Nursing Their Dignity

Around 42,000 people in nursing homes in England should have seen their weekly bills for care fall by up to £110 a week in October. But administrative delays and confusion mean that the new rules are not working as they should.

From October 1 2001 anyone in a nursing home in England – not a residential care home – who pays their own fees should get a contribution towards them from the National Health Service. It is intended to cover the nursing costs of looking after them and will be £35, £70, or £110 a week depending on how much nursing care they need.

The change is in response to the recommendations of the Royal Commission on Long Term Care. In March 1999 it proposed that the full cost of personal and nursing care in all residential and nursing homes should be paid by the state. The other costs of being in the home, mainly food and lodging, would be paid for by the residents but there would still be help for those on low incomes. The Government took more than a year to consider and reject the Commission’s main proposal, saying the cost of up to £1.2 billion a year was too high. Instead it decided that it would pay just for nursing care in nursing homes at a cost of around £200 million a year and these watered down changes were finally introduced in October 2001, nearly four years after the Commission was formed in December 1997.

During that time, the Government introduced devolution which passed responsibility for care homes to the three national administrations in Scotland, Wales and Northern Ireland. So the October changes do not apply outside England – the other three countries in the United Kingdom will all introduce their own changes later (see Rest of the UK below).

There are about 135,000 people living in nursing homes in England and nearly 100,000 of them get all their fees paid by the local authority or through Income Support. That majority will see no difference from the October changes, their nursing home fees will be continue to be paid as before. Only the 42,000 people who pay for their own care will benefit directly. They will each be assessed as to the level of nursing care they need (called the Registered Nursing Contribution to Care). The nursing home will get £110 a week for those who need a high level of care, £70 a week for those who need an average amount and £35 a week for those who need little nursing care. Most people are expected to fall in the £70 band. The payments will be made direct to the home by the local Health Authority or Primary Care Trust and it will be up to the home to reduce the fees charged to the individual concerned. Some may not do so, either fully or at once.

Some residents may also get less than they should because the assessment procedure is running late. The final guidance on how the new system would work was only issued on September 25, just six days before the new scheme began. As a result, many people will not have their nursing needs properly assessed until the end of the year. Meanwhile, an interim payment will be made which may well be at the wrong level. Health authorities have limited budgets and some may pay people at too low a level until the final assessment is done. There is an appeal process against the assessment and anyone who is put in the lowest band should appeal to move up to the middle band. And anyone in a residential care or nursing home who pays their fees themselves should also put in a claim for attendance allowance from the Department for Work and Pensions.

One group of people in England will not be affected by these changes. They are around 11,500 people who have been in a care or nursing home since before April 1993. They will be brought into the new system in two stages from April 2002.

Although nursing care will be paid for, personal care will not and many pressure groups believe the distinction between the two is an artificial one. The Government’s definition is that only care which is done, planned or supervised by a qualified nurse in a nursing home will be paid for. But if someone is incontinent, and needs frequent help with washing and dressing and needs their bed changing twice daily, is that nursing care or personal care? The difference is a fine one. And wherever you draw the line it will go through someone’s dignity. According to the Government it depends where it is done and by whom. Done by a registered nurse in a nursing home it is nursing care and is paid for. Done by a nursing assistant in a residential care home it is personal care. The Scottish Executive has decided to avoid the problem by paying for both nursing and personal care in changes that are expected to start in April 2002.

There have been other changes this year for people in homes throughout the United Kingdom. In April 2001 the capital limits, which stopped some people getting help with their fees, were raised. People can now get some help from the local authority if their capital is less than £18,500 (raised from £16,000) and can get the whole of their fees paid if their capital is up to £11,500 (up from £10,000). Normally, an empty home will count as part of your capital and stop you getting any help. However, from April 9, 2001 local authorities have to ignore the whole value of the empty home for the first twelve weeks in care, though many are not doing so. Anyone who has problems with the local council should refer them to the Local Authority Circular LAC(2001)10.

From October 2001 a further change began. If someone who goes into a residential care or nursing home has an empty property, the local council can now come to an agreement to defer any payment of the fees and to take them out of the proceeds of selling the house or flat in the future when the resident finally dies. No interest is charged while the resident is alive and for up to 56 days after they die. This arrangement can be a very good deal for the family of the person in the home. They can rent out the property and preserve it intact until the resident’s estate is settled, perhaps many years in the future. Again, not all local authorities are really on top of this new rule – even though they can claim financial help from the Government – and may not apply it correctly or at all. People with problems should refer them to the Local Authority Circular LAC(2001)25.

More information from the Department of Health

Scotland The Scottish Executive has said that everyone in a care home in Scotland will get £90 a week for personal care and those in a nursing home will also get another £65 a week for nursing care. These changes are expected to start in April 2002. More information: http://www.scotland.gov.uk/health/ltc/legislation.asp

Wales The cost of nursing care will be paid for in Wales, probably at a flat rate of £90 a week. Personal care will not be paid for. The change is expected sometime after October 19, 2001.

Northern Ireland The Northern Ireland Executive has postponed plans to pay for nursing care, which were due to begin in April 2002, on cost grounds. No implementation date has been announced.

November 2001

e-mail Paul Lewis on paul@paullewis.co.uk