Fairer Charging: Paying for your care at home Customer s Information Handbook 2015/16

Transcription

1 Fairer Charging: Paying for your care at home Customer s Information Handbook 2015/16

2 Important read this first This is a big booklet, but you don t have to read it all unless you want to. Instead of reading it all, you could look at the list of contents on page 3. The list shows what is in the booklet. Look down the list to find the things you want to read about and what pages they are on. When we say we in this booklet, we mean the Directorate for Children and Families. Page 2 of 31

3 Contents About this handbook 5 Before we start 6 Section 1: Working out what you contribute 7 Financial Assessment 7 Completing the financial assessment form 8 What if I do not want a financial assessment? 9 Your weekly income 9 Disability benefits 10 Capital 10 Identify outgoings 11 Identify disability related expenditure 11 Work out your protected level of income 12 Working out your contribution 12 Section 2: Contributing towards your support 20 When will I know how much I have to contribute? 20 What is my weekly contribution based on? 20 Your contribution 21 Will I have to contribute the full cost? 22 Who does not pay a contribution? 23 Payment Arrangements 23 What happens if I am on a cash individual budget? 23 What happens if I do not pay my contribution towards my cash 24 individual budget? What happens if I receive an Individual Service Fund (ISF)? 24 What happens if I do not pay my contribution to my care provider? 24 What happens if I am on a virtual individual budget? 24 What will the statement tell me? 25 How do I pay my contribution? 25 How long do I have to pay my contribution? 25 Page 3 of 31

4 What happens if I do not pay my contribution? 25 What if my financial circumstances change? 25 What if I am unable to pay my contribution? 25 Section 3: If you are not happy with the contribution 26 What if I do not agree with the amount I have to contribute towards 26 my support? You can ask for the contribution to be checked 26 If you still do not agree you can ask for a review 26 If you still do not agree you can appeal 27 If you still do not agree you can formally complain 27 Case Management Team contact details 28 Overview of process if you are unhappy with your contribution 29 Payment Methods 30 Details of some organisations that offer free advice on managing 31 finances Page 4 of 31

5 About this handbook This is a booklet from Manchester City Council. It is about Fairer Charging and the contributions you may have to make towards your support. It provides you with brief details of how Fairer Charging works. The figures used in this handbook relate to 2015/16 and are normally updated each year. Page 5 of 31

6 Before we start You will be reading this booklet because, in most cases, you have already had a care needs assessment undertaken by a Care Assessor/Social Worker and you have been given an Individual Budget. You may need to contribute towards the cost of your Care support and a Finance Case Management Officer will calculate this amount for you. Your contribution may be calculated initially using benefit information obtained from the Council s Revenue and Benefits department and/or from the Department for Works and Pensions (DWP). However, you will always be given the opportunity to supply further relevant financial information to allow us to amend your contribution; this may be supplied by completing a self assessment form, or via the telephone, or via a visit from a Case Management Officer. Most people pay something to the cost of their care. Some people are charged for the full cost of their care because of their financial circumstances. Very few people pay nothing at all towards the cost of their care. Page 6 of 31

7 Section 1: Working out what you contribute Financial Assessment Manchester s Fairer Charging Policy is used to make sure only those who can afford to pay for their care are asked to do so. The Policy, which follows Department of Health Guidelines, enables us to work out how much you will need to contribute. After your Community Care assessment has been completed and you have been assessed as needing an Individual Budget to pay for your support, you will need to provide evidence of how much money you have. We will work out if you are able to contribute towards the cost of your care support, and if so how much that contribution will be. This is called a financial assessment. We carry out the following steps to assess your contribution to the cost of your care. Step Action 1 Complete a financial assessment form 2 Work out your weekly income, including disability benefits and any income from your capital 3 Identify and allow for eligible expenditure (outgoings) 4 Identify and allow for eligible Disability Related Expenditure (DRE) 5 Work out your protected level of income 6 Work out your contribution Page 7 of 31

