1 Personal budgets in social care A new way to arrange your care and support Home & care AgeUKIG26
2 We are Age UK. Our network includes Age Cymru, Age NI, Age Scotland, Age International and more than 160 local partners. This information guide has been prepared by Age UK and contains general advice only, which we hope will be of use to you. Nothing in this guide should be construed as the giving of specific advice and it should not be relied on as a basis for any decision or action. Neither Age UK nor any of its subsidiary companies or charities accepts any liability arising from its use. We aim to ensure that the information is as up to date and accurate as possible, but please be warned that certain areas are subject to change from time to time. Please note that the inclusion of named agencies, websites, companies, products, services or publications in this information guide does not constitute a recommendation or endorsement by Age UK or any of its subsidiary companies or charities. Every effort has been made to ensure that the information contained in this guide is correct. However, things do change, so it is always a good idea to seek expert advice on your personal situation. Date of publication: September 2012 Age UK 2012
3 Contents Introduction 2 Personalisation a new way to manage care 4 Getting help from social services 8 Will I have to contribute? 10 Who can get a personal budget? 12 What can I use direct payments for? 13 Should I choose direct payments? 15 Who can manage a personal budget on my behalf? 18 Arranging your own services 20 Dealing with emergencies 22 Useful organisations 24 1 Personal budgets in social care
4 Introduction If you have a disability and are already receiving help from social services, or you ve just had a care assessment and you re eligible for help, you are likely to have been offered the choice of using a personal budget to pay for your care and support. From April 2013, everyone who receives help from social services will have a personal budget. A personal budget gives you a number of options as to how your needs are met and funded, as well as the support you need to make an informed choice. Its aim is to give you more control, and to ensure that the services you receive meet your particular needs and wishes. If you receive a personal budget, you can choose to manage it yourself by getting direct payments, or have it managed by your local council or by someone else in line with your needs and preferences. Personal budgets give you flexibility in how your care needs are met. For example, you may decide to use yours to continue going to the social club you ve always been to, instead of going to the day centre the council suggests. You could choose to go for a pub lunch or to a local café once a week instead of always getting meals on wheels, or to employ a carer who can come at a time that suits you. This guide aims to help you find out more about personal budgets so that you can decide how you would like your care and support arranged. It also explains the option of receiving your personal budget in the form of direct payments, to help you choose if this is the right option for you. Even if you haven t heard these terms before, it s important to find out more as the Government is introducing them across the country. Direct payments were available under the previous system, so you may be more familiar with this term. 2 Personal budgets in social care
5 Throughout the guide you will find suggestions for organisations that can offer further information and advice about your options. Their contact details can be found in the Useful organisations section (see pages 24 26). Contact details for organisations near you can usually be found in your local phone book. If you have difficulty finding them, your local Age UK should be able to help (see page 24). This guide applies to England only. For information about direct payments in Wales, contact Age Cymru for the factsheet Self-directed support: direct payments in Wales. Personal budgets are not available in Northern Ireland, and are being reviewed in Scotland. Key what next? This symbol indicates who to contact for the next steps you need to take. 3 Personal budgets in social care
6 Personalisation a new way to manage care Personal budgets are part of a new way of managing care and support called personalisation. Personalisation is a government policy that aims to give more power to the recipients of social care services and to improve the way that local authorities provide services. Personalisation will eventually include health care. It aims to ensure that: the care and support that each individual gets is matched to their wishes and needs everyone who needs information and advice about social care gets it your local council works more closely with healthcare providers to give you the right support. Personal budgets are a key part of personalisation. Under the new system, you still have the same rights to services and the council is still obliged to assess and help you. A personal budget is a sum of council money that you can use to arrange and pay for your care and support. The amount that you get depends on the needs identified in your support plan and can alter as your needs change. If you are offered a personal budget, you can arrange to receive this money in a number of ways, including: a direct (cash) payment which is paid into an account for you (see page 13) an account managed by the council, which should be spent in line with your wishes the council might provide you with a type of debit card to draw money out of this account 4 Personal budgets in social care
7 an account held with a care service provider and managed by you this includes Individual Service Funds (ISFs) a trust held on your behalf by your carer, friend or family member a mix of the above. Remember, it s up to you how you receive your personal budget so if you want the council to manage it for you, make that clear when social services talk to you about it, but if you want to take responsibility, make sure the department is aware of that. You may want some services provided to you directly, but the freedom to arrange others yourself. You can be creative and flexible with your personal budget. For example, you might want to pay for someone to help you to go shopping instead of having it done for you, or to take you to a computer course to learn how to stay in touch with your family online. If you have a place of worship, or you like to go to a café to meet up with friends, you can use the money you ve been allocated to get you there, too. You may have an assessment and find that although you re eligible for help, the means test shows that you re not eligible for state-funded care. If this is the case, you are still entitled to support from the council to help you decide how to arrange your social care. You should always get the necessary advice and support to make an informed decision about how your services are funded and arranged. Until April 2013, some local authorities will still use the previous social care system. If you are in one of these areas, the council already has a duty to offer you direct payments to organise your own care, if you re willing and able to manage them. For more information about this system, see the Department of Health s A guide to receiving direct payments (see page 25). 5 Personal budgets in social care
