Care home fees not subject to contract law?

jessthecat_2

Hi
My sister & I are dealing with our recently-deceased Dad's estate.
At some point last year he was removed from his NHS bed, by the NHS, and placed in one of their rehabilitation facilities for a few weeks.
At no point was he asked whether he wanted to go, the paramedics simply took him from his bed and transferred him.
No contract was ever offered or signed, nor was he (or we) ever informed that this would come at a cost.
He stayed there for a couple of months then returned to his own home.
Several weeks after returning home he received a letter stating he'd been assessed as liable for the care home fees (he refused to answer when a social worker demanded to know how much he had in savings. We're not disputing that it's above the limit).
Shortly afterwards came a bill for many thousands of pounds. But he was too ill to deal with it, so it was put on hold by the local authority.
We are now winding up his estate and wondering where we stand with this bill.

Are the local authority exempt from the fundamental basics of contract law, or would a contract have to have been in place before he entered the home?
At the very least, would he have to have been informed in advance of the financial implications?
Or do the local authority have carte blanche to wait until after he returns home, and only then announce that he was liable for the cost and send a bill for an amount entirely of their choosing?
Or can we challenge them to send us a copy of the contract (which we know they don't have) in order to "prove" the debt?

Thanks in advance.

Brie

Sounds similar to what happened to MiL.

She was in hospital and they decided she needed to be moved to a care home.  This was discussed with her and us with someone from the hospital and another person from the local authority.  MiL was about 92 at the time but had the sense to ask what the care home would cost.  And the person from the LA said it would cost her nothing at all as it was being done on request from the NHS. 

There was no input from any of us which home she would be moved to and we were simply told which one it was.  Fortunately it was a nice enough place so that was fine.  The home was nice and friendly and actually did a lot better than the NHS had done with MiL in the nearly 3 months she'd been in hospital as they had her up and walking within a few weeks.  After a 2 month stay she came home.  

And then just like you she received a bill for just short of £5k.  When this was queried we were told flatly that it had to be paid despite being told there would be no cost.  My OH wrote a detailed letter of complaint about how the NHS had acted responsibly and in his mother's interest and then had off loaded with 1 day's notice to any of us.  He stated the fact that we were specifically told "no charge".  The letter was sent to the LA, the local NHS trust and both our counsellor and MP.  Like your dad there was no contract signed at any time.  There was also no financial assessment done.  Pressure from the politicians meant the full cost was written off.

Sorry for your loss.

Spendless

This is similar to what happened to my Nan.  She was taken from her hospital bed to an NHS rehabilitation centre on Christmas Eve 2014. My Mum was only informed this was happening an hour or so beforehand if that. Nan stayed there a few weeks whilst they assessed her and her property. She was found not to be able to go back to her home and went to live in a care home on Valentines day 2015. She lived there until she died in Feb last year.

AFAIK - there was no charge for the weeks she spent in the residential  rehabilitation centre. Once she moved to the care home her property went up for sale and she paid for her care - though I believe the first few weeks were free, though I'm unsure of the details as to why that would be.

DullGreyGuy

Can you remember signing a contract about your bins being emptied? Or with the NHS? The Police? Was it a long negotiation on terms when you dialled 999?

Some things are covered by statute and therefore you don't need to individually negotiate a contract with your local NHS hospital etc. Provision of care home is means tested, hence we get lots of threads on here about how to dispose of assets so the state pays and family get their "full inheritance". 

gm0

You likely owe it.  Whether you can wriggle out of it is separate.

Residential social care is not NHS funded.

Other than in extraordinarily rare circumstances where someone is formally assessed as needing CHC

Some nursing needs are funded by a NHS contributon which tops up the living in a care home without nursing fees by an amount to allow for those extra medical needs.  I think the care home is paid that direct not via the patient/family.

The Local Authority Social Care budget is liable to pay for those without funds to pay for residential social care (Overwhelmed safety net).

