Adult education & social care - Eligibility for residential / nursing home care
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Adult care delivered by your council can include support and care in your home, supported living, care home or nursing home. This guide provides details on how to raise a complaint. You can find additional information from the Local Government Ombudsman or the Care Quality Commission (CQC).You should know
- Adult care complaints are considered by the Local Government Ombudsman
- Cases need to be raised with the relevant council before they are escalated to the ombudsman
- In most circumstances, a case should be escalated within 12 months of the time that you became aware of the issue
- Adult care includes care in your home, supported living, in a care home or in a nursing home.
This guide – which applies to those who live in England – tells you about your choices with regards to the care and support that is paid for by your council. This is known as ‘adult social care’, and provides recipients with personal and practical support to help them live their lives. It also helps individuals maintain their independence and dignity, and ensures that they have as much choice and control over how they live as possible.
Plans of care and support
After your assessment, your local council might decide that you are eligible for social care. This could mean that the council agrees to pay for some or all of the care and support that you need. If this is the case, the council will agree with you a plan for your care and support.
As part of this plan, your council could offer you a personal budget. There are a number ways that this might be managed:
- Via a direct payment. Cash is paid directly to you, rather than you being provided with a service. This gives you the freedom to pay for the service that best meets your needs, although it must be in line with the care and support plan that you have agreed with your council. For example, many people choose to employ a personal assistant to help with their needs, using the money from their direct payment;
- Via an account held by the council, which it will manage in line with your wishes;
- You can ask for someone else to manage the budget for you; for example a family member, voluntary organisation or an organisation providing care;
- Or you can use a combination of the above methods.
If you have eligible needs, the council with responsibility for providing your care and support must ensure that you are provided with direct payments if requested, regardless of whether you have a personal budget. Your council should tell you where you can get independent advice to support you through this process.
Caring for someone else
When the council is assessing the needs of someone that you care for, it should:
- Ask you what you think;
- Agree with both you and the person requiring care how to meet those needs.
Your council must take all reasonable steps to do this.
If you provide, or plan to provide, a substantial amount of care on a regular basis, you can ask for a separate assessment of your needs as a carer. Your assessment should consider whether you:
- Are willing and able to carry on caring, or to provide the same amount of care;
- Work, or wish to work;
- Take part in, or wish to take part in, education, training or leisure activities;
- Have any family responsibilities.
Following an assessment of your needs as a carer, your council might offer you a personal budget.
Your assessment could show that the best way to help you is to provide care and support for the person that you care for. In that case, the person may be offered a personal budget or direct payment to pay for their own care; this will then give you a break from caring.
There are numerous ways that you or the person you care for can manage a personal budget:
- Via a direct payment. Cash is paid to you or the person that you care for, depending on what kind of support is needed. This gives you the freedom to pay for the service that best meets your needs, although it must be in line with the care and support plan that you have agreed with your council.
- Via an account held by the council, which it will manage in line with your wishes, or those of the person you care for. This depends on who it is that has been offered the personal budget.
- The person that you care for can ask for someone else to manage the budget for them. They might ask you to do this, or someone else (for example a family member, voluntary organisation or a care provider).
- Or you can use a combination of the above methods.
The council should tell you where you can get independent advice to support you through this process.
If you care for someone and are offered support paid for by the council, you have the right to ask for a direct payment instead of receiving services, regardless of whether you have a personal budget.
After your assessment, your local council may decide that you are eligible for social care. This means that the council agrees to pay for some or all of the care and support that you need.
Following this assessment, if you require a place in a care home or a care home with nursing care, your council should inform you of your right to:
- Choose any accommodation likely to meet your needs, subject to certain restrictions;
- Choose from the council’s list of care homes (if available);
- Allow your council to make a decision on your behalf.
If the best way to have your needs met is to find a place for you in a care home, or a care home providing nursing care, this placement could be permanent or just for a short time. In either case you have the right to choose where to live, subject to certain restrictions.
What choices do I have?
You can ask your council to:
- Give you information and advice about care and support;
- Assess what support you might need, including what care you may require; or, if you are caring for someone else, what support you might need in your role as a carer.
What advice must your council give?
Your council must:
- Assess your needs and give you advice, no matter what your financial circumstances;
- Tell you about local services, and who to contact for advice or to have your needs assessed;
- Know about services and support options available to you in your area;
- Give this information to you if you are caring for someone.
Who will give me the advice?
Some councils pay independent groups to provide information and advice on their behalf. These might include local voluntary organisations, carers centres and community groups.
The NHS Choices website can give you general details about social care, including information on direct payments and choosing residential care.
It provides tools and resources that can help you consider your options. It also has details of all registered care providers, including nursing and residential care homes, with information on the services and support they offer and how they perform in key areas. It enables you to provide comments and feedback on your experiences, and read reviews that others have left.
Raising a complaint
Your council must have a clear reason for deciding:
- Not to place you in the residential care home that you prefer;
- And/or not to give you a direct payment or personal budget.
It must tell you what decision it has made and why.
Should you wish to, you can complain to your council about its decision via Resolver.
If your issue is not addressed
Bear in mind that, due to the nature and sensitivity of some cases, your council might take longer to reply to your complaint than you would wish. However, if your council does not respond to your complaint at all, or you are dissatisfied with its response, Resolver will tell you to whom you should escalate your issue.
Escalating your case
If your complaint remains unresolved 12 weeks after you submitted it to the council, you can send the case to the Local Government Ombudsman via Resolver. All communications are recorded in your personal case file in the Resolver system, allowing you to easily submit the details for independent assessment.
If you feel that the council has been given sufficient time to respond to your issue, you can escalate your case to the Local Government Ombudsman before the 12 weeks is up. However, the nature and sensitivity of some cases means that you should allow the council reasonable time to reply in the first instance.
If your case has gone to court, or is with the court, your case cannot be raised to the ombudsman. This also applies if the council is taking court action against you.
If you fund your own social care
If you fund your own social care, you should raise your case to the social care provider. If the issue is not resolved, you can send the case to the Local Government Ombudsman for independent assessment.
Unless there are exceptional circumstances, you should escalate your case to the ombudsman within 12 months of the issue becoming apparent.
What can the ombudsman do?
The ombudsman’s actions will depend on the issues uncovered, and how it believes that they have affected you.
- The ombudsman might decide that the council or care provider hasn't handled your complaint properly, but that the result was the same as if it had been correctly addressed. In this case, the ombudsman will probably only ask the council to apologise to you, and perhaps make a payment in recognition of your wasted time.
- However, if the ombudsman decides that the council should have recognised that your complaint was justified, it will consider how the original faults that you complained about affected you, and how the council might now put things right.
If the ombudsman believes that something the council has done has harmed you, it will ask it to take action to make up for this, as far as is possible. For example, it might ask the council to:
- Ensure that any services you’re receiving are up to standard and meeting your needs;
- Take prompt action to provide you with any help that you’ve been waiting for. This could include home or respite care, home aids and adaptations, or support for a carer;
- Make any financial loss up to you and, if appropriate, pay you compensation, or assess your needs properly if it hasn't yet done so.
If the ombudsman finds fault with the council's procedures, it could ask the council to make changes so that the same problem doesn't happen to anyone in future.
If you need additional advice you can contact the Local Government Ombudsman on 0300 061 0614 (Monday to Friday from 8:30am-5pm).
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