Residential & nursing care

Before moving to a care home it would be worth considering what support may be available to help you to continue to live at home. You, or your relative, may be thinking about a care home because you have gradually found it more difficult to manage at home, or because an illness or accident has affected your ability to live independently.

Residential care homes offer services such as laundry and meals and help with personal care. Some homes offer short-term stays but normally they provide more long-term or permanent care. You may need to move to a nursing care home if your illness or disability means you need regular nursing care and this cannot be given in your own home. Nursing staff will be available 24 hours a day in a nursing home.

Moving to a care home is a very important decision in your life and you may need assistance to help you think this through. A discussion with a social worker will help you work out what is right for you. Once you know the type of care you need, you can get more details of homes that can meet your needs, and perhaps arrange to visit a number of homes.

When visiting a home it can be helpful to prepare a list of questions you want to ask before you get there. This helps you get the most out of the visit. It is important that where you live is somewhere that you will feel comfortable and secure. Some homes encourage people to stay for a short period or have a meal at mealtimes to see whether or not the home suits them.

All care homes have to be inspected by the Care and Social Services Inspectorate Wales (CSSIW). How much you will have to pay for residential care depends on your income, savings and other assets. Some people pay the full charge for their placement and most people will pay something. The care will be free if:

  • you receive after care services provided under S117 of the Mental Health Act 1983
  • you are assessed to receive a convalescence service • (for up to the first 6 weeks, a charge will apply after that)
  • your services are funded through Continuing Health Care by the Local Health Board
  • you are an adult who has been diagnosed with Creutzfeldt-Jakob disease (CJD)

The cost will vary from person to person and will depend on your type of stay or placement and the result of your financial assessment and the cost of the placement provided. Types of placements are:-

  • Residential reablement (convalescence) – is a service that offers the opportunity for you to gradually recover your health and strength after surgery or illness in a supported environment. It offers you the opportunity to access supportive services which will enable you to build your confidence before you return home or to a more suitable environment where your needs can be better met. There is no charge for this service for up to 6 weeks.
  • Flexi Bed – for service users who are awaiting start or restart of home based care packages, awaiting minor adaptations to their home e.g. hand rails or awaiting re-housing. A flexi bed placement is charged under non-residential short-term charging rules.
  • Respite care/Short-term care - • is a planned or unplanned short stay in a care home, which at the point of admission is unlikely to exceed 8 weeks. The level and duration of care and support to be provided will be as a result of your needs assessment and the admission can be for any reason, e.g. to give your carer(s) a break. Respite/Short-term care placements are charged under non-residential short-term charging rules. The charge will apply for the short-term period up to a maximum of 8 weeks and will change at the end of the respite/short-term period or the first day of the 9th week, whichever is the sooner.
  • Temporary stay – temporary stays relate to a period of care where it is anticipated that you will be able to return to your own home sometime in the future. Your temporary stay is likely to exceed 8 weeks and can last for up to 52 weeks and the charge will be based on the outcome of a financial assessment. The financial assessment rules are the same as for permanent residents except that if you own a property the value of your main residence will not be taken into account for the first 52 weeks. However, if you own another property/land then the value of this asset would be included in the financial assessment from the first day of the placement.
  • Permanent stay – a permanent stay is an admission to a care home when it is anticipated that you will need to remain a resident indefinitely. Your charge will be based on the outcome of your financial assessment. If you are subsequently able to return to your own home, then in certain circumstances the temporary rules will be applied retrospectively.

Is there a maximum charge?
The maximum charge will be no more than the actual cost of your placement, and this can vary for a number of reasons.

Is there a minimum charge?
Everyone will be required to pay something towards their temporary or permanent care. The charge for temporary and permanent care will be directly linked to your Departments of Work and Pensions benefits, other income and capital. The charging week runs from a Monday to Sunday. Short-term placements are charged under non-residential charging rules up to a maximum of £70 per week depending on the result of the financial assessment. It should be noted that you could be charged £70.00 for one night’s respite/short-term care in a charging week due to the cost of the service provided.

What will I be charged if I am admitted to hospital during my stay at the home?
If you are in a Care Home on a temporary or permanent basis and you are admitted to hospital, we will normally keep your placement available until it is decided that the placement is no longer needed or will not meet your future needs. During the time that you are in hospital, you will still be charged for your placement. The amount you will be charged will be based on the pensions and benefits you receive from the Department for Work and Pensions only.