8 Step 1: Completing the financial assessment form We may initially use your benefit information obtained from our Revenue and Benefits electronic system or from the DWP to calculate your weekly contribution. You will be informed of the contribution in writing and we will ask you to provide details of any other income, savings or eligible expenditure, for example disability related expenditure, which you feel we should take into account in calculating your contribution. If you have further income or expenditure you wish us to take into account you will be contacted by a Case Management Officer who will arrange with you how you can supply this information; this may be through a visit at a suitable time and place of your choice, or via a self assessment form, or over the telephone. We will usually assess you as an individual, but if you are living with a partner and you receive DWP benefits at the couple rate, it may be more advantageous for to you to be assessed as a couple. If your partner is willing to disclose their financial details we will do two calculations; one taking only your finances into account and one taking both you and your partner s finances into account. We will apply the lower of the two assessments. If your partner chooses not to divulge their financial circumstances we will assess you as an individual. We will: - Carry out a financial assessment to decide if you need to contribute towards the cost of your support, and if so, how to do this. - Where appropriate, a better off assessment will be carried out to determine whether the inclusion of a partner s income / savings details would result in a reduced contribution. Page 8 of 31

9 What if I do not want a financial assessment? If you do not want a financial assessment, you will have to pay the full costs of your service. Step 2: Your weekly income including disability benefits and any income from your capital What will we need to know about? Your Case Management Officer needs to know about all the money you receive each week. This is called income. The list below gives you some examples of the types of income: - Retirement Pensions - Occupational and private pensions from previous employment - State benefits and allowances - Charitable and voluntary payments you receive - Maintenance payments and payments from family and friends - Annuity payments - Money from trusts - Money from abroad The list above does not cover all types of income and should be used as a guide only. Some income can be ignored. The list below gives you examples: - Mobility component of Disability Living Allowance/Personal Independence Payment, except in circumstances where day care transport is provided by the Council. - Earnings from employment - War Pensions - Savings Credit part of Pension Credit - Ex-gratia payments for former Far Eastern Prisoners of War - Payments made under the Vaccine Damage Payments scheme Page 9 of 31

10 Disability benefits Disability benefits may be taken into account as part of your income when calculating how much it is reasonable to charge you. Disability benefits include: - Attendance Allowance (AA) - Disability Living Allowance (DLA)/Personal Independence Payment (PIP) (care component only). Depending on which services you receive we may take the full rate of your Attendance Allowance or Disability Living Allowance/PIP into account when calculating your charge. Capital We also take into account any savings or investments you have. We will ignore the first 14,250 of your total savings and investments. We apply a tariff of 1 for every 250 over 14,250 that you have. For example: Capital 25,000 Capital over 14,250 10,750 ( 25,000-14,250) Weekly tariff 43 ( 10, ) The list below gives you examples of the types of savings we will take into account. - Money in banks and building societies - National Savings Certificates - Premium Bonds and Income Bonds - Stocks and shares - Individual Savings Accounts (ISAs) Page 10 of 31

11 - Cash - Funds held by the Court of Protection or your Deputy. If your capital is held abroad, then we will need an up to date statement showing the current balance. If your capital is jointly owned with another person, you should value your share by dividing the total value by the number of people who own it. If you give away any capital which has the effect of reducing your contribution towards your care you need to inform us. We will need to decide whether you should be treated as still having that capital. If you own the property that you live in, its value will be disregarded. However, if you own other property, this will be taken into account. Step 3: Identify and allow for eligible expenditure (outgoings) We need to know what money you have going out. This includes your rent (over and above the amount you get as Housing Benefit), your mortgage (after you get any Income Support or Pension Credit), Council Tax (after you get Council Tax Benefit), and buildings insurance (if you are an owner-occupier). Step 4: Identify and allow for eligible Disability Related Expenditure Disability Related Expenditure (DRE) is the extra expenses you have because of your disability. These expenses might be for things such as extra laundry, toiletries, personal care items, heating, transport, a special diet, clothing and equipment. Keep receipts for all these expenses, as we will need to look at them. If you do not know which expenses we count as Disability Related Expenditure, keep the receipts anyway. Some expenses may not be allowed if they are for things that are already covered by some of the other benefits you receive. Page 11 of 31

