Social Work Services Charging Policy

Transcription

1 Educational and Social Services Social Work Services Social Work Services Charging Policy Date Completed: 04/02/2014 Date of Equality Impact Assessment: 04/02/2014 Date approved by Cabinet: Date Review Due: February 2015 Lead Officer: Eddie Fraser 1

2 CHARGING POLICY CONTENTS PAGE PARA PAGE 1 Section 1: Introduction 3 Section 2: Charging for Non-Residential Services 4 8 What are Non-Residential Services? 4 10 What Services cannot be charged for? 4 12 What Services does East Ayrshire Council Charge for? 5 15 How Are Charges for non-residential services calculated? 6 20 Financial Assessments 7 25 Income Disregarded in the Financial Assessment 7 28 Treatment of Capital 8 31 Temporary or emergency admissions to hospital or care 8 home/absence from home 32 Non-disclosure or incorrect information provided in respect of 8 financial assessment 34 Waiver of Charges and Write off of Debt 9 38 Self Directed Support 10 Section 3: Charging for Residential Services What Are Residential Services How Are Charges for Residential Services Calculated? Treatment of Income Funding Thresholds Treatment of Property Deprivation of Capital Hospital Admissions/planned absences Annual financial re-assessments Respite Care Section 4: Charges to other Local Authorities Public Information 15 Appendices - this section provides the details of the approved rates and charges, threshold and funding levels for the current financial year. 15 2

3 INTRODUCTION 1. East Ayrshire Council is committed to support aspirations of people with social care needs to live at home independently, safely and for as long as possible. The Council commits a significant proportion of our annual budget to this priority but like all other Councils we work within limited resources and face continuing financial pressure through increased costs, financial constraints and demands on services. Charges are an important source of Council income and are a means to help the Council deliver services and its policy aims. Income from service charges is reinvested in order to maintain and develop services. 2. This Charging Policy explains how East Ayrshire Council considers and calculates the contribution to care that people who use services will be expected to pay towards the services they receive from Social Work. Charges apply whether the service is provided directly from East Ayrshire Council, by an external provider commissioned by the Council to provide services on the Council s behalf or where a person receives an individual budget (direct payment) from the Council and arranges their own support. 3. East Ayrshire Council charges are set in line with statutory requirements and National Guidance and are approved by elected members on an annual basis through the budget setting process. 4. This policy is based on: Fairness and equality Consistent decision making Transparency of cost of charges COSLA National Guidance and Statutory requirements 5. This policy is also based on the following list of principles: People who use services will not be charged more than it costs to provide the services for which their contribution has been assessed. Services will be provided in accordance with service users assessed needs and not on their ability to pay. All people who use services will be offered a benefits check to provide them with information, advice and support to maximise their income. This policy is based on people claiming their full benefit entitlement. Service users who do not wish to claim benefits to which they have an entitlement, will be financially assessed as if they were in receipt of these benefits. 6. It is the expectation of East Ayrshire Council that people who are in receipt of benefits for specific purposes i.e. mobility allowance, attendance allowance, DLA Care Component/PIP will utilise these benefits to support access to services and/ or purchase care services. 7. This charging policy aims to: Provide a consistent framework for charging Recover appropriate contributions towards the cost of service provision Maximise service user income Maintain essential services Support high standard of care within available resources Monitor the impact of service charges on people who use services 3

4 SECTION 2: CHARGING FOR NON-RESIDENTIAL SERVICES What are Non-Residential Services? 8. Non-residential services are services which support people with a range of needs to remain living at home. These services are provided following an assessment of need and are intended to assist people to meet their identified outcomes. 9. The legal basis for charging for non-residential services is the Social Work (Scotland) Act 1968, (as amended) and the Community Care and Health (Scotland) Act What Services cannot be charged for? 10. The following services are free and are NOT subject to a charge: Criminal Justice Social Work Services Information and advice Needs assessment Care management Personal care for people aged 65 years and over Intermediate Care and Enablement Service (I.C.E.S) 11. The following people cannot be charged for care services: People with a mental illness who are subject to a Compulsory Treatment Order under the Mental Health (Care and Treatment) (Scotland) Act 2003 or a Compulsion Order under the Criminal Procedure (Scotland) Act People aged 65 years and over leaving hospital who are assessed as requiring Home Care and have been in NHS in-patient care for more than 24 hours for treatment, assessment or rehabilitation or had surgery as an NHS day patient. Home Care is free for a period of up to 42 days and this does not apply to people who have been discharged following admission on a regular or frequent basis as part of a person s ongoing care arrangements or episodic treatment. Only new, intermediate or additional services provided after the person comes out of hospital will be free, services which were in place pre-admission and continue after discharge will continue to be chargeable. People who are referred for services to support end of life care. East Ayrshire Council will not charge for care at home services, when at the point of referral for services; the life expectancy of the service user is less than 4 weeks. 4