A financial assessment is a calculation of what you can afford to pay towards your care.

If it is your preferred option not to give us details of your income and other assets or you refuse to provide information the Council may charge you the full cost of the care provided.

If you choose to declare your finances then you will be asked to complete and sign a financial assessment form and you will need to provide details of your income, capital and expenses. You will also need to provide proof of the information detailed on the form (e.g. bank statements, benefit notification letters); this will help us work out how much you can afford to pay towards your care.

We can help you complete the form if needed; this would normally involve a visit to your home or any other convenient place to complete the form with you and/or your representative.

We will inform you of the result of the financial assessment in writing.

We will review your financial assessment annually, unless there is a change in your circumstances, in which case we will the review the financial assessment sooner.

We will only share information in accordance with the permissions given by you and in accordance with our data protection policy.

Income
Can include state benefits, occupational/private pensions (including a pension after a late spouse), annuity payments, trust income, income from investment bonds, rental income and most other incomes. This is not an exhaustive list. We will only include income to which you have an entitlement.

Capital
This can include property (see What if I own a Property? for further information), land, savings in bank, building society or any other savings accounts (including current accounts and Post Office card accounts, money held in a safekeeping account), cash premium bonds, stocks and shares, ISAs and most other forms of capital. This is not an exhaustive list.

If you hold jointly owned capital with another person, you and the other joint owner(s) are normally treated as having equal interests in that capital.

Some capital is disregarded; this includes the first £30,000 (for 2017/18) of your assets and this amount is set by the Welsh Government each year. This does not mean that you can retain income until your capital reaches this threshold.

If you are admitted to a care home as a temporary placement then your main residence is disregarded from the financial assessment for the period of the temporary residence, up to a maximum of 52 weeks. If you own any additional properties or land then the value of these are included in the financial assessment from the start of the placement.

If you are admitted as a permanent placement, the value of your main residence is disregarded from the financial assessment for the first 12 weeks following your admission into care. If however you were to sell your main residence during this initial 12 week period, then the sale proceeds will be included in the financial assessment from the date of the sale. If you own any additional properties or land then the value is included in the financial assessment from the start of the placement.

In some circumstances your main residence will be disregarded from the financial assessment completely, if it is also the main residence of any of the following people:

  • Your partner (this means husband or wife, or someone you live with as husband/wife or civil partner)
  • A relative who is aged 60 or over
  • A relative who is incapacitated
  • Your child aged under 18
  • A lone parent with a dependent child who is your estranged or divorced partner

The Local Authority has discretion to consider other situations and these are considered on their individual merits.

If any of these conditions cease during the placement then the value of the property will be included in the financial assessment from that date.

What if someone jointly owns my main residence/additional property?
We would examine documentation to confirm that the property is jointly owned and we would normally only take into account the value of your share of the property.

What if my main residence/additional property has been transferred to someone else?
We would examine the documentation confirming this and we will ask you to provide information relating to the terms of the transfer. We will use this information to base our decision on whether the property is included or disregarded from the financial assessment.

Will I have to sell my main residence?
You can choose whether or not to sell your main residence. If you choose not to sell your main residence and you are unable to pay the assessed charge for your placement then you will be asked to enter into a Deferred Payment agreement (see What is a Deferred Payment Agreement?). The department will put a “Legal Charge” on the main residence and accrue the debt until a later date. This means that we will recover the amount that you owe us from the money you get if or when you decide to sell your home or from your estate after your placement has ended. You will however be required to use your weekly income and any accessible savings to pay towards your weekly charge until your property is sold or until your savings have reduced.

What happens if I sell my main residence?
If you choose to put your main residence up for sale we will continue to help you pay for your care costs until your property is sold. Once it is sold you must tell us and we will then calculate how much you owe for the placement costs.

As part of the financial assessment the local authority will value all of your properties for financial assessment purposes. If the sale price differs from the valuation then we will consider the reasons for this at that time.

What is a Deferred Payment Agreement?
A Deferred Payment Agreement is a legal agreement between the service user and the local authority.

Where a service user owns their main residence and they do not wish or cannot sell their property, the Deferred Payment Scheme enables the service user to meet their care costs by entering into an agreement with the local authority to defer their payment for care.