12 You and your Case Management Officer will look at the money you spend in relation to your disability. Before you meet with the Case Management Officer, it would be useful if you could think about what types of things you spend your money on. Step 5: Work out your protected level of income This is the minimum amount that the Department of Health says a person needs to live on. The allowance or protected income depends on your age and disability. In Manchester, the minimum level of allowance is currently equivalent to Income Support plus 25%. The current allowance for a single person in 2014/15 is as follows: Age Minimum Income Levels (IS +25%) = and in receipt of DLA/PIP High Rate = Care 25 until reaching State Pensionable Age* = until reaching State Pensionable Age* and = in receipt of DLA/PIP High Rate Care Upon Reaching State Pensionable Age* = *If you are a man and were born after 06 Apr 1951 or a woman born after 06 April 1953 you qualify for your state pension at different ages depending on when you were born. You only qualify for the upper level of on reaching your qualifying date for the receipt of your state pension. You will have been advised in writing by the DWP of what your qualifying age is. Step 6: Working out your contribution We will look at your total income (step 2) and allow for any eligible money you pay out (step 3) and money you pay in relation to your disability (step 4). We Page 12 of 31

13 will ensure that you keep a minimum level of income (step 5) The amount left is your contribution also called your Net Assessable Income. Important: Your contribution will be set at the lower amount of either your Net Assessable Income identified in step 6 or the weekly value of your Individual Budget. This ensures that you do not pay more than the annual value of your Individual Budget. Step 2 Total assessed income 3 - Eligible Money you pay out (expenditure) 4 - Money you pay in relation to your disability (Disability Related Expenditure) 5 - Basic allowances plus 25% 6 = Net Assessable Income See examples of how this is calculated for different types of customers in the next few pages. Page 13 of 31

14 Example 1: Net Assessable Income is less than weekly Individual Budget Mrs Beswick is a 96 year old customer and has an Individual Budget of 6,753 per year ( per week). Step Action 2 Income - She receives a Retirement Pension She receives Pension Credit ( per week; this is made up of Guarantee Credit, which we take into account, and 5.82 Savings Credit, which we disregard) She has savings of 20,000, giving her a tariff income of 23 per week ( 20,000-14,250 = = 23) She receives low rate Attendance Allowance ( per week) Total assessed income 3 She has no Step 3 eligible outgoings 0 4 She has no eligible Disability Related Expenditure 0 5 Protected income (Income Support + 25%) Net Assessable Income (total assessed income minus protected income) Her assessed contribution she has to pay towards her support is set at per week as her Net Assessable Income is lower than her weekly Individual Budget. Page 14 of 31

15 Example 2: Net Assessable Income is less than weekly Individual Budget Mr Cheetham is a 44 year old man with a learning disability and he has an Individual Budget of 5,402 per year ( per week). Step Action 2 He receives Income Support He has savings of 2,620.51, which we ignore He receives middle rate Disability Living Allowance /PIP ( per week) Total assessed income He has eligible outgoings for his rent (net of Housing Benefit) 4 He has no eligible Disability Related Expenditure 0 5 Protected income (Income Support + 25%) Net Assessable Income (total assessed income minus protected income) His assessed contribution he has to pay towards his support is set at per week as his Net Assessable Income is lower than his weekly Individual Budget. Page 15 of 31

