Care Package Cost Guidance
Cost limits for Community Care Packages
Guidance Notes
November 2009
The maximum weekly cost for the community based care packages should be no more than the gross cost of a care home per week for the individual
Context
This guidance applies to all service users. It should be applied where a high cost community care package is being considered for an individual which may exceed the gross cost of a care home and where the individual has been assessed as having eligible needs that require health and social care funded services.
In the UK the national FACS (Fair Access Care Services) guidance states that:
‘Councils are reminded that they should consider potential outcomes for individuals and the cost effectiveness of providing care to them, on the merits of each individual case. In doing so they should tailor services to each individual’s circumstances, and should only use upper-cost parameters of care packages as guidance. The aim should be to secure the most cost effective package of services that meets the user's care needs, taking account of the user’s and carer’s preferences. When supporting the user in their home would make a better life, this is to be preferred to admission to residential or nursing care. However, Health and Social Services also has a responsibility to meet needs within available resources and this will sometimes involve difficult decisions where it will be necessary to strike a balance between meeting the needs identified within available resources and meeting the care preferences of the individual. ’
In providing care packages to meet the assessed health and social care needs of an individual H&SS has to be mindful of its overall responsibilities to provide care for the whole population within its available resources. Therefore the appropriate care packages for each individual must be decided upon on a case by cases basis.
H&SS does not have to provide care in the community if it is more expensive than providing care in a residential setting. However there should be clear evidence that a full range of options for care have been explored in partnership with the individual and their carer. This should include clear evidence that patient choices and shared risk management approaches have been considered as a means of meeting individuals’ preferences within available resources.
Principles
The principles underpinning this policy are:
- Decisions must not discriminate against individuals on the grounds of age, gender, ethnic group, religion, disability, culture, disability and / or personal relationships. This means that it may be necessary to pay more (or less) in order to meet an individual’s eligible needs in a way that does not discriminate against them.
- Decisions must promote independence, autonomy, and self determination
- A service users ability to pay, or not, for their care should not be taken into account once a decision has been made that the person both requires and wishes social care funded services. That means we compare gross and NOT net costs of the care package.
- Subject to the above, it is a matter for H&SS as to how to supply services to meet the assessed needs of an individual, and it is the right of the service user to refuse services.
- Appropriate services to meet eligible needs should be provided in the most cost effective way. These may be either traditional or non traditional if the latter meet the needs more effectively and/or cost effectively.
Assessments and Care Planning
Assessments and the use of the appropriate Placement Tool are central to decision making about whether an individual has eligible needs or not. There must be an up to date (within twelve months) (re) assessment of a persons needs sufficient to define the objectives of care, outcomes being sought and levels and types of support required to meet the needs and manage the risks. The national FACS Guidance (DoH2003) states that:
'Cost ceilings may be used as a guide, but they should not be applied rigidly. Councils should always base their decisions on the assessment of a particular individuals needs and if spending above the ceiling can make a difference to an individual, then the council should consider doing so.
Practice Guidance
The maximum weekly cost for the community based care packages should, in all but exceptional circumstances, be no more than the gross cost of a care home per week for the individual.
The upper cost parameter for Community Care for people who are 65 yrs. or older should be the gross cost of the type of Care Home provision that they would otherwise require, based on the banded rates for Care Home placements.
The upper cost parameter for Community Care paid for by the H&SS for people who are less than 65 years old should be the gross cost of the type of Care Home placement that they would otherwise require.
In cases where an individual Care Package costs would be particularly high due to very high and complex levels of need, it is important to remember that this guidance should be considered in the context of the National FACS guidance quoted on the first page of this paper i.e.
“Councils are reminded that they should consider potential outcomes for individuals and the cost effectiveness of providing care to them, on the merits of each individual case………”
Social workers must therefore establish:
- The gross cost of the care home placement suitable to meet the eligible need of the individual.
- The gross cost of community based services required to meet eligible needs of the individual.
- Then compare the gross cost of the care home package against the gross cost of the community based package
- The gross cost of services is provided as guidance only. Decision making must be based on a combination of needs rather than on tight boundaries about the average costs per user group.
- Where community based care packages are above the upper cost parameter this cannot be used to deny community based support in the first instance. Social workers will need to discuss all such cases with their manager.
- All complex care packages and those above the upper cost parameter will require Placement Panel approval.
- The process of budget approval should not add delays to the care package being agreed and arranged.
- The social worker must record any differences of view and the service user / representative must always be informed of their right to make a complaint using the Health and Social Services Complaints procedure if they remain unhappy with the decision.
In the event of a patient or client disputing the decision of the placement panel they should utilise the standard Health and Social Services complaints procedure to express their concerns and identify why they feel the decision needs to be re-considered. This must be done in writing through the approved complaints procedure. Letters direct to the Minister will be diverted into the approved complaints process to be managed accordingly. If the Chief Executive considers the decision of the placement panel to be inequitable then he must formally instruct the placement panel chairperson to waive the agreed policy with clear justifying for the decision.
- Health and Social Services reserves the right to review all care packages and provide a cheaper alternative if this will meet the needs of the service user.
Issues to Consider
Social workers will need to consider:
- In deciding how to proceed, practitioners and managers will need to consider each individual situation. Some factors that will need to be taken into account include:
- is there an up to date assessment and care plan specifying needs and outcomes?
- Is the community based package to support cultural, religious, gender etc reasons? This may require a higher level of payment to meet eligible needs.
- Is the community based package preventive and / or short term? For example, by supporting the carer to continue the caring role or by avoiding short term admission to care / hospital. This may justify a higher level of payment.
- Would admission to a care home cause grave distress, for example separating a husband and wife who do not want to be parted?
- Has the assessment been examined with the service user to see if any of the eligible needs can be met in less expensive ways or with assistance from other agencies? For example, by use of ordinary community facilities or by the provision of equipment and or adaptations.
It is the intention of Health and Social Services to ensure the implementation of the most cost effective package of services which meets the user’s care needs, whilst taking into account the user’s and carer’s preferences.
LAW/Nov 09
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