The local authority can only agree to a deferred payment if the person in the care home owns their own property and has insufficient income and/or other accessible assets (other than the value of their main residence) to meet the costs of care.

As part of your financial assessment all of your income is considered and then where applicable certain types of income are disregarded from the financial assessment.

Included in your benefits there is an amount commonly known as Minimum Income Amount and this amount is disregarded from your financial assessment. The amount is set by the Welsh Government and it is reviewed annually. The amount for 2017/18 is £27.50 per week.

Within the financial assessment there are other forms of benefit and income which are disregarded from the financial assessment. Examples are:

  • all the mobility components of Disability Living Allowance and Personal Independent Payment
  • the first £10 of War Widows/Widowers pensions
  • all of the War Widows supplementary pension
  • all of the War Disablement pension
  • all earnings
  • all of the Armed Forces Independence payment
  • all of the Guaranteed Income Payments made under the Armed Forces compensation scheme
  • up to £5.75 of savings credit (part of pension credit). This is the amount for 2016/17 and this amount is set by the Welsh Government

This is not an exhaustive list.

As part of your financial assessment all of your capital is considered and where applicable certain types of capital are disregarded from the financial assessment.

Each year the Welsh Government sets an amount which must be disregarded from the calculation. The amount for 2017/18 is £30,000.00. The value of capital in excess of this figure is included in the financial assessment. If your capital is below this figure then it does not mean that you can retain income until your capital reaches this threshold.

In addition, capital received in the form of ex-gratia payments made to former Far Eastern POWs, payments made under the Vaccine Damage Scheme and some payments made by charities, trusts etc. will also be disregarded from the financial assessment. This is not an exhaustive list. Please contact the Assessment Team for further advice.

If you gave away savings, money or other assets or sold a property at less than its value before coming into a care home, or whilst receiving care then we may assess you as though you still have the full value of the asset. The person who benefits may become liable for any unpaid charges.

We will ask you about the timing, reason, recipient and the monetary value of the transfer and use this information to base our decision on whether the asset is included or disregarded from the financial assessment.

The local authority has set rates for different types of care. If a service user chooses a care home which is more expensive than the two care homes offered at the time of placement, i.e. where the care home chosen charges a weekly fee that is higher than the fees required by the two care homes offered, then the service user only pays the additional cost if they have sufficient weekly income to meet the cost of the placement, or their assets exceed the current maximum capital threshold.

If the service user has insufficient income to meet the cost of the placement or their total assets are below the capital threshold then a third party must agree to pay the additional cost and he/she will be responsible for paying this amount and it will be in addition to the assessed charge. The third party, or service user, depending on the circumstances, will be asked to sign an agreement with the local authority to pay the additional cost. 

The additional cost payment will be in addition to the means tested charge for the placement.

Additional costs are not paid directly to the care home by the service user or by the third party. All additional costs are paid directly to the authority who then includes this amount in their contract with the care home.

You should inform us if you get an increase or decrease in your benefits, you get any new benefits, you benefit from an inheritance or any other transfer, or if your savings/capital has gone above or falls below the maximum capital threshold (currently £30,000.00 for 2017/18).

By Invoice – for residential and nursing placements
There are a number of ways in which you can pay for your accommodation charges and you can choose which option suits you best. We would normally invoice you for your accommodation charge once every quarter, however in future, invoices will be sent four weekly in arrears. In certain circumstances, you can have your state pensions and occupational pension re-directed to be paid directly to Carmarthenshire County Council, this may mean that we will not have to send you any invoices at all or reduce the value of the invoices that we send you.

How do I pay my invoice?
There are various ways that you can pay an invoice. If you choose to pay by Direct Debit you will still have an invoice and the payment will be collected from your bank account approximately 21 days later.

What happens if I don’t pay?
If the invoice(s) remains unpaid the Local Authority will pursue these through its debt recovery arrangements.

Do you charge interest on any charges or debts?
The authority does charge interest in certain circumstances. When someone has passed away the authority will charge interest on the whole of the outstanding debt from 91 days after the service user passes away. There are also other circumstances when the department is able to charge interest on debts, e.g. where the debtor deliberately refuses to pay for care even though they have the financial means. Each case is considered on an individual basis.

If you think that the Financial Assessment or invoice is incorrect, you should contact us and we will review our calculation and consider any information that is provided at that time.

If you are still unhappy with the outcome then the staff can explain the steps you should follow next.

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