16 Example 3: Net Assessable Income is more than weekly Individual Budget Mrs Burnage is a 68 year old customer with an Individual Budget of 3000 per year ( per week). Step Action 2 - She receives a retirement pension of She receives Pension Credit per week ( Guarantee Credit, which we include as income, and Savings Credit) She has savings of 25,000 on which we levy a p/wk tariff. ( 25,000-14,250 = 10, = 43) She receives high rate Attendance Allowance of per week. As she only receives care services during the daytime, only is counted Total assessed income She has no Step 3 outgoings 0 4 Unable to do her own laundry she pays 5.00 per week 5.00 for service washes, which she has evidence for) 5 Protected income Net Assessable Income (total assessed income minus Disability Related Expenditure minus protected income) Her assessed contribution is set at per week i.e. the weekly value of her Individual Budget, as this is lower than her net assessable income Page 16 of 31

17 Example 4: Customer does not make a contribution to the cost of their care Mr Blackley is a 24 year old customer and has an Individual Budget of 6,000 per year ( per week). Step Action 2 He receives benefits amounting to per week He also receives low rate DLA/PIP of per week He has no savings Total assessed income He has no Step 3 outgoings 0 4 He has Disability-Related Expenditure (DRE) Laundry 3.61, Gas/Electricity 10, Equipment Protected income Net Assessable Income NIL (total assessed income minus protected income) = minus As his Net Assessable Income is nil, he will not be asked to contribute towards the cost of his Individual Budget Page 17 of 31

18 Example 5: The Better Off Assessment Mr Didsbury is a 68 year old customer and has an Individual Budget of 10,000 per year ( per week). He and his partner live in rented accommodation If his partner is willing to disclose their financial details we will do two calculations, one taking only Mr Didsbury s finances into account and one taking both Mr Didsbury s and his partner s finances into account. We will apply the lower of the 2 assessments Assessment 1: Individual Assessment Step Action 2 He receives pensions/pension credit amounting to He has savings in his own name of 25,000 on which we levy a 43 per wk tariff ( 25,000-14,250 = 10, = 43) He gets High Rate Attendance Allowance of As he only receives care services during the daytime, only is counted Total assessed income The household rent is 20 p/wk. He pays 10 towards this. 4 He has no Disability Related Expenditure 0 5 Protected income Net Assessable Income (total assessed income minus protected income) His assessed contribution he has to pay towards his care support is set at per week as his Net Assessable Income is lower than his weekly Individual Budget. Page 18 of 31

19 Assessment 2: Couple Assessment Step Action 2 They receive pensions and benefits amounting to The total value of their savings is on which we levy 26 p/wk tariff ( (couple allowance) = = 26 He gets High Rate Attendance Allowance of As he only receives care services during the daytime, only is counted Total assessed income The household rent is 20 p/wk They have no Disability Related Expenditure Protected income (couples rate) Net Assessable Income (total assessed income minus protected income) = 8.50 His assessed contribution he has to pay towards his care support is set at 8.50 per week as his Net Assessable Income is lower than his weekly Individual Budget The Better off assessment is assessment 2 Page 19 of 31

20 Section 2: Contributing towards your support If you have to contribute towards your support, we will tell you how much to contribute and how to pay your contribution. Some people may not have to contribute anything. When will I know how much I have to contribute? We may use your benefit information to calculate your weekly contribution. If we do this we will contact you to inform you of the contribution and ask you if you have any other income, savings or expenses you think we should take into account in calculating your contribution. You will then be able to provide us with this information by completing the self assessment form included with the letter. Where appropriate a home visit may be arranged. Once we have all the relevant financial information we will be able to tell you how much your maximum contribution will be towards your care. This figure may change as a result of any further checks that the Case Management Officer undertakes. Your assessed contribution is also dependent upon the value of your individual budget. Once we have confirmed your contribution, we will send you a letter that explains how we have worked out the amount you have to pay. You must start paying towards your support from the date of your initial light touch financial assessment, or the date the support started if this is later. What is my weekly contribution based on? Your contribution is the amount we have assessed that you can afford to pay towards your annual Individual Budget divided over 52 weeks based on your current financial details. This means that your contribution will stay the same throughout the year unless your financial circumstances change, there is a change in your Individual Budget amount, for example, following a care or financial reassessment, or there is a change in the Fairer Charging Policy. Page 20 of 31

