6. get the insurance you ll need to meet your legal responsibilities as an employer. Your council may be able to direct you to a local support service that offers recruitment, training or payroll services. However, support services vary widely across the UK. 2. Contracting with an agency If you don t want the responsibility of being an employer, you can use your direct payment to arrange your care with a provider such as Allied Healthcare. You stay completely in control and can choose the services, care workers and times that suit you. Everything we do aims to maximise your long-term independence, choice and quality of life. We offer a wide range of healthcare and wellbeing services. We can assist with your personal care, such as getting up or going to bed, having a bath, dressing, shaving or taking your medication. We can also help with many other day to day tasks, including shopping, cooking, cleaning, going with you to your medical appointments or on social outings, or just being your companion. We offer a sleepover service if you need us there at night, or live-in care if you want the reassurance of 24-hour support. 11

12 If you have healthcare needs, we offer dementia and Alzheimer s care, palliative care, end of life care and a range of specialist nursing services. We also provide enablement care, which helps you to learn new skills or relearn old ones. 3. Contracting with someone who is self-employed Another option is to arrange for a self-employed care worker to provide the services you need. This means you avoid the responsibilities of being an employer. However, if you re not careful, someone you thought was self-employed can end up being treated as your employee for tax, National Insurance and legal purposes. This can have financial consequences for you. Several factors affect whether someone is employed or self-employed, including whether they have to do the work themselves, the amount of control you have over their work, whether they have set hours and whether they get overtime or bonuses. You need to check the terms of your contract very carefully, to ensure your care worker does not lose his or her self-employed status. You should be able to get advice on this from your council or local organisations. HM Revenue & Customs also has information on its website, which you can find at Be clear about what you re contracting for Whether you re contracting with an agency or a self-employed care worker, you need to understand what s included. Before entering into an agreement, confirm the following with the agency or individual involved: the tasks you expect them to do and how you would like them done what the quoted price covers (some agencies add VAT or charge extra for travelling) Guide to Personal Budgets 12

13 what insurance cover they have what training the staff have had cover arrangements, for example for sickness what happens if you have to cancel the service suddenly. To avoid misunderstandings, your contract should be as clear as possible. If you re making your own contract with someone who is self-employed, examples of contracts may be useful. Dealing with issues What happens if I disagree with my assessment and support plan? The assessment and support plan record your views about your needs. When your support plan is developed, you ll be able to talk about how you would like the support delivered. It s possible that your support plan will need to be reviewed and revised, to make sure that your funding covers all your needs. You ll also be given a copy of your assessment, so you can check that the information recorded is accurate. If you and the care manager don t agree about your assessment and support plan, or you re unhappy with how you were assessed, the details will usually be passed to the care manager s line manager for further discussion. If that happens, the six-week review from when your care starts will be an opportunity to resolve any outstanding issues. If the issue still isn t resolved, then you can use your council s complaints procedure. 13

14 Can I get someone to speak on my behalf? If you find it difficult to express your views and needs, you may be able to get help from a local advocacy service. This service can be provided by a voluntary organisation such as Age UK or a group of local organisations working together. Your council can tell you how to contact organisations that provide advocacy services. Support for older people Older people have particular needs that the assessment process must recognise. For example, they are likely to be assessed at a time of crisis, may have a deteriorating condition and often understate their needs and overstate their abilities. They also frequently lack adequate support from family and friends. If you want additional support, Allied Healthcare can be present to provide assistance, guidance and advocacy during this time. What happens in an emergency? If your council becomes aware that your care isn t meeting your needs or that you re at excessive risk, it must review your case and resolve the issue. You should not be left without support and should have a named person to contact in an emergency as part of your care plan. Your council should agree with you how they ll check on your care, based on your ongoing needs. It s useful to discuss potential problems with social services when your direct payments are set up. Your care plan should include arrangements for covering issues such as equipment breaking down or your personal assistant being sick or on holiday. Some support schemes offer back-up in the form of emergency staff. Your direct payments may need to be adjusted from time to time to take account of any extra costs Guide to Personal Budgets 14

15 How do I complain? You or your representative have the right to use your council s complaints procedure if you disagree with any decision about direct payments or personal budgets. You can complain about any aspect of your council s actions, as well as the actions of organisations providing services on its behalf. Each council must publish details of its complaints procedure and you should be told about it. If you re not satisfied with the way your council handles your complaint, you can make a further complaint to the Local Government Ombudsman. Other sources of information Assist UK A national organisation of Disabled Living Centres throughout the UK. Redbank House, 4 St Chad s Street, Manchester, M8 8QA Tel: Tel Helpline: general.info@assist-uk.org Website: Care Quality Commission (The) The independent regulator of adult health and social care services in England, whether provided by the NHS, local authorities, private companies or voluntary organisations. Also protects the rights of people detained under the Mental Health Act. CQC National Customer Service Centre, Citygate, Gallowgate, Newcastle upon Tyne, NE1 4PA Tel: (free call) enquiries@cqc.org.uk Website: 15

16 Carers UK National charity working on behalf of carers. Offers wide range of information on carers rights and sources of help and contact details for local carers support groups. 20 Great Dover Street, London, SE1 4LX Tel: (free call) Website: Disability Rights UK An organisation run by and for disabled people working on campaigns and policy. It provides a wide range of publications relating to personal budgets, direct payments and personal assistance. It also offers training and consultancy on direct payments and personal assistance. There is also a helpline. 12 City Forum, 250 City Road, London, EC1V 8AF Tel: s: enquiries@disabilityrightsuk.org Website: New Employers Helpline Helpline run by the HMRC providing information to those considering becoming employers. Tel: Website: Think Local, Act Personal Partnership (TLAP) A national, cross sector leadership partnership set up to drive the development of personalisation forward. TLAP produces a wide range of resource and publications. See website: Allied Healthcare To learn more about the services available from the UK s largest care provider call or go to Guide to Personal Budgets 16

17 The care you deserve in the home you love Copyright 2014 Allied Healthcare Disclaimer The information given in this Guide is applicable in England only and is correct at time of publication. To check for further guidance from government visit Guide to Personal Budgets 17