Self funders (those with money above the threshold) are liable to pay their way. 
The LA steps in ONLY if these are exhausted.  Complex rules apply - deprivation of assets etc.  .

He used an unfunded by the NHS nursing home service - so it is his bill - if he had money and not if he did not. 
Check it carefully and then consider paying the invoice as a liability of the estate.

So based on the law - and the intent of it around what the NHS pays for and doesn't - your father's estate has a bill.

£5000 for two months is a bargain.  £1000 per week is not a surprising number for quite ordinary places.

Many people think the system needs radical reform and a large lump of new additional social care money will have to be taken via taxation - from somewhere if we are to move from "those who use it pay if they can" to "everybody pays".

Whether you can use process and paperwork delays (or lapses by the care home, LA social care team or others) and media/political pressure on those bodies to wriggle out of it is a separate question.  That is your choice to make now.

But it is fairly normal for the paperwork to lag and to follow.  And people would find a more aggressively officious up front approach with the extremely ill elderly - unacceptable for different reasons. 

Exodi

gm0 said:

Many people think the system needs radical reform and a large lump of new additional social care money will have to be taken via taxation - from somewhere if we are to move from "those who use it pay if they can" to "everybody pays".

As we know, very difficult politically.

National Insurance increased by 1.25% from April 2022 to (eventually) subsidise social care.
*Public uproar, very damaging to the Tories aspired reputation as the party of low tax.*
National Insurance decreased by 1.25% from November 2022, cancelling out the above.
National Insurance* decreased 2% from January 2024, intended to win voters before a general election this year.

As is often the case, the general public is against high care costs but simultaneously against paying higher taxes to mitigate them. As we see time and time again on this forum, the preferred view is to make 'someone else' pay for the care, despite having the financial means to do so.

I think whoever gets in after the next GE needs to make some serious reforms to social care via general taxation, as Boris Johnson once tried to do. The current system is not sustainable, self-funders are subsidising those without and there is a evidently a large effort by self-funders to wrangle out of even paying for their own care.

We apply the 'everybody pays' principle to NHS treatment, so it's not unfamiliar to do the same with social care. You still have the option for private treatment, like you do with healthcare.

I do not mind paying more tax if it means we have a more sustainable social care sector and we get less of the blatant DoA threads.

MeteredOut

Exodi said:

gm0 said:

Many people think the system needs radical reform and a large lump of new additional social care money will have to be taken via taxation - from somewhere if we are to move from "those who use it pay if they can" to "everybody pays".

As we know, very difficult politically.

National Insurance increased by 1.25% from April 2022 to (eventually) subsidise social care.
*Public uproar, very damaging to the Tories aspired reputation as the party of low tax.*
National Insurance decreased by 1.25% from November 2022, cancelling out the above.
National Insurance* decreased 2% from January 2024, intended to win voters before a general election this year.

As is often the case, the general public is against high care costs but simultaneously against paying higher taxes to mitigate them. As we see time and time again on this forum, the preferred view is to make 'someone else' pay for the care, despite having the financial means to do so.

I think whoever gets in after the next GE needs to make some serious reforms to social care via general taxation, as Boris Johnson once tried to do. The current system is not sustainable, self-funders are subsidising those without and there is a evidently a large effort by self-funders to wrangle out of even paying for their own care.

We apply the 'everybody pays' principle to NHS treatment, so it's not unfamiliar to do the same with social care. You still have the option for private treatment, like you do with healthcare.

I do not mind paying more tax if it means we have a more sustainable social care sector and we get less of the blatant DoA threads.

Has anyone calculated what that would cost, both in absolute terms, or in the increase in tax level that would be required to sustain it, as people are living longer and longer?

And therein lies the issue; if someone have a policy that stated "Pay x% more tax now and we'll fund your social care in future", would it be a vote winner?

Spendless

To me it's not the issue that the care needs paying for.   In those circs I'd just have preferred that someone would make it clear upfront that would be the case. The OP says this didn't happen. 

