Mary Goudge is an experienced matron/manager who worked in several nursing homes herself before moving on to work as a management consultant in a firm specialising in nursing homes.
All homes have their own fee structure. Most homes charge different rates for single rooms, double rooms and for en suite facilities. Some homes will only admit residents who are self-funding, others will also admit those who are being helped by Social Services; some homes only admit residents who rely on Social Services for their funding.
It is sensible to contact your local Social Services offices and ask for a financial assessment before making any final decisions regarding your relative’s transfer to a care home.
Your relative’s care manager will assess the needs of your relative and decide the type of care which is most appropriate for them. This may be a residential care home, a nursing home or another type of care. If you disagree with their decision you may ask for a second opinion.
They will give you a list of homes in the area and guidance regarding the listed homes which may be suitable for your relative. However, care managers are not allowed to recommend any particular home.
Before you visit the various homes jot down a list of financial issues you need to know about, for instance:
- Will a monthly account be sent to me?
- Do the fees cover everything?
- Are there any extra charges for anything?
- When are fees due?
- Can fees be paid by direct debit?
- Who are the direct debit or cheques made payable to?
- Do Social Services send their contribution to the home?
Your care manager will arrange for your relative to have a financial assessment. This is mandatory if they hope to have financial help from Social Services. Even those people who expect to be self-funding may benefit from such an assessment because the assessor will ensure your relative is getting all the allowances to which they are entitled.
THE FINANCIAL ASSESSMENT
An appointment will be made for a financial assessment to be carried out by one of the staff of the financial department of Social Services. They will visit your relative, provided they wish to have such an assessment which your relative is at liberty to refuse. You will be able to be with them during the assessment.
The assessor will need to know the source of your relative’s total income including any regular amounts of money from grants.
Some examples of income that the finance officer will need details of:
- State pension.
- Other pensions including disability; invalidity; industrial and war pensions.
- All allowances including attendance and disability living allowance.
- Net earnings and sick pay.
- Income from tenants and non-dependent relatives.
- Annuities and all other income.
Some other sources of income
Your relative may have monthly or quarterly income from:
- stocks and shares
- rented property
- seasonal lettings from holiday homes or caravans, etc
- full-or part-time work
- working from home
- charitable grants.
At the time of writing:
- If your relative has savings and investments of over £19,500 they will have to pay the full cost of care. In this case they will not have to divulge any information regarding their income.
- If your relative has savings and investments between £12,000 and £19,499 they may have to contribute something from their savings towards the cost of care.
- If they have less than £12,000 nothing will be taken from their investments or savings.
- Bear in mind that pensions, allowances, residents’ contributions toward their care, etc are subject to change annually or even more frequently. Check them with your care manager or Social Services finance department (see Figure 5).
Your relative’s house
If your relative owns their own home and leaves it to enter into a care home permanently the house will be counted as an asset after the first 12 weeks. If their spouse or one of their relatives continues to live there it may not
be taken into account. However, if they own more than one property the second house will be taken into consideration.
Although this information is accurate for East Sussex it is possible that there may be minor changes in different counties of England.
Wherever your relative lives it would be wise to telephone or write to your local Social Services office and ask for information. They will send you a variety of helpful booklets with useful addresses and telephone numbers of relevant organisations.
Sometimes the home’s basic fees are listed on the brochure but not always.
You may be given a list of fees (see Figure 6) or they may be discussed when you go to view the home and see the matron. You should ask if there are any items for which you are expected to pay extra.
Generally speaking the basic fee includes:
- the resident’s room
- bed linen
- meals including elevenses, afternoon tea and night drinks, etc
- laundering of machine washable personal clothing
- light and heating.
Items which may attract extra charges in some homes
All homes are different and what is included in the fees of one home may be classed as an extra in another, such as:
- double rooms used as a single room
- en suite facilities
- refreshments and meals for visitors
- incontinence aids
- hiring of special equipment
- heavily dependent residents
- extra staff for one-to-one basis in special circumstances
- personal laundry and dry cleaning
- occupational therapy materials
- speech therapy
- private consultants’ and doctors’ visits
- private prescriptions
- anything else the management considers is not covered by the basic fee.
Find out what is included and what is termed an extra.
PAYING THE ACCOUNTS
The matron will probably suggest that the fees are paid by direct debit and will give you the appropriate form if you wish. This will ensure that the money is debited form your relative’s bank account and transferred into the home’s account on the due date.
