IMPLEMENTATION TOOLKIT Top-ups Produced by NAFAO on commission from: Supporting implementation of the Care Act 2014 1|Page Contents Top Ups Top-up Leaflet ……………………………………………………………………. 3 Top-up financial questionnaire …………………………………………………. 9 Top-up agreement/contract ……………………………………………………… 14 2|Page Information Leaflet Template on Choice of Accommodation CHOICE OF ACCOMMODATION THIRD PARTY TOP UP’S WHAT DO I NEED TO KNOW? Introduction This leaflet tells you about your rights to choose the accommodation in which you will receive care and support, whether it is in a care home, supported living or shared lives, once the care planning process has identified that one of these types of accommodation is the most appropriate way of meeting your needs. It also explains what you will have to do if you wish to choose accommodation that costs more than the amount that has been specified in your personal budget for the provision of accommodation of that type. For choice to apply the council could be proposing that you live in, a care home that also provides nursing care, a shared lives setting or supported living and social work staff will have advised you which will meet your care needs. A personal budget is the cost to the council of meeting those of your needs which it is required to or has decided to meet and has identified in your care and support plan. Your Right to Choose The care planning process will have identified how your needs are to be met. Where this involves a particular type of accommodation, you have the right to choose between different providers and/or locations of that type of accommodation in England and your social worker or care coordinator will be able to give you a list of all of the relevant settings for you to choose from. You may wish to choose to live near to where you are living now or move to a different area to be closer to your family, or in a specialist home such as one run by a religious organisation. There are special cross-border arrangements if you wish your local council to arrange for you 3|Page to live in accommodation in Wales, Scotland or Northern Ireland. You should seek advice from social work staff if you would like your local council to arrange this. There are 6 conditions which need to be met for you to have your choice of setting. Care and support needs That your care and support plan specifies that your need a are going to be met by arranging care in a care home, shared lives or a supported living accommodation. Type of Accommodation That the accommodation you choose is of the type specified in your care and support plan. Suitability of Accommodation That the accommodation you choose is suitable to meet your eligible care needs. Social work staff will advise you which types of accommodation are suitable to meet the needs that are set out in your care and support plan. Cost Your council will have undertaken a care planning process and prepared a personal budget for you that will cover the cost of meeting your eligible care and support needs. The amount in your personal budget must be sufficient to meet your assessed eligible needs and ensure that you have at least one choice of setting that is affordable within that amount and the council should try to ensure there is more than one affordable setting. However, you might wish to choose a setting that costs more than the amount in your personal budget. If you do, a payment will need to be made to pay the difference between the accommodations weekly charge and your personal budget. These are called Top Up payments and these are explained later in this leaflet. If you choose a setting outside of your local area the local authority will still pay the amount identified in your personal budget. 4|Page Availability The accommodation that you choose may not have space available. If you do not want to choose different accommodation it may be necessary for you to go on a waiting list until a place becomes available and go into alternative accommodation or receive care at home while you are waiting. This is called an Interim Care arrangement. Your social worker will tell you how long you are likely to wait but this will only be an estimate and not a guarantee. If the temporary accommodation charges more than the amount in your personal budget the council will pay the difference. If this happens and you decide to stay in that accommodation permanently you will only be able to stay there if a top up is made – top up payments are explained later in this leaflet. Terms and Conditions The provider of the accommodation you choose must agree to contract with the council to provide you with accommodation subject to the council’s usual terms and conditions. If you are in Hospital You have all of the rights set out in this leaflet if you are going to move from hospital to accommodation of your choice, but there are some special rules for this. Once the medical staff are sure that you can be discharged from hospital the law requires that the council must arrange your move within a very short period. If the accommodation that you choose does not have a place available, the hospital will not be able to allow you to stay in hospital until a place becomes available and you may need to have an Interim Care arrangement, as set out above. Your Right to Choose More Expensive Accommodation and Top Up Payments When making your choice, you may choose a setting that costs more than the amount identified in your personal budget. There are many reasons why a setting 5|Page may cost more such as commercial business reasons or because it considers it provides accommodation of a superior standard, for example a bigger room or other additional services. The amount identified in your personal budget must be sufficient to meet your needs and the council must ensure that at least one option is available that is affordable within your personal budget and should ensure that there is more than one. However, you can choose to live somewhere that costs more if you wish. If you do, your family, a friend or someone else such as a charity, or in some circumstances you, must be willing and able to make a top up payment to cover the difference between the care homes fees and the amount in your personal budget for the likely duration of your stay. Your council must never force you into having to pay a top up fee because no suitable accommodation is