Care home fees not subject to contract law?

Gavin83

Exodi said:

jessthecat_2 said:

sheramber said:

if he had been open and tansparent about his finances he could  have had better facilities.  Maybe not a five star hotel but a more comfortable care home .

From my discussions with the families of many in similar circumstances, elderly people who have spent their entire life paying into the system are loathe to tell a busybody social worker exactly how much money they've managed to save in their lifetime, lest they be awarded the privilege of paying for their care all over again.

This reminds me of that study which found that 2/3rds of Americas believed they were above average intelligence ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6029792/ ), it is tiresome that so many people seem to think that they are net contributors to the tax system, when in reality the opposite is usually true.

Ignoring those that consider themselves less intelligent than they are (which I suspect is not many) then statistically that only makes 1/6th of those Americans wrong! I do take your point though, people often have a tendency to over estimate their abilities in a wide range of areas. Try asking Brits if they considered themselves an above average driver, or even an above average lover. I suspect the results would be even more skewed!

It does raise the question regarding at which point you become a net contributor though. I very much suspect I am. I earn a good salary (comfortably into the 40% tax bracket) so I pay a fair amount in. I don't have children, so don't claim benefits there and I very rarely use medical services. I've never called the emergency services for myself or any family. Ignoring the stuff that everyone uses to some degree I don't take anything optional out. However even if I am a net contributor I don't have an issue with this and consider it necessary to provide a good standard of living across the country. There are of course limits to this however.

Exodi said:

jessthecat_2 said:

sheramber said:

if he had been open and tansparent about his finances he could  have had better facilities.  Maybe not a five star hotel but a more comfortable care home .

From my discussions with the families of many in similar circumstances, elderly people who have spent their entire life paying into the system are loathe to tell a busybody social worker exactly how much money they've managed to save in their lifetime, lest they be awarded the privilege of paying for their care all over again.

No idea what the contempt is for social workers, I salute them for the thankless work they do - as in your case, they're just doing their job. Quite strange to have expected means tested care, but have taken offence to being means tested. It make you wonder if this whole mess would have still happened if he wasn't trying to to hide his significant assets.

I think I said it earlier in the thread but I used to work in this area. To be specific the council department that calculated residential care costs. It was my experience that the most vocal were those attempting to hide assets to the point that we'd actually investigate the case in more depth. It wasn't uncommon you'd get a child of someone going into care who wanted the council to fund the placement in a very specific care home. Naturally this would nearly always be one of the best in the area and therefore way above what the council would be prepared to pay but they'd try and force the council to pay it anyway. It never worked.

90% of the time upon a more detailed look at the case you'd find assets that had been hidden. I'm expecting the reason they complain more or insist on an excellent care home is down to guilt, knowing they've denied their parent that choice. On the plus side the parent did then get the choice as they'd suddenly become self funding but naturally their children, who in their eyes had just lost an inheritance they felt entitled to were upset.

Moral of the story? Be careful how much you complain if you're hiding assets.

Kim_13

Clearly those who can afford to pay for more of their own care should pay for it to some extent, but without making a political point about what that should be, it’s hardly surprising that the client or their families feel aggrieved when there is a lack of transparency (and you do wonder where the money is going when basic rooms are billed so highly and carers aren’t well paid for the work that they do.) 

Care is funded while the needs assessment is ongoing, so wouldn’t it solve a lot of the immediate issue if on discharge, a letter was provided to the patient and sent to their next of kin setting out that he/she no longer has a clinical need to be in hospital and therefore arrangements have been made to place them at X Care Home free of charge while a needs assessment is ongoing. It would outline that this period of funded care is Y days/weeks, after which the resident will need to pay in accordance with either their income less the applicable amount allowed for personal expenses, or their capital if that is in excess of Z, at a minimum of (insert care home’s standard tariff for the room they’ve been placed in and explain that that is what that indicative figure is.) Should the resident or their loved ones be unhappy with this, then they are advised to use the period to either make arrangements to provide care themselves or secure a place at an alternative setting. From the date that care becomes chargeable, a deemed contract will be entered into that will be required to be paid for as set out above.