8 My story I liked my regular carers so I m really happy I ve been able to keep them When Mary had a stroke that left her with reduced mobility, she qualified for help from social services. She wanted more flexible care to feel more independent and in control. When I had a stroke two years ago, it left me with various problems. In the beginning, it was hard for me to even get out of bed on my own and I had trouble with washing and dressing. I gradually improved but my recovery was so slow that I got frustrated and upset. I needed someone with me whenever I left the house in case I fell, but my husband has his own health problems so he couldn t help me. I used to do all the housework, so seeing the house getting messy made me feel very depressed. A carer from a care agency came round each day to help with my personal care, do some cleaning and get my shopping for me. It helped a lot but I wanted something more flexible so I could have more independence and control. I explained this to my care plan manager and we talked to my husband and my care agency about what would be best for me. As a result of these discussions, I agreed to have a personal budget in the form of an Individual Service Fund. This means my care agency holds the money I ve been allocated by the council, and I control how it s spent. I liked my regular carers so I m really happy I ve been able to keep them. I don t feel safe going out alone, so I arranged for someone to come with me when I go shopping, rather than them doing the shopping for me. I ve got my social life back as well, as someone comes with me to the social club I went to at the British Legion before all of this happened.
10 Getting help from social services If you find everyday tasks difficult or need help with personal care, you may be able to get help and support in your home and with getting out and about. The first thing to do is contact your local council s social services department and ask for an assessment of your needs. If you have a disability or if they can offer a service that you might need, you have the right to an assessment. A social care needs assessment will usually take place in your home and be carried out by social services staff usually a social worker, care manager or an occupational therapist. Before your assessment, think about all the things you want to talk about and the difficulties you face, and make sure that you list them all even if they don t seem important. For example, you could tell them if you need help getting dressed or undressed, washing or bathing, preparing a meal, or getting out of the house to join in with activities. The person doing the assessment should discuss your care and support needs with you to decide what services might be suitable for you. If you have a carer they also have a right to an assessment. The carer s needs will be included in your assessment, as the outcome may affect them. Some voluntary organisations have developed ways to help you assess your own needs, but your local authority must also carry out its own assessment. If you have a personal budget, you may hear the term RAS or Resource Allocation System this is the system the council uses to estimate the size of the personal budget that is necessary to meet your needs. You have the right to receive enough money for these needs to be met, and to get the amount adjusted if it isn t correct. 8 Personal budgets in social care
11 You ll be means-tested to see whether you need to contribute and, if so, how much (see page 10). Alongside the support that you re entitled to from social services, you may wish to use a support planner or broker to help you plan your support and put it in place (see page 20). Alternatively, your carer, a friend or a family member may be able to help you. This is sometimes referred to as the self-directed support planning process. After the assessment, you should be given a written care plan detailing your needs, what you want to achieve, how you will receive the support you need and details of who to contact if you have a problem or your needs change. The kinds of services that the council might provide are: carers to help with personal care or housework, a direct payment-funded personal assistant, day centre visits, meals on wheels and adaptations to your home. The council might have its own services or it might arrange the services through an agency or other organisations. Under personalisation, you should always get a choice over who provides your care and how it s delivered. what next? For more information about needs assessments and the services that local councils provide, see our free guide Care at home. 9 Personal budgets in social care
12 Will I have to contribute? Depending on your income and savings, you may have to pay for social care services. However, any health services, such as a community nurse, will be provided free of charge. Following the assessment, and after the council has estimated the costs of the social care and support needed, you ll be means-tested to see if you need to contribute. The amount you pay towards your social care must not bring your income below a certain amount. For more information, see our free factsheet Paying for care and support at home. If you don t feel that the assessment covered everything, or if you re turned down for help, or feel that the charge is causing you hardship, you can make a complaint to the local council. For more information, see our free factsheet How to resolve problems and make a complaint about the local authority. what next? See our free factsheets Self-directed support: direct payments and personal budgets and Local authority assessment for community care services. For more information about care assessments, read the free guide produced by Counsel and Care, Assessment and services from your local council in England (see page 25). 10 Personal budgets in social care