21 There will be no reduction in the contribution you are required to make even if you vary the weekly amount of support you receive, for example if you go on holiday, cancel some support or go in hospital, unless your circumstances have also changed. If it becomes apparent that your annual contribution is likely to exceed the amount of support that you actually receive over the course of the year we will ask for your Individual Budget and your corresponding contributions to be reviewed and ensure that you will never be asked to contribute more than the annual cost of the support that you receive. If this means that you have overpaid we will refund this. Your contribution Most people will need to make a contribution towards their support. If you are assessed to contribute you need to be aware that your contribution is always counted towards the cost of your individual budget before any funding support you may receive from the Council. In effect we make up the difference between your assessed annual contribution and the value of your annual individual budget. We will not make any adjustments to your contribution for fluctuations in the level of your support unless the total annual cost of your support reduces to a level lower than your assessed annual contribution, For example, if your annual assessed support budget is 10,400 and you are assessed to contribute 2,600 we will provide you with 7,800 of funding to make up the difference. Your support cost would need to reduce to below 2,600 before we reduced your annual assessed contribution. Although the figures quoted are annual figures you are expected to pay your contribution on a regular basis throughout the year. You are advised of the weekly amount when your contribution is calculated, which would be 50 per Page 21 of 31

22 week in the example shown below. Will I have to contribute the full cost? You will be liable to pay the full cost of your support if your weekly net assessable income is equal to or more than your annual Individual Budget averaged out over 52 weeks. You will also have to pay the full cost of your support if you have refused to have a financial assessment, or provide us with your financial details, or you have chosen to pay the full cost. Who does not pay a contribution? - People who are diagnosed as terminally ill, Page 22 of 31

23 Regulation 2 of the Financial Assistance Scheme Regulations 2005 defines terminally ill as A person is terminally ill at any time if, at that time, they are suffering from a progressive disease and their death as a result of that disease can reasonably be expected within six months. - Customers suffering from Creuzfeldt Jacob Disease (CJD) - People who are exempt from contributions by law, for example Section 117 of the Mental Health Act, People who have no Net Assessable Income. (See example 4 in Section 1) - People whose Net Assessable Income is less than 1 per week. Payment Arrangements You are expected to pay your weekly contribution at the assessed rate The way your contribution is collected will depend upon whether you have a cash individual budget, an Individual Service Fund (ISF) or a virtual individual budget. What happens if I am on a Cash Individual Budget? If you receive a cash individual budget, we will pay an amount of cash minus the cost of your contribution into your dedicated bank account every four weeks. You will need to pay your contribution into the dedicated bank account every week or at the minimum of four weekly. You will receive a notification every four weeks showing how much the City Council has paid into your dedicated bank account and how much you need to pay into the same account. This document is called a remittance. Page 23 of 31

24 What happens if I do not pay my contribution towards my cash individual budget? In accordance with your individual budget agreement you will be audited on a regular basis. This will include ensuring that you are paying your contribution regularly in to your dedicated bank account. If you do not do this you will be asked to make those payments. If you do not do this you will be asked to pay your outstanding contributions to the Council; your individual budget cash payments may be suspended and you may be moved to a virtual budget. Your care reassessment will take this in to account What happens if I receive an Individual Budget in the form of an Individual Service Fund (ISF)? If you receive an individual budget via an ISF, we will pay your care provider an agreed amount of cash minus your contribution every four weeks. You will need to pay your contribution directly to your care provider weekly or at least every four weeks. The weekly amount you have to pay to your care provider is the contribution figure shown on the letter sent to you by the Case Management Officer when your financial assessment was carried out. What happens if I do not pay my contribution to my care provider? If you do not pay your contribution to your care provider you will be contacted by them and asked to do so. If you still do not make your contribution your care provider will take action to seek this payment, which may lead to legal recovery action through the courts. What happens if I am on a Virtual Individual Budget? If you receive a virtual individual budget we will pay for the services you receive and we will send you a statement every four weeks detailing the contribution you are required to make towards your care support Page 24 of 31