5 What Services do East Ayrshire Council Charge for? 12. East Ayrshire Council Social Work currently charges for the following non-residential services: Care at Home (Home Care, including Housing Support) Day opportunities (Day Care) Smart Supports (Community Alarm and Telecare Equipment) Blue Badge administration 13. East Ayrshire Council Social Work does NOT charge for the following services: Sensory impairment services Transport to access services Children s Services Equipment and Adaptations 14. Whilst there is no charge for equipment, East Ayrshire Council will not provide small items of equipment which are readily available for general purchase and expects these items to be purchased privately by the service users. Some examples of small items of equipment are: tap turners, pick up sticks, kettle, tippers and bottle/ jar openers. 5

6 How are Charges for Non-Residential Services Calculated? 15. East Ayrshire Council operates 2 charging formats a flat rate charge and a charge based on a financial assessment. 16. The following services are subject to a flat rate charge: Smart Supports (Community Alarm and Telecare Equipment) Building based Day Care Blue Badge administration 17. Charges for the services below are determined on an individual basis by completion of a financial assessment. A member of Social Work staff will assist service users in the completion of financial assessments which require to be undertaken prior to the commencement of services and thereafter on an annual basis. Care at Home Day Opportunities (community based) Self Directed Support (Direct Payments option) 18. In addition to the above, East Ayrshire Council pays a subsidy per meal to the Meals at Home service in respect of service users who access this service following assessment. 19. The services a person receives will always be based on assessed needs and the charge will be based on ability to pay. 6

7 Financial Assessments 20. The Convention of Scottish Local Authorities (CoSLA) provides annual advice on the level of weekly income below which a person cannot be asked to pay charges. These are known as Minimum Income Thresholds and are updated each financial year in line with the Department of Work and Pensions (DWP) benefit up-rates. 21. If the assessable weekly income is less than the income threshold figure, there will be no charge for services other than the flat rate charges. 22. If the assessable weekly income is more than the income threshold figure, the income based charge will be a %( agreed annually) of the difference between the threshold income figure and a person s assessed income. Please refer to Appendix 1 which provides an illustration of assessable income. 23. East Ayrshire Council will then undertake a Better Off calculation, by calculating a charge based on the indicative cost of the service being provided and comparing this with the income based charge. The service user will then be charged the LOWER of the two charges. 24. East Ayrshire Council sets a maximum charge, above which service users cannot be charged, irrespective of the income based charge or the indicative cost of the service/s provided. Income Disregarded in the Financial Assessment 25. The following income sources are disregarded when calculating charges: The Mobility Component of Disability Living Allowance (being replaced for new claimants by Personal Independence Payment (PIP) from June 2013) War Pensioner s Mobility Supplement War Widows Supplementary Pension Income derived from benefits paid for or on behalf of children Up to of any earned income 26. If a service user has the higher rate of Attendance Allowance, DLA (Disability Living Allowance) (Care Component) or the enhanced rate of PIP, this higher rate is only taken into account in the financial assessment, if services are provided during the night as well as during the day. 27. Where services are not provided during the night, only the lower rate of Attendance Allowance, the middle rate of DLA (Care Component) or the standard rate of PIP will be treated as assessable income. 7

8 Treatment of Capital 28. Capital such as savings, bonds, stocks and shares, ISAs etc. will be taken into account in determining charges for non-residential services. 29. Capital and/ or savings up to a set disregard threshold will be disregarded (this amount is reviewed annually) as will be any property owned and lived in by the service user. 30. For service users with capital in excess of the disregard threshold, a tariff income is applied. For people over 60 years, this is currently 1 for each band of 500 over the disregard threshold and for people under 60 years, the tariff is 1.00 for each band of 250 over the disregard threshold. These amounts are added to assessed income. Temporary or Emergency Admission to Hospital or Care Home/Absence from their Home 31. If a service user is absent from home on a temporary basis, there will be no charge for Home Care or building based Day Care during the absence period. The flat rate charge for Smart Supports will continue to be payable during any temporary absence from the home. Non-Disclosure or Incorrect Information Provided in Respect of Financial Assessment 32. If a service user does not wish to divulge financial information for the financial assessment, East Ayrshire Council will charge the full charge for the service, up to the maximum charge. 33. If incorrect financial information has been provided by a service user or representative, the Council will seek to recover any amount due by the service user or reimburse any amount overpaid. A new financial assessment will be undertaken and the correct charge applied. 8