Keep_pedalling

Local authorities have a duty of care to vulnerable adults, if someone needs temporary care and is not safe to be sent home them they are obliged to provide it even if the person refuses, or is unable, to cooperate in a financial assesment. In those cases the finances are dealt with after the event.

 

Exodi

MeteredOut said:

Exodi said:

gm0 said:

Many people think the system needs radical reform and a large lump of new additional social care money will have to be taken via taxation - from somewhere if we are to move from "those who use it pay if they can" to "everybody pays".

As we know, very difficult politically.

National Insurance increased by 1.25% from April 2022 to (eventually) subsidise social care.
*Public uproar, very damaging to the Tories aspired reputation as the party of low tax.*
National Insurance decreased by 1.25% from November 2022, cancelling out the above.
National Insurance* decreased 2% from January 2024, intended to win voters before a general election this year.

As is often the case, the general public is against high care costs but simultaneously against paying higher taxes to mitigate them. As we see time and time again on this forum, the preferred view is to make 'someone else' pay for the care, despite having the financial means to do so.

I think whoever gets in after the next GE needs to make some serious reforms to social care via general taxation, as Boris Johnson once tried to do. The current system is not sustainable, self-funders are subsidising those without and there is a evidently a large effort by self-funders to wrangle out of even paying for their own care.

We apply the 'everybody pays' principle to NHS treatment, so it's not unfamiliar to do the same with social care. You still have the option for private treatment, like you do with healthcare.

I do not mind paying more tax if it means we have a more sustainable social care sector and we get less of the blatant DoA threads.

Has anyone calculated what that would cost, both in absolute terms, or in the increase in tax level that would be required to sustain it, as people are living longer and longer?

And therein lies the issue; if someone have a policy that stated "Pay x% more tax now and we'll fund your social care in future", would it be a vote winner?

I'm sure the government has done these sums. I expect it is a large number to cover all care costs, hence why the government previously opted to put a maximum ceiling on care fees instead.

There are also practical challenges:

1. Last time it was implemented through raising national insurance, which left a sour taste in some peoples mouths as employed people pay more than self-employed people who pay more than a landlord receiving rent (who pays no NI at all). It also benefits pensioners who don't pay NI, meaning the ones directly receiving the benefit are not contributing to it (though a levy was later added).

2. There is an inherent unfairness (as there is with all policies implementation) that someone just entering a care home would benefit from this subsidy despite paying virtually nothing towards it, and someone just turning 18 would enjoy paying towards it for the next 50+ years of their working life.

3. The government would need to be very careful with it's guarantees. Much like the state pension, there would be considerable backlash if the government was to get the balance between taxation and subsidy wrong and try to row back on what the policy provides after people have contributed to it for many years. I already have strong fears that the state pension will be gutted before I retire (the triple lock is not sustainable by design, it is only endlessly continued because pensioners make up a large portion of the active voter-base and upsetting pensioners would spell the end for any party).

4. There is also the common question of 'why should I pay for the care for Duke Richington Manorhouse IV when he has way more money than I do?' (though this issue already exists within the NHS and we look the other way).

None of these have easy answers, hence Boris Johnson's first stab at this was mired in controversy. I'm sure most political parties would rather keep sweeping it under the rug and letting future politicians deal with it. Unfortunately this can not continue ad infinitum.

For consistency you could continue with the idea of a ceiling, perhaps using the IHT threshold of £325k. Part of this would require a big clamp down and public education to prevent people continuing to 'gift' everything they own to their kids a decade or so before they might need care, forcing themselves into taxpayer funded care. Solicitors should be fined for facilitating the practice, assets should be vigorously recovered from the estate/beneficiaries, penalties should be deterring.

onomatopoeia99

If you think the decision by the local authority to move him to the social care that caused the charges was incorrect, you (as in a barrister acting for you) could potentially apply for a writ of certiorari to have the decision found incorrect and quashed.

Not sure why people are discussing how to fund social care in the future, what's that got to do with answering the question?