Intermediate Care Services

Non Charging for Intermediate Care Services - Interim Guidance – June 2004

1.  Purpose

1.1  The Community Care (Delayed Discharges etc.) Act 2003 requires that all intermediate care (IC) services, whether provided in a care home setting or in a person’s home in the community, are provided free of any charges to service users or their carers.      

1.2 The principles set out in this document are equally relevant to intermediate care services provided in either setting.  However, the processes will vary.

2.  Defining Intermediate Care Services

2.1  The discussion paper agreed by the Director of Devon Social Services and the PCT Chief Executives both defines intermediate care services and sets out the range of services that fall within this definition. The paper is entitled:

"A discussion paper: Joint Health and Social Services Senior Managers Group - Intermediate Care."

2.2  Appendix A sets out the Department of Health definition of Intermediate care services.  

3.  Principles

3.1  The following principles apply: People / carers / families must be involved at all stages in decisions about their care

• People / carers / families must be given clear and accessible written information about the purpose of the intermediate care service, how long the service will last, the decision making process about eligibility for services at the end of the intermediate care period and the charging policy for such services
  
• People do not have the right to intermediate care services if they no longer have an assessed need for those services.  However, where a person is seeking a Panel review of a decision concerning NHS Continuing Care there should be no change to their care arrangements until the outcome of that Review
  
• Intermediate care services can only be provided following at least a Level 2 assessment and the completion of a Fair Access to Care Services (FACS) Eligibility Criteria checklist (SS14).

4.  Practice

4.1  Where a person has been assessed as needing intermediate care services and he / she agrees to such a service, he / she must not be charged for any intermediate care services, whether that care is provided in a care home setting or their own home.

4.2  Wherever intermediate care is delivered the service user will be expected to pay for any meals provided.  Therefore if community meals are provided (hot or frozen) the service user will pay for their meal at the point of delivery.  If meals are provided within a supported unit service users will pay for the cost of the provisions.

4.3  Intermediate care services will normally be for a period of up to six weeks but could be more / less time depending on the assessed needs.  

4.4  Where individuals have an assessed need for intermediate care services beyond six weeks, this should normally have been identified and agreed with both the authorising manager and the service user prior to the start of the service or within the first two weeks of the service commencing.

4.5  Once a person has completed the agreed period of intermediate care, they should move from that service and be charged for any subsequent eligible Community Care services arranged for them based on the Fairer Charging Policy.

4.6  Intermediate care services should not continue where the individual does not have an assessed need for the IC service.  This includes situations where the preferred service is not immediately available.  (A new policy on "Directions of Choice of Accommodation and Managing Reluctant Discharge" will be agreed and published during July / August 2004.)  

4.7  The responsibility for deciding on assessed and eligible needs remains with the responsible practitioner / multi disciplinary team undertaking the assessment and should be informed by the service provider.   

5.   Process for Intermediate Care Services in a Care Home

5.1  The following process should be followed:

• Do not complete an SS280 for the intermediate care service.

5.2  For intermediate care services in a care home setting:

• The SS619 should be completed with the intermediate care service box ticked for the service type and the length of stay being set out.  This will ensure the person is not charged for the IC service for the length of time identified on the SS619.  As an end date has been specified, if the person is to continue his / her stay in the same care home or move to a different care home setting, a new SS619 must completed, detailing the new stay type (such long term, short term and so on).
  
• If the IC service is extended beyond the original timescale, an SS619(a) must be completed to ensure the person is not charged for any IC service that goes beyond the date on the original SS619.
  
• If charging is to commence when the intermediate care finishes, a completed form SS280 will need to be sent to Client Finance Services (CFS) at County Hall, preferably before the status of the stay changes.

6.  Process for Intermediate Care Services in the Community

6.1  The following process should be followed:

• Do not complete an SS280(a) for the intermediate care service.

The rest of the Process Guidance will follow at a later date.

7.  CareFirst Requirements

7.1  The following process must be followed to ensure individuals are not charged for intermediate care placements and charged when they receive services following a period of intermediate care.

• All Intermediate care placements (IC) must be shown as such on CareFirst.  To do this, locality finance staff must choose the service element of Ex or Ih Intermediate Care when recording the service agreement.  If the supplier does not have Intermediate Care as an option on CareFirst, contact the Systems Management & Support Unit via an email to sssystem.
  
• Client Finance Services (CFS) will set the charge for such cases to £0.00, but conversely, if it is not shown as IC, a default charge will be added and bills sent.  Any resulting complaints will be forwarded to the locality for resolution.
  
• Where other care home services are required at the end of the agreed timescale for the IC service, the status must be changed locally and an SS280 completed and sent to CFS at County Hall.
  
• As soon as a decision is made to provide ongoing services, then for residential care, a form SS280 should be completed and sent to CFS or for non-residential care a request put to Care Direct for a FAB Assessment (SS280(a)) to be undertaken.  Charges will start from the day the assessment is completed if that is after the date the IC service stops or the ongoing services start.  The exception to this is when the service user / carer causes the delay.
  
• Staff in DCC homes and clerks who process SS115 Admission and Discharge returns at locality office must have clarity about the status of a service user’s stay so that the appropriate entries can be made to CareFirst.
  
• Regardless of whether an ongoing service is to be provided by the same service provider as the IC service or a different provider, a new service agreement will need to be recorded on CareFirst to show the different service type.  Use the appropriate residential End Reason to close the IC service agreement.
  
• As end dates cannot be extended on CareFirst, if the IC service is extended beyond the original end date set out on the contract, a new IC service agreement will need to be set up on CareFirst.

Appendix A (17KB - pdf help) - Definition of IntermediateCare
Appendix B (42KB - pdf help) - Joint Health and Social Services Senior Managers Group
Appendix C (25KB - pdf help) - Intermediate Care Provision - Local Authority March 2004 (showing number of beds in Districts)