Care home 'stealth tax' forced on elderly entitled to free care

Almost 50,000 families of care home residents, whose care is supposed to be free, are being forced into paying top-up fees, Age UK has reported.

A quarter of care home residents who are legally entitled to free care are not getting it, with fees which are meant to be voluntary, amounting to thousands of pounds a year.

In its latest 'Behind the headlines' report, the charity Age UK reveals that when it comes to voluntary top-ups ‘the system is being abused’ with families expected to pay the ‘stealth tax’ which can vary from £25 a week to more than £100 a week.

Caroline Abrahams, Age UK’s charity director, said: "Over the last year Age UK took over 250 calls from worried families complaining about demands for extra fees, when their loved one’s care home place was supposed to be paid for in full by the local council.

"Families are finding themselves in horrible situations, such as knowing that unless they pay up their older relative will have to live in a care home that is so far away they will be cut off from everyone they know. In some cases families are being asked to pay a lot more than they can afford and in others we have heard of families under pressure not to dispute an unfair request for a ‘top up’, when their loved one is in hospital and ready to leave, because otherwise it would take even longer for them to be discharged."

A person moving into a care home takes a means-test to decide whether they are able to pay for their own care or whether the council should pay. To qualify for state-funded help, they must show they have assets which can only be up to the value of £23,250. Age UK’s report highlights that even those who have met these strict conditions and pass the means test must pay ‘top-up fees’ to supplement the council’s payment of their care.

For example, people can opt to pay for a home closer to their family or for extra facilities. However, if there is no local care home place that the council has enough money to pay for, the resident is now being forced to contribute to their ‘free’ care if they want to live in their chosen area.

The report reveals top-up fees are also being demanded when the cost of a care home which the council originally had enough money to fund has gone up or when a self-funder has run out of money so they become eligible for free care, but need to pay a top-up.

Pay a top-up or move out

Linda’s mother went into a care home in 2015 and is funded by the council, who helped her to find a care home that didn’t require a top-up. But just four weeks after her mother had moved in, Linda was told that she had to leave if a top-up of £120 a month wasn’t paid. This has since risen to £160. Linda has been told that her mother will have to search for a different home if she can’t pay the top-up.

One council has sent one woman ‘Joan’ an email, saying a top-up needs to be paid or her mother-in-law must move to a care home 35 miles away. Joan is clear she cannot pay a top-up. Joan feels a move will affect her mother-in-law’s wellbeing, as Joan, and her mother-in-law's friends won’t be able to visit, so she will be left abandoned.

What the law says

The Care Act 2014 states: ‘The local authority must ensure that the person has a genuine choice of accommodation. It must ensure that at least one accommodation option is available and affordable within the person’s personal budget and it should ensure that there is more than one of those options. However, a person must also be able to choose alternative options, including a more expensive setting, where a third party or in certain circumstances the resident is willing and able to pay the additional cost (‘top up’). However, an additional payment must always be optional and never as a result of commissioning failures leading to a lack of choice.’

‘The council is also responsible for paying the full amount, including where a ‘top-up’ fee is being paid’.

The person paying the third party top-up must have a written agreement with the council. Only if all three parties (resident, care home and council) agree can the third party top-up be paid directly to the home. In other words, the law says a care home cannot approach the resident directly for a top-up. The council is supposed to pay the full cost of the care placement and if a top-up is required it is paid to the council, unless everyone, including the family, agrees otherwise in writing.

What the Government says

A Department of Health spokeswoman said: “While some people choose to ‘top-up’ their care in order to have a more expensive service, legally the local authority must ensure that people have a genuine choice of accommodation by making at least one option available and affordable within the person’s budget.”

What the care homes say

Martin Green, chief executive of Care England, whose members include care homes says: “This latest Age UK report shows the confusion over the funding of social care. As the largest representative body for independent providers of adult social care, Care England urges the Government to work with providers and commissioners on the forthcoming green paper.

"The payment of third-party top-ups is complicated, because individuals do not know whether they are paying for services genuinely over and above their assessed needs or merely making up for inadequate local authority payments. The shortfall in funding needs to be addressed as a matter of urgency”.

Care home residents' rights

The charity is calling for:

• Independent information- The charity has demanded councils make the public aware of ‘independent information’ so they can make informed decisions.

• Clear costs - It argues costs need to be made clear. Councils should provide a statement setting out what residents have paid for including care and support, accommodation and ‘hotel costs’.

• Care home contract protection against eviction- Care home contracts should give residents much greater protection against eviction and should clearly set out the circumstances in which care homes can give them notice.

Age UK publishes Factsheets which set out the rights of care home residents. Factsheet 48 titled ‘Paying for Permanent Residential Care’, explains these rights in detail. To view it visit:

www.ageuk.org.uk/Documents/ENGB/Factsheets/FS10_Paying_for_permanent_residential_care_fcs.pdf?epslanguage =en-GB?dtrk=true