Department of Health
Published: 16 May, 2014
guidance on charging for care and support
The Care and Support and Aftercare (Choice of Accommodation) Regulations 2014
Back to choice of accommodation and additional payments
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The question appears to be incorrect, as the Choice of Accom Directions 1992 are very explicit about INCLUDING accomodation in ‘general housing’ IN THE COMMUNITY (which appears to have been Gov policy for several years (as ‘Care in the Community’ is felt to be more comfortable for the client (for as long as it’s practicable), in addition to being less expensive for the public-sector provider than the more formal settings defined in these draft regs.
This means that the Act, and the Choice Regs, need to be much more explicit about Loc Auth Adult Soc Care depts needing to be set-up to be ‘Housing Providers’ for some of their clients (regardless of how ASC depts may actually commission ‘appropriate accommodation’ for their clients).
In the proposed draft Choice Regs the limitations of the list of ‘Personal Care’ categories are wholly unacceptable. The reality is that life in the UK has become very complex, especially for those unable to earn due to age or disability, resulting in many people who ‘Can’t cope’, and therefore need to be provided, according to their various needs, with a very broad range of support (not necessarily the proposed kinds of ‘Personal Care’) to maximise their degree of ‘Social Inclusion’. In numerous cases an important kind of care (rarely provided by ASC, it seems) will be ‘Admin Support’, with a trained worker visiting the client at home every fortnight or so to write whatever letters/emails etc are needed to keep the client’s life ‘on track’, and thus to minimise the adverse effects of potential anxiety on the client arising from the fear associated with a ‘Can’t cope’ situation.
Self evidently ‘Wellbeing’ requires stable long-term (in principle ‘Lifetime’, for as long as the client’s health permits) ‘Appropriate Accommodation’ from which the client can be assisted to maximise their ‘Social Inclusion’, and to delay, for as long as practicable, the onset of higher levels of ‘Need’ (from illness and/or from disability) requiring a move to more expensive formal ‘Care Home’ settings.
So ASC depts must NOT push unaccommodated clients over to LA Housing depts, but MUST themselves DIRECTLY arrange housing for their clients with assessed needs.
The guidance should be the same regardless of the type of accommodation which should be driven by care needs.
We welcome that paragraphs the definition of choice of accommodation at paragraph 8.32 “extends to shared lives, supporting living and extra care housing.” This list should be noted as indicative in order not to exclude other forms of accommodation that local authorities may contract the provision of care within.
The guidance should also highlight the potential changes being considered by the government to cover the housing costs of specialist accommodation other than residential care. Rented housing costs are separately paid for by housing benefit, as the accommodation is linked to individual tenancy rights, however, the potential for changes to this payment system and the closure of local housing benefit departments may have an impact on the development and therefore availability of such accommodation in the future.
It is essential to have a ‘level playing field’ when assessing and meeting accommodation costs to avoid unintended distortions in the way care is commissioned and provided. As things stand, it is less costly for social services to contract for care that is provided in extra care or other forms of supported housing development where care costs do not have to cover accommodation costs. Given the pressures on local authority funding this is understandable, but potentially damaging. Systems for funding accommodation should be based on need, and not on the nature of the accommodation that is occupied.
There is a particular rural / small town reason why this is so important. Supported independent living schemes such as extra care developments are only viable if provided in large establishments or care ‘villages’, and this means in practice that such establishments are almost invariably located in larger urban areas. The provision of sustainable care facilities close to people’s familiar neighbourhood enhances well being, but this cannot happen if the care market becomes increasingly dominated by large developments. Innovative ways of providing small scale supported housing schemes need to be identified and provided along with larger schemes, but not at the cost of undermining the viability of smaller and locally responsive care homes.
The Care Act will require care home providers to identify separate costs for care and accommodation , and once this happens it would be feasible to have a common basis for estimating accommodation and related costs. Factsheet 6 proposes that payment to meet accommodation needs will be set at £12,000 /annum, which appears wholly inadequate if it is to cover all accommodation and ‘hotel’ type costs. More work is needed on this aspect of the reforms.
Care and housing is currently split and we currently charge under the Fairer Charging policy so this would not change what we do. Providers that are more expensive would probably not meet tender criteria therefore we would not commission.
Section 1 of the Care Act states includes the suitability of living accommodation in the definition of wellbeing. Individuals whose care and support needs require residential accommodation should be able to choose a service that will best support independent living and wellbeing. Currently the guidance on this lacks sufficient clarity as it is split across 3 sections – Chapter 8 on Charging, Chapter 10 on Care and Support Planning, and Annex A on Choice of Accommodation.
The guidance is clear that individuals must be able to choose between providers of the same accommodation (8.32), but needs to go further to clearly set out that individuals with care and support needs are able to exercise choice over the type of accommodation that best suits their needs. Presently the suitability of accommodation is referenced in Annex A, but this section is not linked to Care and Support planning. In order to ensure that local authorities provide a choice of accommodation that is suitable to a person’s assessed needs, 10.10 should include a link to Annex A. The amended paragraph at 10.10 should read:
“Where, through the assessment and care and support planning process, it has been identified that a person’s needs would be best met in a residential setting, local authorities must ensure they comply with the regulations on choice of accommodation (see chapter 8 and Annex A). Local authorities must ensure that accommodation is suitable to meet a person’s assessed needs and identified outcomes established as part of the care and support process.”
The regulations set out what types of accommodation are covered by the choice of accommodation provisions. Expanding the definition to include shared lives and supported living is a welcome step that will ensure greater choice for individuals with care and support needs.
However, the current definitions in the regulations of supported living require amending to ensure that the choice of accommodation rules apply within the variety of supported living accommodation models that exist, and others that could be developed. Amending the regulations to reflect this will enable a greater diversity of supported living products to be encouraged and developed, promoting diversity of services in line with Section 5 of the Care Act.
Currently the regulations on supported living at (8) include two categories, the second of which requires personal care to be available (b). Personal care is defined in (1)(2) a), but this definition does not correspond to the list of basic care activities in the eligibility criteria. As a result we are concerned that some groups may not be covered by these provisions, such as some people with mental health issues who do not require personal care as set out in (1)(2) a), but nonetheless require care or support and are eligible. To ensure the regulations are not overly restrictive, the definition of “Supported living” at (8) (b) should be amended to:
8) (b) accommodation in premises which are designated (whether or not specifically designed or adapted for the purpose) for occupation by adults with needs for care and support (to enable them to adjust to living more independently).
Response: Cannot see with current practice where and how this would apply. More guidance is needed
with regards to extra care housing the regulations will need to cover the intentions for relationships between the care provision and the management of the extra care provision. this also needs to be linked into the LA commissioning process
relationships and joint working need to reflect the needs of individuals and work a across the different types of tenures associated with Extra Care Housing.
Yes the guidance should the whole range of accommodation where people might be in receipt of care and support services including extra care housing and sheltered housing (which might be a cheaper option) where people can remain independent whilst receiving lower levels of support and care.
The Guidance should extend to Shared Lives and Extra Care Housing because the right to choose between different providers is just as important to users. Furthermore the ability to use top up funds is also important. It might be useful to consider Housing Benefit. Local Authorities meet the whole cost of residential care, but Housing Benefit covers the cost of supported living. Could Housing Benefit assist with residential care, to pay for more expensive providers, or extra services.
This is something that needs to be dealt with by care management, commissioning and contracting teams to ensure that care and accommodation costs are fair within different types of supported housing environments in particular Shared Lives (Adult Placement schemes)