Third Party Top Ups, Deferred Payments and Market Shaping for Care Homes

Third Party Top – ups

1. (a) What is the total number of care home placements for individuals aged 65+ organised by the local authority? Please provide data for the following dates.

31 March 2017

2631

31 March 2016

2668

(b) What is the total number of care home placements that include a third party top-up for someone aged 65 and over organised by the local authority? Please provide data for the following dates.

31 March 2017

672

31 March 2016

736

(c) Of the total number of care home placements for someone aged 65 and over that include a third party top-up, how many of these agreements are between:

i) the third party, the provider, and the local authority

ii) just the third party and the provider Please provide data for the following date.

31 March 2017

The Council administers all third party top ups which it is aware of. The Council is not aware of any top up arrangements existing directly between third parties and providers

2. What percentage of those individuals aged 65+ who have entered a third party top-up arrangement with the local authority were presented with a written agreement before starting the payment, as outlined in the Care Act 2014?

Please provide data for the following financial years.

1 April 2016 – 31 March 2017

1 April 2015 – 31 March 2016

Devon County Council does not routinely record this information and for us to provide accurate figures we would need to manually check over 700 of our records. From our preliminary assessment, we estimate that compliance with your request for this question would exceed the appropriate costs limit under section 12 of the Freedom of information Act 2000 and is therefore exempt. This is currently £450 or 18 hours of officer time.

3. How often does the local authority review third party top-up agreements for care homes in your area with the individual who pays this top up? (Please specify whether this review takes place as part of the service user’s annual review and also how the third party is included.)

Once a year (As part of service user’s annual review) unless needed more frequently

4. What information and advice services are provided by your local authority to ensure people receive ‘sufficient’ information and advice prior to entering a third party top-up agreement? Please specify both online and offline sources. (Please attach any information materials made available if possible.)

Does this include a referral to independent financial information and advice? (Please attach any information materials made available if possible. We would be particularly interested to know if a directory is provided.)

Please see link below

Paying for care

5. How does the council satisfy itself that each person assessed as needing state funded care has been offered at least one care home place that can be met within their personal budget?

As a local authority we send out a request to the market to best meet the eligible needs of the individual, for the most cost effective service possible.

We only look to a 3rd party top up, where the person themselves has chosen specific accommodation, and the cost of that care home service goes above the most cost effective service that we have sourced, to best meet the needs and circumstances of the individual.

Our DCC brokerage team now source the available beds in the area of choice, within a suitable travelling distance, that can adequately meet the eligible needs of the person, whilst proving the most cost effective option.

We work with the person/their representatives to look at the care homes on offer. If they choose a home that is financially above the most cost effective and most suitable option that we have sourced, then we look at the 3rd party top up option with the person/family.

Our practice positon with reference to long term care home placements; is to look at the person’s eligible needs, consider their circumstances and look at the most suitable and cost effective option to meet their eligible needs.

Please include any guidance procedure or policy documents describing the steps that should be taken to ensure that an option not requiring a third party top up has been offered.

Charging Policy for Residential Care Services for Adults – this shows the financial process that is followed for residential care.

Link:

https://devoncc.sharepoint.com/sites/PublicDocs/AdultSocialCare/_layouts/15/guestaccess.aspx?guestaccesstoken=Un5GMWhxcRWTSGzcvnV2yjCvHSuRpbYm5OWB0GQ56YY%3d&docid=08e235d5fad064706b518abc93f7c4685

Top Up payments for your chosen accommodation

https://devoncc.sharepoint.com/sites/PublicDocs/AdultSocialCare/_layouts/15/guestaccess.aspx?guestaccesstoken=ShrG9vBtcRLHQxDiDMUnDxbAdLCxcP82rONC6LZP%2bu0%3d&docid=0ad2e2f3d24804986821485888c4498d4

The most important part of this policy is:

2. An additional payment (top up) is when extra money is needed to fund the difference between the value of your social care personal budget and the cost of
your chosen accommodation. The payment may be required where your chosen accommodation costs more than the amount in your personal budget.

And our Fair and Affordable Care policy:

https://devoncc.sharepoint.com/sites/PublicDocs/AdultSocialCare/_layouts/15/guestaccess.aspx?guestaccesstoken=2KFZBOd%2bMKxdpTZ5ECZFYU1YnOka7u39HajmHq9Y5Ac%3d&docid=07c68f2f01e8946b4aa3db49b8eb8ac26

4.7 We will arrange care in a manner that takes into account the choice and preferences of individuals but balances the need for us to arrange care that is sufficient to meet eligible needs whilst always looking to meet eligible needs in the most cost effective way possible.

Deferred Payments

6. For each of the financial years below, how many applications did the council receive for deferred payments with regards to care homes and how many of these were accepted?

Please provide data for the following financial years.

1 April 2016 – 31 March 2017

105

1 April 2015 – 31 March 2016

134

1 April 2014 – 31 March 2015

101

Market Shaping

7. How does the Local Authority satisfy itself that it has met its need to ensure a person with assessed care needs has a variety of high quality (care) services to choose from (as outlined in the Care Act 2014)?

When seeking a placement we usually try to offer at least 3 options (having established where suitable vacancies exist) for people to consider but we will also direct them to wider lists of care homes in the area should the family wish to look more widely themselves

8. Does the local authority take into account the Care Quality Commission ratings of care homes when choosing which care home placements to offer individuals who have been assessed as needing state funded care?

Yes, we do not place in homes rated inadequate but may not move people from homes that subsequently are rated as such.

9. a.) If yes, of all of those people who have been assessed as needing a state funded care home placement, what number and percentage were placed in a care home rated by the Care Quality Commission as either ‘inadequate’ or ‘requires improvement’?

Please provide data for the following financial years.

1 April 2016 – 31 March 2017 

1 April 2015 – 31 March 2016

Our systems allow only monthly snapshots not analysis of a number over a period

b.) Please provide statistics for the number of people who are residents in ‘inadequate’ and ‘requires improvement’ care homes on the following dates.

Snapshot in March 2016

Inadequate – 99 placements, 3.0%.
Required Improvement – 739 placements 22.1%

Snapshot in March 2017

Inadequate – 8 placements, 0.2%,
Required Improvement – 561 placements, 17.2%