Doesn’t allow bed blocking while ensuring that there is some amount of choice about the costs that are being incurred. There will be those willing to pay for a home of their liking but begrudging paying for something they perceive to be substandard (though one hopes that even the cheapest homes are adhering to CQC standards.)

elsien

That sort of letter could make sense (aside from the next of kin bit) but you are presuming that there is more of a  joined up system, which we don't have in practice.
The nursing bed people get sent to may not be one they can stay in even if they want to if they don't have nursing needs, because of both care home registration and finances if not self-funding. Social services coming on board can take longer than it should so although there should be a finite timescale it can slip. And health have bulk short term contracts which means that what they pay is different to what an individual may pay long term so no-one can give a figure as to the long term costs at that point. 
Whole system needs an overhaul. 

Kim_13

elsien said:

That sort of letter could make sense (aside from the next of kin bit) but you are presuming that there is more of a  joined up system, which we don't have in practice.
The nursing bed people get sent to may not be one they can stay in even if they want to if they don't have nursing needs, because of both care home registration and finances if not self-funding. Social services coming on board can take longer than it should so although there should be a finite timescale it can slip. And health have bulk short term contracts which means that what they pay is different to what an individual may pay long term so no-one can give a figure as to the long term costs at that point. 
Whole system needs an overhaul. 

Reason for the next of kin part was primarily so that no longer having capacity cannot be used to avoid paying for care. If two copies of a letter go out as a matter of course stating that care, howsoever arranged will soon be chargeable, then billing for a ‘default’ placement cannot be exploiting those who may be vulnerable in other ways, e.g. not yet having a formal diagnosis.

Completely agree than an overhaul is needed.

elsien

I have to be honest “Next of Kin” is one of my soapboxes. It’s fine if someone has nominated a person as their point of contact while they have capacity, but if someone loses capacity, it has no legal meaning. 

And hospitals tend to latch onto next of kin as being a blood relative, even if they’ve not seen the person in twenty odd years and have no clue what they might like or what decisions they might have made for themselves were they able to do so. And it confers no legal status at all, in terms of decision-making or finances. That needs a power-of-attorney or a deputyship.

Spendless

Kim_13 said:

Clearly those who can afford to pay for more of their own care should pay for it to some extent, but without making a political point about what that should be, it’s hardly surprising that the client or their families feel aggrieved when there is a lack of transparency (and you do wonder where the money is going when basic rooms are billed so highly and carers aren’t well paid for the work that they do.) 

Care is funded while the needs assessment is ongoing, so wouldn’t it solve a lot of the immediate issue if on discharge, a letter was provided to the patient and sent to their next of kin setting out that he/she no longer has a clinical need to be in hospital and therefore arrangements have been made to place them at X Care Home free of charge while a needs assessment is ongoing. It would outline that this period of funded care is Y days/weeks, after which the resident will need to pay in accordance with either their income less the applicable amount allowed for personal expenses, or their capital if that is in excess of Z, at a minimum of (insert care home’s standard tariff for the room they’ve been placed in and explain that that is what that indicative figure is.) Should the resident or their loved ones be unhappy with this, then they are advised to use the period to either make arrangements to provide care themselves or secure a place at an alternative setting. From the date that care becomes chargeable, a deemed contract will be entered into that will be required to be paid for as set out above.

Doesn’t allow bed blocking while ensuring that there is some amount of choice about the costs that are being incurred. There will be those willing to pay for a home of their liking but begrudging paying for something they perceive to be substandard (though one hopes that even the cheapest homes are adhering to CQC standards.)

Tbh I don't know why the SW didn't explain that at the point OP Dad was asked for details for his finances. I did say in a previous post it would have been more helpful for the Dad to have answered 'why is this information needed' rather than 'I'm not telling you'

Savvy_Sue

elsien said:
Social services coming on board can take longer than it should so although there should be a finite timescale it can slip. 