13 Depending on your income and savings, you may have to pay for social care services.
14 Who can get a personal budget? If you currently receive help from social services and live in an area that has already adopted the new personalisation system, you should be offered a personal budget. If you re currently having your care needs assessed, or you have them assessed in the future, you will also be offered a personal budget if you re eligible for social care. Personal budgets will be rolled out to every area in England by April The person who you speak to in social services should explain your options and help you to make a decision. Carers can also receive personal budgets to purchase the services that they are assessed as needing, such as help with caring, support from carers groups and respite breaks. Those who are unable to make their own decisions can also benefit from personal budgets. From November 2009, direct payments (one form of personal budget arrangement) became available to people who lack mental capacity, as long as they have a suitable person to manage them on their behalf. This must be someone reliable who will manage things in their best interests, like a close family member. It will often, but not always, be someone who has a power of attorney for that person. The local authority is responsible for making sure that this person can take on the role. 12 Personal budgets in social care
15 What can I use direct payments for? Direct payments are one way to receive your personal budget. If you re able to manage your own finances and feel comfortable doing so, getting your personal budget in the form of direct payments might suit you. Direct payments were launched under the old social care system, so local councils already have a duty to offer them to anyone who is eligible and who is willing and able to manage them. You and the local authority must agree that direct payments are right for you. If you re already getting help from the council but you don t receive it through direct payments, you can ask the social services department about them. However, direct payments are not suitable for everyone you may be happy to have social services arranging your care for you, or want to carry on receiving your care in the same way. There are rules about what you can and can t use direct payments for. The money must be used to meet the needs identified in your assessment. You can use direct payments to: employ your own care workers buy services from a voluntary or private agency buy equipment or pay for home adaptations purchase other types of support to meet your assessed needs get to a café to meet your friends, a place of worship, or other places that are important to you. 13 Personal budgets in social care
16 You can t use direct payments to: pay a spouse, civil partner, live-in partner, or a close relative who lives in the same household as you to care for you (except in certain circumstances that have been agreed with your local authority) buy services from your local council pay for permanent care in a care home. You can, however, pay for a short stay of up to four consecutive weeks within any 12-month period. For more information about employing your own care workers, see Arranging your own services on page 20. You can use direct payments to get to a café to meet your friends, a place of worship, or other places that are important to you. 14 Personal budgets in social care
17 Should I choose direct payments? Direct payments are not suitable for everyone and you need to think carefully before choosing this arrangement. If you employ your own care worker (sometimes called a personal assistant), you will need to deal with tax and national insurance for them, or ask a support service to manage this for you. You ll also need to make sure that you re insured in case your assistant has an accident. If someone has a Lasting Power of Attorney (LPA) or Enduring Power of Attorney (EPA) to manage your affairs, they may be able to manage your direct payments for you, under the council s supervision (see page 18). The majority of people receiving help from social services are entitled to direct payments but there are limited circumstances when they are not. If you are refused direct payments, your social services department will explain why it does not think direct payments are suitable for you. If you re not happy with their explanation, you have a right to make a complaint. For more information about making a complaint to the council, see our free factsheet How to resolve problems and make a complaint about the local authority. If you decide to manage your own personal budget, there is help available for finding carers and arranging insurance (see pages 20 21). what next? For more information about using direct payments, see the Department of Health s A guide to receiving direct payments from your local council (see page 25). 15 Personal budgets in social care
19 My story I could pick my own carer, someone I could rely on. Abdul switched to direct payments when he realised he wanted a more personal kind of care. I have rheumatoid arthritis, alongside other health conditions, and after social services assessed my needs they put in place a care plan for me. This gave me help with shopping, bathing, dressing and all the other things I needed at the time. They also provided meals on wheels, but I didn t like the food they gave me. I had agency carers coming in every morning, seven days a week. I also had additional visits on Tuesdays to do the cleaning and on Fridays to do the shopping. It wasn t too bad but I never knew who was coming it was a different person every week. Sometimes their timekeeping was bad, too. Then I heard about direct payments. I got in touch with my local Age UK and they came round and explained that with direct payments I could pick my own carer, someone I could rely on. I found someone who could meet my requirements and she s now been with me for more than two years. I have even given her keys to my flat, because I know that I can trust her fully. I had to set up a special bank account to have my direct payments paid into, but that wasn t a problem. A local voluntary agency organised a payroll company to do my carer s wages for me and set up employer s insurance. All I have to do is write my carer a pay cheque once a month, pay any bills that come in and pay the tax to HMRC each quarter. In two years I have never had any problems either with HMRC or with the council. It s all very simple, as long as you keep all the papers in one place.