9 Waiver of Charges and Write off of Debt 34. East Ayrshire Council expects people who use services, assessed as being able to pay for essential support services, to contribute towards the costs of these services. The Council will pursue all charges not paid by people assessed as being able to pay, through the Corporate Council Debt Recovery process. However the Council acknowledges that there are some exceptional circumstances which may result in financial hardship. 35. Waiving of charges means that before a service commences, a decision by the Head of Service is made not to charge for the service. Charges cannot be waived retrospectively. The Head of Service can use discretion to waive charges in the following circumstances: For abnormal expenditure caused by serious or long term illness or disability. Where there are exceptional domestic circumstances, or Where there is an exceptional need not recognised in the normal financial assessment procedure. 36. All or part of the charge can be waived for up to 6 months. 37. In respect of write off, only the Executive Director of Finance and Corporate Support can recommend debt for write off. All normal debt recovery procedures will be followed before considering write off. Write-off of debt for non-residential services can only be considered on the following grounds: Social grounds to pursue the debt would be at the detriment of the service user s wellbeing. Financial reasons the service user has died and has left no estate or has absconded. 9

10 Self Directed Support 38. The Social Care (Self Directed Support) (Scotland) Act 2013 places new duties on Councils to offer four options to individuals following an outcome based assessment of their need. Option 1 provision of a direct payment. Option 2 the supported person chooses their support and the Council makes arrangements for the support on behalf of the person. Option 3 The person chooses that the Council selects the appropriate support and makes arrangements for its provision. Option 4 a mix of options 1, 2 and 3 in recognition that some individuals may have preferences for how different elements of their support is provided. 39. Under SDS, the focus moves toward enabling people to control and adjust their support at point of delivery, the link between the service and any appropriate charge becomes less well defined. The process of assessment leads to agreement on outcomes to be achieved rather than provision of services to meet need. 40. In East Ayrshire need for adults will be identified through the Talking Points based My Life, My Plan assessment framework which adopts a conversational approach. For children needs identified through the Children s Plan (IAF) it is proposed that through a Resource Allocation System (RAS), assessed needs will be allocated points according to criteria which will convert to a s per point allocation a personal budget. The means of meeting identified needs achieving agreed outcomes - is not proscribed to traditional and existing services. 41. The RAS in effect becomes the mechanism for identifying the indicative cost of meeting the service user s needs. 42. For people choosing to take option one in whole or in respect of part of their support plan, a cash payment in respect of the personal budget will be made directly to them. 43. Regardless of how the support required to meet service user outcomes is categorised, the financial assessment process itself requires to remain largely unchanged, in order to ensure that the charging system remains equitable and that existing service users and those not opting for option 1are not disadvantaged. 44. It is proposed that: The income side of the financial assessment calculation is retained per the existing charging policy. The personal budget amount identified through the RAS is entered into the calculation as an equivalent to the weekly indicative cost of service. The better off calculation is then done as normal and the charge identified. This is then deducted from the personal budget paid to the individual (net payment)*. 45. In this way people are required to fund a part of their overall package in the same way as if the Council were arranging a care package comprising traditional services under the current arrangements. 46. A flow chart which illustrates the process from the most recent CoSLA Guidance, can be found at Appendix 2. 10

11 SECTION 3: CHARGING FOR RESIDENTIAL SERVICES What are Residential Services? 47. Residential services for adults refer to 24 hour care and support provided in a care home setting. The care home must be a registered service with the Care Inspectorate and meet the assessed needs of service users on either a residential or nursing care basis or both. 48. Care provision can be on a permanent, temporary or respite basis and is usually planned in advance. However on occasions, emergency admissions to care homes can occur. 49. The legal basis for charging residential services is the National Assistance Act 1948, as amended by the National Assistance (Assessment of Resources) Amendment (Scotland) Regulations 2010 and the National Assistance (Sons for Personal Requirements) (Scotland) Regulations East Ayrshire Council s charging for residential services is based on this legislation and on the Charging for Residential Accommodation Guide (CRAG). Residential care includes care provided directly by the Council or by the voluntary and private sectors. How are Charges for Residential Services Calculated? 51. Permanent Residential Services 52. Charges for permanent or temporary residential services are based on a financial assessment and are usually referred to as the Service User Contribution. 53. The financial assessment identifies the level of income, savings and capital assets belonging to the person moving to a care home which allows the service user s contribution towards the cost of care to be calculated. Capital assets include any property owned by the service user, either solely or jointly with others. Treatment of Income 54. In general, all income received by the service user with the exception of Mobility Allowance, if in payment, requires to be paid towards the service user s contribution to their care costs. 55. If an Occupational Pension is in payment, the service user can give 50% of the amount paid to a spouse/ partner. This must be declared on the financial assessment form. 56. The service user is also entitled to a Weekly Personal Allowance from Income and some outgoings such as life insurance can be disregarded in the financial assessment. Funding Thresholds 57. There is both an upper and lower funding threshold in respect of charges for residential services. The upper threshold is the amount of assessable capital, defined by legislation, that a service user has, above which they are required to meet the full cost of their care (Self Funding service users). 58. For service users aged 65 years and over who have capital in excess of the upper funding threshold, there is an entitlement to a Free Personal Care payment if residing in a residential unit and a Free Personal and Nursing Care payment if residing in a nursing home. 59. Self Funding service users under 65 years are also eligible for the Free Nursing Care Entitlement. 60. The Free Personal and/or Nursing Care entitlement is a fixed weekly amount, paid direct to the care home by the Council, the amounts payable being set nationally. 11

