Cost of care in the home a postcode lottery

With an increasing demand for care services, a Which? investigation finds that over the last five years some local authorities have been restricting home care and increasing costs above inflation, leading to a widening postcode lottery in care costs.

Using Freedom of Information requests over the last five years, we asked councils in England and Wales what level of home care they provided each year from 2009 to 2013. Our latest results show that more than 80% of councils now restrict care to those whose needs are ‘critical’ or ‘substantial’, up from just over 70% in 2009. Of the 26 councils who told us they offered care to people with ‘moderate’ or ‘low’ needs in 2009, only 12 continue to do so.

At the same time, of the 100 councils that responded about their care charges in both 2009 and 2013, around a third (36) have increased charges above the rate of inflation. Barnsley Metropolitan Council has increased its hourly rates the most, by 160%, whereas Tower Hamlets London Borough Council has maintained a zero charge policy and remains the least expensive council for care costs.

And some local authorities have either scrapped weekly caps that limit how much people have to pay, or raised the level of the cap so they have to pay more. The proportion of councils offering weekly caps has more than halved in the last five years, from two-thirds (66%) who responded to our FOI in 2009 to just one in three (31%) in 2013. The average cap has also increased from £245 per week in 2009 to £297.50 per week in 2013.

With such varying changes in eligibility and care costs, Which? wants the Government to make sure elderly people and their families get better information and advice about the care they’re entitled to and how much they will need to pay. The Care Bill will place new duties on local authorities to do this for everyone, not just those who are eligible for care. We want councils to provide information that is tailored to individual situations, and targeted at key pinch points, for example when people see their GP or are discharged from hospital.

Which? is launching a new, free-to-use elderly care website later this year to give relatives of older people the information and advice they need to be confident that they are making the best decisions on behalf of their relatives.

Which? executive director, Richard Lloyd, said:

“Our research starkly exposes the postcode lottery of home care provision. With limited resources and changes being introduced through the Care Bill, it has never been more important for people to get the best possible advice and information about the help they can expect.

“We want to see greater transparency from local authorities over the provision of care and greater consistency in the way they charge.”

Notes to editor:

1.    Over the last five years, each year we have sent Freedom of Information requests to 181 Councils with Adult Social Services Responsibilities (CASSRs) in England, Wales and Northern Ireland asking about their care costs. The full list of all Local Authorities that responded to our FOI each year over the last five years is available on request.

2.    149 councils responded to our 2009/10 survey and 152 responded to our 2013/14 survey. 126 councils responded to both surveys from 2009/10 and 2013/14. 79 councils responded to all five surveys.

3.    In 2013, 16 of 148 councils (11%) who answered our FOI question on eligibility criteria supported people with ‘low’ or ‘moderate’ needs. Of the rest, 11 support people with ‘some moderate needs’, 117 support people with ‘substantial needs’, 2 support people with ‘greater substantial’ needs and 2 support people with ‘critical’ needs.

4.    In 2009, 95 of 134 councils (70.9%) who responded to our FOI supported people with ‘substantial’ needs or above. In 2013, 121 out of 148 councils (81.76%) support people with ‘substantial’ needs or above.

5.     In England and Wales, care needs are identified as being either ‘low’, ‘moderate’, ‘substantial’ or ‘critical’ under the Fair Access to Care Services (FACS) system. ‘Critical’ needs mean actual or potential threat to life, and/or significant health problems, unable to carry out vital everyday routines like washing or dressing. ‘Substantial’ needs mean unable to perform most everyday routines and/or have little support. ‘Moderate’ needs mean unable to carry out several everyday activities and/or have little support. ‘Low’ needs mean unable to carry out one or two domestic routines and/or have limited support.

6.      The Government has committed to introduce a national minimum eligibility threshold for social care, to be set at the equivalent of the current ‘substantial’ level, to be introduced in 2015.

7.    Barnsley Metropolitan Council has increased its hourly rates from £5 in 2009 to £13 in 2013.

8.    The Care Bill will introduce, from 2016, a national cap on total care costs, including both domiciliary and residential care, of £72,000. However, rates for care paid by local authorities and the amount that consumers will have to pay in charges will continue to vary locally. Costs counting towards the cap will be based on local authority rates and will not include living costs for residential care of up to £12k per year.

9.    Only 39 councils in England now currently operate a weekly cap. All councils in Wales operate a weekly cap of £50. Councils in Northern Ireland and Scotland don’t charge for personal care for those who are eligible.

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