available within the amount in your personal budget. In these circumstances, the personal budget must be adjusted to meet the costs of the accommodation needed to meet your assessed eligible needs. It is very important that you are aware of the following:- The amount set in your personal budget will be reviewed regularly and may increase to ensure the amount is still sufficient to meet your eligible needs. However, the council cannot guarantee that the accommodation will increase its costs at the same rate and this may affect the level of the top up payment. The top up will always be the difference between the care home’s fees and your personal budget. Whoever is paying the top-up (you or the third party) will need to sign a written agreement that they are willing and able to meet the difference in cost and will continue to do so throughout your stay. Prior to signing the agreement, the person paying the top-up will have to satisfy the Council that they can afford the weekly top up amount. (They will need to complete a financial circumstances form providing details of their assets and 6|Page liabilities, as well as their income and expenditure) [delete as appropriate]. If the person paying the top-up cannot satisfy the Council that they will be able to afford the top up for the likely duration of your stay, the Council will not agree to arrange care and support in the preferred accommodation. The person paying the top-up should be aware that the top-up amount may vary as providers review their fee levels. If the person paying the top-up is unable to continue to pay the difference you may have to move to another room within the accommodation or to another accommodation that charges fees that are within the amount set in your personal budget. Any move to other accommodation will only happen after a community care and risk assessment of your needs to make sure that the other accommodation is right for you. I am a considering paying a top up fee, what does this mean for me? The council providing care and support will want to know that you are willing and able to make the additional payment for the likely duration of the contract. They will therefore want to assure themselves that you can afford this and will ask you to fill out a financial questionnaire and to sign a written agreement confirming you are willing and able to make the payments. What will be in the written agreement? The written agreement must include the following: The amount of the top up payment The amount of the person’s personal budget How often payments must be paid To whom the payments must be paid – this should normally be the council as they must have oversight of all top up arrangements as they are ultimately responsible for the full cost of care should the top up arrangement break down. 7|Page How an arrangement is to be reviewed The consequences should you be unable to continue to make a payment. This could include moving the person receiving care. The effect of any increases in charges made by the provider The effect of any changes in the financial circumstances of the person paying the top-up. Other Information If you or your family have any other questions about your rights to choose accommodation, please talk to your social worker. Information on payments for the accommodation is given in a separate leaflet “XXXXX” (general leaflet on charging) which your social worker can provide for you. 8|Page Application to make a top up payment for accommodation charges Please Return to: Local authority address Instructions For Completion 1. 2. 3. 4. Please complete this questionnaire in full Please write legibly (print if necessary) Please declare ALL income and expenditure Please ensure all values are verified by an Officer OR by providing supporting documents 9|Page Personal Details Title: Mr / Mrs / Ms / Miss First Name(s) _____________________ Surname________________ Date of Birth: ____/____/________ National Insurance No: _______________________________ Full Home Address & Postcode: ______________________________________________________ ________________________________________________________________________________ Marital Status (please circle) Married / Single / Widowed / Divorced Dependants (Children of 17 and under) Age ___ Date of Birth _________________________ Address _________________________________________ ___ _________________________ _________________________________________ ___ _________________________ _________________________________________ Employment Are you employed? Yes/No What is your occupation? ___________________________________________ Name of your Employer? ___________________________________________ Address of Employer? ___________________________________________ ___________________________________________ Income (Gross) from Employment?1 £________per ________Hourly/Weekly/Monthly (please circle) If presently unemployed, please state the date you became unemployed. __ __ / __ __ /__ __ 10 | P a g e Your Income How Often? Company & Reference/ Account Number Amount? (Please Circle) State Retirement Pension* Documents seen by Officer Week/ Fortnight/ Four Weeks £ Week/ Fortnight/ Four Weeks £ Week/ Fortnight/ Four Weeks £ Week/ Fortnight/ Four Weeks £ Week/ Fortnight/ Four Weeks £ *With all benefit payments, please enclose either the ‘Letter of Award’,(which will be returned) a copy of the front page of the Benefit Book, or a copy of a bank statement indicating the benefits received. Evidence of all expenses must be provided to & verified by the Officer conducting the interview Your Spending How Often? (Please Circle) Amount? Rent & Ground Rent1 (less Housing Benefit) Week/Month £ Council Tax 2 (less CT Benefit) Week/Month £ Mortgage repayment Week/Month £ Insurances Week/Month £ Food Week/Month £ Maintenance payments Week/Month £ Other Week/Month £ Company & Reference/ Account Number Documents seen by Officer 11 | P a g e Your Debts Company & Reference/ account number Amount? Rent or Mortgage £ Council Tax £ Utility Bills £ Bank Loans £ Credit Cards/ Store Cards Other (Specify) ……………………. Documents seen by Officer £ £ Please provide proof of monies owing. Final Demands/ Court Orders Order details/instalments ______________________________________________________ ______________________________________________________ Your Capital & Savings Savings Accounts Stocks/ Shares Other (Specify) Company & Reference/ account number Amount? Documents seen by Officer £ Number held: £ £ Do you own property? YES / NO If Yes, please provide details of all the properties you own Estimated Documents Your Mortgage Address & Post Code Market seen by Property Balance Value Officer UK £ £ UK £ £ Overseas £ £ 12 | P a g e DECLARATION As far as I know the information that I have given on this form is true and complete. If my financial circumstances change I must notify the Council immediately, e.g.: If I become unemployed or change jobs. I am willing to make payment of the top up to [local authority name] for the length of stay in the accommodation. It is likely that there will be an increase in the top up each financial year but these will need to be reviewed and are not automatically to be taken on by one party.. This will be discussed with the local authority following a review of the personal budget. I understand that if I default on the top-up payment the local authority may take action against me. This may result in the accommodation being terminated and alternative accommodation arranged. The top-up payment must not be derived from the person’s savings or capital unless it is a property that is subject to the 12-week disregard or the costs of care are being met through a DPA. A top-up payment must be paid in addition to the assessed contribution. Print name………………………………………………… Signed…………………………………………………. Dated______/______/______ 13 | P a g e Draft third party contribution written agreement [Local Authority Name & Address to be entered here] THIRD PARTY CONTRIBUTIONS AGREEMENT LETTER THIS AGREEMENT is made on the Date between Local Authority Name and Address of the first part And of (Name of Provider) (herein after referred to as “the Contractor”) of the second part And (Name of person making the top up contribution) of contribution) (Address of the person making the top up WHEREAS 1. (Name of Resident) of name and address of local authority (herein after called “The Resident”) wishes to reside at a care home, supported living, shared lives called (herein after called “The Home”) which is a Home operated by the Contractor. The Contractor is willing to provide the Resident with care under and in accordance with the terms and conditions of the Contract (as herein after defined) 2. The Resident/a Third Party has agreed to pay the Council the top up contribution (as herein after defined) 3. In the light of the agreement of [the Resident/a Third Party] herein contained the Council is willing to nominate the Resident for occupation of the Home and Provision by the Contractor of Residential Care under and in accordance with the terms of the Council's Residential and Nursing Care contract. NOW IT IS HEREBY AGREED BY AND BETWEEN THE PARTIES HERETO as follows: 4. Definitions In this agreement the expression already defined shall have the meanings assigned thereto and the following expression shall unless the subject or context otherwise require have the following meanings. “The Contract” The Council's Residential and Nursing Care Contract signed by the Service Provider. 14 | P a g e “Third-Party” A persons or persons who have entered into an agreement to pay the top up contribution. “Resident” The person living in the accommodation [and who has entered into an agreement to pay the top up contribution. “Top Up Contribution”. The difference between the Service Provider’s rate and the person’s personal budget “Service provider rate”. The amount the provider charges. “Personal budget”. in the care plan. The cost to the local authority of meeting the needs identified Agreement The person making the top up contribution agrees to pay the Sum of being the difference between the Service Provider's rate (which at the date hereof is per week) and the person’s personal budget. (which at the date hereof is per week). This should be paid on a monthly basis unless alternative arrangements are agreed in writing. The Council is responsible for notifying the person making the top up contribution of any changes to the charges outlined in this agreement. Terms otherwise used in this Agreement shall have the same meaning as in the Contract. 5. The person making the top up hereby agrees to pay the Top Up Contribution to the Council in line with the Local authority’s payment schedule. 6. For the avoidance of doubt it is hereby declared and agreed between the parties hereto as follows: a. Arrangements will be reviewed in line with arrangements for reviewing the cared for person’s financial assessment and personal budget. These are reviewed following a change in circumstances or on an annual basis. b. The person making the top up shall notify the Local Authority immediately of any changes in their circumstances which could affect their ability to make Top Up Contributions. This may trigger a review of arrangements. c. If there is an increase in the difference between the Service Provider's weekly rate and the Declared Price a review will take place to discuss how the increase will be shared. . I,e both parties will pay the same percentage increase in their contributions. d. The person making the top up shall forthwith make arrangements to pay the Top Up Contribution by direct debit or such other arrangements as the Council may reasonably require. e. . 15 | P a g e f. In the event of the failure by the person making the top up to pay the Top Up Contributions in full at any time the council will have the right in 4-weeks’ notice to withdraw the Resident from occupation of the accommodation and place them in alternative accommodation that is affordable within the amount identified in the cared for person’s personal budget. g. Without prejudice to its right under clause 3 (b) herein the Council agrees with the Contractor that it will use all reasonable endeavours to keep the Contractor advised of any substantial delay in or change in the pattern of payment of the top up payment by the person making the top up. AS WITNESS the hand of the person making the top up payment and the hand of the duly advised representatives of the Council and the Service Provider the day and year first before written. Signed: (Signature of Budget Holder) On behalf of Local Authority Signed: (Signature of Contractor) On behalf of: ………………………………………… (name of Home) Signed: ……………………………………………….. (Signature of person making the top up payment) 16 | P a g e