12 61. The lower threshold is the amount of assessable capital, defined by legislation, that a service user has, below which they are not required to contribute towards the cost of their care from their capital. 62. Service users whose capital falls between the upper and lower threshold levels will have a tariff income applied. This is currently 1 for each band of 250 above the lower threshold level. 63. The threshold levels are reviewed nationally on an annual basis. 12

13 Treatment of Property 64. The treatment of property requires to be based on the individual circumstances surrounding the property and its ownership. East Ayrshire Council, in line with national guidance will disregard the value of a service user s property where; The service user s partner is continuing to reside in the property. A relative of the service user who is over 60 years is continuing to reside in the property. A relative aged under 16 years and is liable to be maintained by the service user is continuing to reside in the property. A relative who resides in the property is incapacitated. 65. Other discretionary disregards in respect of property may also apply. 66. For service user s who do not have savings in excess of the upper funding threshold, but who do own a property, the value of which is to be taken into account in the financial assessment, the value of the property is disregarded for the first 12 weeks following admission to a care home. 67. This is called a 12 Week Property Disregard and allows service user s this time period to decide if they wish to remain in a care home setting, and to allow them to make arrangements for the sale of the property, if appropriate. 68. After the 12 week disregard period, the value of the property will be taken into account in the financial assessment. If the service user or legal representative makes the decision to sell the property and the property is not sold within the 12 week period, the Council can assist with interim funding, either by placing a Charging Order on the property or arranging a Deferred Payment. 69. More detailed information regarding the use of Charging Orders or Deferred Payments can be provided by the worker assisting with the completion of the financial assessment. Deprivation of Capital 70. Where East Ayrshire Council is of the opinion that a service user or representative has deprived the service user of a capital asset in order to avoid liability for care home costs, the service user will be treated as still possessing the asset and the value of this asset will be included in the financial assessment. 13

14 Hospital Admissions/Planned Absences 71. Where a non Self Funding service user is admitted to hospital or has a planned absence for any other reason, East Ayrshire Council, in line with national guidance, will continue to pay the Council s normal contribution to the care home for a maximum of 6 weeks. After 6 weeks, the Council reduces this payment to 80% of the Council s contribution. The service user requires to continue to pay the service user contribution during any absence, unless the placement is terminated. 72. Where a Self Funding service user is admitted to hospital or has a planned absence for any other reason, East Ayrshire Council, in line with national guidance, will continue to pay the Free Personal and/or Nursing Care entitlement for 14 days. This payment will then cease and be reinstated on the date of the service user s return to the care home. The service user requires to continue to pay the service user contribution during any absence, unless the placement is terminated. Annual Financial Re-Assessments 73. All service users residing in care homes on a permanent basis are subject to an annual financial re-assessment in line with DWP up-rating of benefits and the annual review of national guidance. 74. Self funding service users or their representative must advise the Council at least 2 months in advance of capital falling below the self funding threshold. This is in order for a new financial assessment to be completed in respect of additional funding being required from the Council. Failure to comply with this timescale for notification may result in additional cost to the service user. Respite Care 75. The charge for adult respite provision within a care home setting is a standard charge based on the minimum income guarantee minus a weekly personal allowance. This is also the interim charge for adult service users who require an emergency admission to a care home, until such times as a financial assessment is completed to determine the actual service user contribution. The financially assessed service user contribution is backdated to the date of admission. 76. The charge for respite provision for young people within residential units is based upon the level of Disability Living Allowance (DLA)/PIP Care Component which the service user is in receipt of. 14