25 What will the statement tell me? The statement will tell you: - The contribution you have to make - Any payments you have made towards your Individual Budget How do I pay my contribution? Details of how to pay are shown on the penultimate page of this document, on the back of your four weekly statements and included in the letters we send you about your contribution. You can make payment by: Standing Order Bank etransfer PayPoint Online Telephone How long do I have to pay my contribution? From the date shown on the statement, you have 28 days to pay the contribution. After this, you will be sent a reminder to pay. What happens if I do not pay my contribution? If you do not pay, we will follow our debt recovery process and we will continue to pursue any debt that is owed to the Council. This may lead to legal recovery action through the courts if payment is not made. The Council has a duty to recover all its fees in order to keep funding existing services. What if my financial circumstances change? If your circumstances change, you should ask your Case Management Officer to check how much you should be paying. You can do this at any time, for example if your income changes or if you have extra money to pay out. What if I am unable to pay my contribution? It is important that you contact the Case Management Team at the earliest opportunity if you feel that you are unable to pay your contribution. This way, we can provide additional support and prevent arrears from building up. Page 25 of 31

26 Section 3: If you are not happy with the contribution What if I do not agree with the amount I have to contribute towards my support? If you think we have not worked out the amount you have to contribute correctly you can ask us to look at it again under the following process. Check You can ask a Case Management Officer to check the contribution. Contact details are on page 29 This means that we will: - Check that the financial information that we hold for you is correct - Look at any new information that you have provided - Check that we have worked out the contribution correctly - Decide whether our decision was fair and correct - Write to you with our decision Appeal If you do not agree with the outcome of the review, you can ask for an appeal. You can ask the Case Management Officer that dealt with the review to refer it to the Case Management team Leader for an appeal. They will: - Check that the Case Management Officer managed the review correctly - Consider any other circumstances that may be relevant - If appropriate convene a case conference with representatives of care management, case management and where required a member of the Directorate s complaints team - Write to you with their decision The check, review, appeal process is currently under review and may change during the life of this document. Page 26 of 31

27 Case Management Team contact details If you have any queries about the financial assessments and Fairer Charging, please contact the Case Management Team. Contact details for the Case Management Team are: Address: Case Management Team Revenues and Benefits Unit, Benefits Service PO Box 3 Manchester M15 5BA Telephone: We will treat all information you disclose to us with the strictest confidence and will only use the information for the purposes for which it was disclosed to us. The Council is under a duty to protect the public funds it administers, and to this end may share the information you have provided on this agreement with other bodies responsible for auditing or administering public funds for the prevention and detection of fraud. The Council can data match internally or with other organisations and is currently required to participate in the Audit Commissions National Fraud Initiative (NFI) data match exercise. Further information on this can be obtained from: Page 27 of 31

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29 Summary of what to do if you are not happy with the contribution Dissatisfied with the contribution assessment? ask for check Case Management Officer carries out check Dissatisfied with check? ask for appeal Case Management Team Leader carries out review Dissatisfied with appeal? make a complaint Directorate for Families, Health & Wellbeing complaints procedure Page 29 of 31

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31 Financial advice for customers There are a number of organisations that offer free advice on managing finances as well as debt and money problems. They include: Manchester Citizens Advice Bureau Consumer Credit Counselling Service (StepChange Debt Charity) National Debtline Money Advice Service For Housing problems: Shelter Greater Manchester Shelter National web page The council s Debt Management and Recovery Policy for Domiciliary & Residential Care Debt is available on our internet site. Page 31 of 31