20 Who can manage a personal budget on my behalf? A suitable person (see page 12) can manage a personal budget in the form of a direct payment under certain circumstances, such as when someone is unable to make their own decisions. It s also possible for someone with an Enduring or Lasting Power of Attorney to manage a direct payment. The local council is responsible for making sure that the arrangement is properly set up and monitored. Anyone working with a person who lacks mental capacity must act in their best interests as defined by the Mental Capacity Act Remember that you have the option of your local council managing your personal budget. You should have just as much choice in how you receive your care and support if it s managed this way as you would if you were managing it yourself. You can also have your personal budget held in an Individual Service Fund or other account by your care service provider, with you controlling how it s spent. Alternatively, you can set up an independent living trust (or user-controlled trust). The money belongs to you and the trust is managed for you by trustees. These can include friends, family, a solicitor, an independent advocate or other appropriate person. what next? For more information about mental capacity and the duties of those working with people who lack capacity, see our free factsheet Arranging for others to make decisions about your finances and welfare. 18 Personal budgets in social care
21 Remember that you have the option of your local council managing your personal budget.
22 Arranging your own services If you choose a personal budget in the form of a direct payment, your local council should help you to arrange and manage your own care. A relative or friend may also be able to help. Social services should give you details of a local direct payment support service that can help you to manage your personal budget. If you re arranging your own care, the local authority must still check regularly that you are getting what you need and aren t at risk. Some Age UKs and other voluntary organisations offer a support planning and brokerage service to help you manage your direct payments and arrange your care and support. You will usually be referred to these services by the local authority. This can be used alongside the support that you re entitled to from your local authority. If the brokerage service isn t free, you may be able to pay for it out of your personal budget. Call Age UK Advice for contact details of your nearest Age UK (see page 24). Alternatively, contact Disability Rights UK (see page 26) to find your nearest support service. There are agencies that can help you find a suitable carer. A local disability organisation or direct payments support service will help you to find an agency in your area. Many of these agencies will deal with tax and national insurance contributions for the carer on your behalf. 20 Personal budgets in social care
23 When choosing who to employ, think about: what kind of person you want how many people you will need (including back-up for holidays and sick leave) the tasks they will have to do the skills and qualities they will need what hours they will work and when the rate of pay. In the local council s assessment they should decide, with your input, what support you need and any risks involved. They should set up reviews to make sure that your needs are being met and the direct payment is being spent appropriately. what next? If you re employing your own care staff directly, get information about filing accounts and paying the right taxes by calling the HM Revenue & Customs New Employer Helpline The Department of Health s A guide to receiving direct payments from your local council also has more information on employing your own care workers. You can order this from the publications order line on Personal budgets in social care
24 Dealing with emergencies Whatever arrangements you make, there may be times when things go wrong. Make an emergency plan and discuss it with social services, so that it is included in your care plan. If you employ your own care worker, your emergency plan might include making arrangements with an independent agency for cover when your care worker is sick or on holiday. Some support schemes offer back-up in the form of emergency staff. If it is likely that your carer will have times when they are unable to care for you for example, if a relative cares for you and they have their own ongoing health issues the local authority should take this into account, as part of its duty of care, when calculating the financial support it will give you. If the local authority becomes aware that your assessed needs are not being met, it has a duty to act to resolve the problem. It also has a duty to act if you are being mistreated. You should have a named person to contact for help. what next? The local council also has a duty to make sure that you are not at risk. For more information about safeguarding, see our free factsheet Safeguarding older people from abuse. 22 Personal budgets in social care
25 Make an emergency plan and discuss it with social services, so that it is included in your care plan.
26 Useful organisations Age UK We provide advice and information for people in later life through our Age UK Advice line publications and online. Age UK Advice: Lines are open seven days a week from 8am to 7pm. Call Age UK Advice to find out whether there is a local Age UK near you, and to order free copies of our information guides and factsheets. In Wales, contact Age Cymru: In Northern Ireland, contact Age NI: In Scotland, contact Age Scotland: Personal budgets in social care
27 Care Quality Commission Independent regulator of adult health and social care services in England, whether provided by the NHS, local authorities, private companies or voluntary organisations. You can search social care service providers on the CQC website and check that they re up to government standards. CQC National Customer Service Centre Citygate Gallowgate Newcastle upon Tyne NE1 4PA Tel: Counsel and Care Provides advice and information to older people, their families and carers. Produces a wide range of publications. 6 Avonmore Road Kensington Olympia London W14 8RL Tel: (to order publications: ) Department of Health Government department in charge of the move to personalisation. Publishes a booklet about receiving and using direct payments. Tel: Personal budgets in social care
28 Disability Rights UK Provides advice on direct payments and personal budgets. Tel: HM Revenue & Customs New Employer Helpline Provides information on how to file accounts and pay the right taxes when you employ people. Tel: Think Local Act Personal Partnership Promotes personalisation and helps organisations providing social care to understand and deliver their new commitments. Social Care Institute for Excellence Fifth floor 2 4 Cockspur Street London SW1Y 5DH Tel: Personal budgets in social care
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