Tell me about it. 13 months to assess needs, whether entitled to CHC ( which I knew they wouldn't be). That was 6 months ago, nothing yet. They will be self-funding, but not been asked any finance questions yet.

tooldle

Kim_13 said:

Clearly those who can afford to pay for more of their own care should pay for it to some extent, but without making a political point about what that should be, it’s hardly surprising that the client or their families feel aggrieved when there is a lack of transparency (and you do wonder where the money is going when basic rooms are billed so highly and carers aren’t well paid for the work that they do.) 

My mum was in residential care for 10 years. When you break it down the charges are very reasonable. Mum’s care fees were a little under £50k which breaks down to £135ish per day or £5.70 per hour. When she was moved into nursing care the rate dropped a little to roughly £120 per day plus the nursing element which the NHS covered.  Considering we all have to live somewhere and when we need help, our costs would rise regardless of where we lived. Mum had chef cooked meals with a wide choice, laundry done daily, room cleaned daily, assistance with getting up washing/ dressing / toileting / medication (in her later years the basics often required 3 staff assisting), moving safely around the building, heating, lighting, visiting entertainers and craft classes. 

Mum was in hospital for a while prior to her death. On that occasion the discharge team (made up of nursing and social work staff) were swift in completing their parts of the process. The financial assessment was the last part of the discharge process. I did receive printed materials setting out funding options, from several different sources including the NHS Care Home Team.  In our area it is a lack of care/nursing home beds that is slowing discharge. Part of the financial assessment here, includes confirmation of the chosen facility’s charges. 

tenko

Hi, I am dealing with a situation similar to yourself.
About three years ago my brother was detained under the mental health act for his and the publics safety.

He was sectioned and diagnosed with front lobe dementia and spent the remainder of his life in a care home.

When he passed away in December 2023, I was a named executer of his will and became aware of quite a few issue's relating to his care and the cost, which was for thousands of pounds.

One of my main concerns was that I discovered he was taken from the care home by a social worker, to his local branch of Barclay's bank, as a "TEST" of his capacity, to see if he could sign a cheque, he was also taken to a department store to try on a pair of shoes and see if he could fasten the laces. His son had objected to all of this happening but his protests were ignored and they did it anyway.

When I was made aware of this incident and others that I was not comfortable with, I wrote a letter to his council asking for explanations.

Their initial reply was that they did not consider me to have the legal right to complain about his situation and that being an executer to his will was not sufficient, they may want to reconsider that statement when I get probate and have the legal responsibility to settle any outstanding debts associated to his estate.

 Their second reply, via my nephew, was to now say that my brother requested to visit his bank and they were merely accommodating his wish, he could have asked them to take him to Australia, I wonder if they would have accommodated that. No mention of the department store or my nephews objection to them doing what they did and nothing about if a risk assessment was in place for this outing.

 You did not require any medical expertise to see that my brother lacked capacity and there was absolutely no need to take him out on a real life scenario and basically humiliate him in public, how could this be in his best interest.

 All of the above could have been carried out in the care home, where he would have felt safe and comfortable in his surroundings. A simple test such as asking him his date of birth, what his home address was and indeed getting him to try on a pair of shoes and see if he could manage the laces would have proved that he lacked capacity.

I  have raised the above issue with his MP and I will be taking this to the relevant ombudsman to get their opinion.

Malthusian

One of the basic principles of caring for those who lack capacity is that you should try to give them as much agency as possible and accommodate their wishes providing it is in their interests. Not infantilise them and shut them up in the home forever.

I see absolutely nothing wrong with accommodating his wish to visit the bank and a department store. Assuming a care worker could be spared, and it sounds like he was fortunate enough to have enough money for a well-staffed and compassionate care home. 

Trying and failing to tie a pair of laces is likely to be less distressing for a dementia patient than to be told "no you can't ever leave the home because it costs too much". 

There is no evidence in your post that they did anything wrong or that they owe you or his son any compo. 

Hopefully your campaign does not result in them denying a similar level of service to other residents in fear of complaints.