15 SECTION 4: CHARGES TO OTHER LOCAL AUTHORITIES 77. East Ayrshire Council set annual charges in respect of providing services on behalf of other Local Authorities. These charges are designed to achieve full cost recovery for the service. PUBLIC INFORMATION 78. East Ayrshire Council s Social Work Charging Policy is available on the Council s Website. A charging information leaflet is also available in Social Work offices and on the Website. APPENDICES Appendix 1 - Maximum charge illustration (CoSLA) Appendix 2 Self Directed Support charging illustration (CoSLA) Appendix 3 Approved rates and charges for financial year 2014/15 Appendix4 Threshold levels for non-residential services 2014/ 15 Appendix 5 Threshold and funding levels for residential services 2013/ 14 15

16 APPENDIX 1 Maximum Charge - Illustration (example Couple 60+) Threshold Maximum Charge (ie 60%) Excess Income Buffer 16.5% Pension Credit Guarantee or 100 Income Support Personal Allowance Minimum Guaranteed Income & 50 Disability Premium 0 Maximum Charge should not exceed cost of service. 16

17 APPENDIX 2 FROM COSLA GUIDANCE 2013/14 SELF DIRECTED SUPPORT Individual with potential support needs becomes known Outcomes-based Assessment of Needs Initial Financial Assessment Eligibility for support established Yes No Information and Advice Required to Contribute? Yes No Calculation of personal budget through RAS Calculate likely personal contribution to personal budget Total transparent picture of resources Support Planning Retrospective attribution of service hours for Free Personal Care Final Financial elements agreed and support package signed off 17

18 APPENDIX 3 CHARGES FOR NON-RESIDENTIAL SOCIAL WORK SERVICES APRIL 2014 BENEFIT RATES REVISED THRESHOLD LEVELS BASED ON COSLA RECOMMENDATIONS Single People 60+ living alone with h/r AA, h/r DLA care or e/r PIP living alone with l/r AA, M/R DLA care or s/r PIP with h/r AA, h/r DLA care or e/r PIP 60+ with l/r AA, m/r DLA care or s/r PIP Under 60 living alone with h/r DLA care or e/r PIP Under 60, living alone with m/r DLA care or s/r PIP Under 60, living alone with l/r DLA care Under 60 with h/r DLA care or e/r PIP Under 60 with m/r DLA care or s/r PIP Under 60 with l/r DLA care Under 25 living alone with h/r DLA care or e/r PIP Under 25 living alone with m/r DLA care or s/r PIP Under 25 living alone with l/r DLA care Under 25 with h/r DLA care or e/r PIP Under 25 with m/r DLA care or s/r PIP Under 25 with l/r DLA care 2014/15 Maximised Income /15 Threshold Couples 2014/15 Maximised Income 60+ living alone, both with h/r AA, DLA care or e/r PIP 60+ living alone,1 h/r AA, DLA or e/r PIP,1 l/r AA, m/r DLA or s/r PIP 60+ living alone, both with l/r AA, m/r DLA care or s/r PIP 60+ both with h/r AA, DLA care or e/r PIP h/r AA, DLA care or e/r PIP, 1 l/r AA, m/r DLA care or s/r PIP 60+ both with l/r AA, m/r DLA care or s/r PIP 60+ one with h/r AA, DLA care or e/r PIP 60+ one with l/r AA, m/r DLA care or s/r PIP Under 60, living alone, both with h/r DLA care or e/r PIP Under 60, living alone,1 has h/r or e/r DLA care or PIP &1 has m/r or s/r Under 60, living alone, both with m/r DLA care or s/r PIP Under 60, both with h/r DLA care or e/r PIP Under 60,1 with h/r DLA or e/r PIP, 1 with m/r DLA care or s/r PIP Under 60, both with m/r DLA care or s/r PIP Under 60, one with h/r DLA care or e/r PIP Under 60, one with m/r DLA care or s/r PIP Under 60, both with L/R DLA care Under 60, one with L/R DLA care /15 Threshold e/r PIP Enhanced Rate of Personal Independence Payment 2 s/r PIP Standard Rate of Personal Independence Payment 18

19 APPENDIX 4 RESIDENTIAL SERVICES FINANCIAL INFORMATION 2013/ 2014 Benefit Levels 2013/ 2014 ( ) Minimum income Attendance Allowance Disability Living Allowance Care Disability Living Allowance Mobility Severe Disability Premium Severe Disability Allowance Personal Allowance Savings Credit Disregard 5.90 Capital: Lower Threshold 15, Upper Threshold 25, Cost of Care Home Bed: Residential Shared Residential Single Nursing Shared Nursing Single Interim & Respite- Over 65years Interim & Respite- Under 65years Free Personal Care and Nursing Care Payments FPC FP & NC NC- Under