Providing the home manager is in agreement the fees can be paid by cheque on or before the due date.
It is very unusual for residents or their relatives to pay with cash and in this case the proprietor and the manager must be in agreement in allowing this method of payment as special arrangements would have to be made to receive such substantial amounts of cash.
APPLYING FOR A GRANT
It may have been suggested that your relative should apply for a grant from a charitable organisation. There are many charities that may offer financial support either by a one-off payment, perhaps for clothing or a piece of equipment such as a type of computer to aid speech or mobility aids.
Finding charities that may offer help
- Set aside a morning or afternoon to do some research armed with an A4 notepad and biros.
- Go to the reference section in the main library in your area.
- Ask the librarian for The Encyclopaedia of Charities UK 2003 Edition 15. This book has 31 sections and 8,000 listed charities.
- Read through the index of each section which might be suitable for your relative’s needs and write down the numbers, eg Diabetes 426; Stroke Association 438; this will help you find them more easily without having to keep referring to the index.
- Check each entry to discover whether your relative might qualify for a grant.
- Jot down the name of all the organisations which you think might offer help. Make a note of each organisation’s name, address, telephone number and person to contact if it is given.
- Take the details of as many as you can including what they appear to be offering.
The next step
- Study the list at home.
- Phone the organisation and check the name of the person to whom you should apply.
- Write a letter stating your relative’s circumstances and needs to the three most likely organisations (see Figure 7).
- They will probably send you a formal application form. Fill it in accurately, black biro is best, sign and return it with any required documentation to support the application as soon as possible.
- Keep copies of all correspondence for your reference.
- Wait patiently for their reply.
- If the first three cannot help write to the next three and so on.
- Letters asking for financial assistance usually have to be discussed at a committee meeting and it may take some weeks before you receive an answer.
You will find various organisations only apply to a certain group of people, for instance some charities only consider people born and bred in a certain place. If your relative does not fulfil the criteria don’t apply.
Do remember that any grant your relative receives must be declared at their financial assessment.
Sarah lived alone after the sudden death of her husband, Keith, in 1998. Keith had always kept the garden looking lovely and Sarah had always kept the bungalow in a pristine condition. Now, after four long years, she was struggling. The garden was too much for her, the steps to the front and back doors were steep and difficult.
She decided to sell the bungalow and move into a care home. Her nephew suggested she went to live in the Bourne mouth area, near some of the family.
‘After all,’ he said, ‘your sister lives in Penny Lodge Nursing Home, why don’t you live there?’
He took Sarah to the nursing home to see her sister who was very sick indeed. The proprietor knew the circumstances and offered Sarah a lovely room on the ground floor which she accepted and put down a deposit. Sarah was fine until she was back in her own home again, then she realised she would be living in Bournemouth and all her friends would be living in Eastbourne.
Then the tears flowed, Sarah became more and more depressed.
‘Why don’t you stay up here where all your friends are?’ I asked her one day.
‘Because my sister is ill and I ought to be there with her.’
‘What will you do if your sister doesn’t get better?’
‘I don’t know, she has her own room and she can’t speak very much now, she’s too ill.’
Several people suggested she stayed in the area where she knew so many people.
One day she told me she had changed her mind about going to live in Bournemouth. ‘The only thing is, I’ve got nowhere to live now and the house sale is going through. We exchange contracts in a couple of weeks.’ Sarah thought of one of our mutual friends who lives in a warden controlled flat.
She phoned and asked if there were any flats vacant. There was and Sarah made an appointment to view. In the meantime she met somebody else who told her about a beautiful residential home in Eastbourne. She liked the sound of it. She cancelled the appointment to view the flat.
‘I’m going to live at Birchwood Manor’ Sarah told me the next time I saw her.
‘I thought you were going to live in a warden controlled flat near Elsie.’
‘Oh, I’ve changed my mind. I don’t want to cook any more.’ she explained.
‘Anyway, I’ve seen the room I’m going to have, it’s spacious and on the top floor. There’s a shower and toilet and a sort of mini kitchen. I think I shall be happy there.’
‘When are you moving in?’
‘Next Wednesday,’ Sarah replied. ‘You will come and see me won’t you?’
A few weeks later I visited Sarah in her new home and admired her choice. She seemed to be quite comfortable and happy.
Because her assets were above £19,500 she didn’t need to contact Social Services.