Elderly and disabled face ‘widening postcode lottery’ in home care costs

Elderly and disabled people are the victims of a “widening postcode lottery” leaving them facing different levels of home care costs and eligibility.

A Which? Investigation found that over the last five years some local authorities have been restricting home care and increasing costs above inflation.

Using Freedom of Information requests over the last five years, Which? asked councils in England and Wales what level of home care they provided each year from 2009 to 2013.

It found more than 80 per cent of councils now restrict care to those whose needs are ‘critical’ or ‘substantial’, up from just over 70 per cent in 2009. Of the 26 councils who 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 per cent) have increased charges above the rate of inflation. Barnsley Metropolitan Council has increased its hourly rates the most, by 160 per cent, whereas Tower Hamlets London Borough Council has maintained a zero charge policy and remains the least expensive council for care costs.

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.”

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 per cent) in 2009 to just one in three (31 per cent) in 2013. The average cap has also increased from £245 per week in 2009 to £297.50 per week in 2013.

In response to the findings, Caroline Abrahams, charity director at Age UK said: “The postcode lottery of care is unfair. By the time older people need to buy care services they are less able to move area to access better services and this new research shows that they may be stuck with vastly different levels of care from one borough to the next.”

The Government recently announced new national eligibility criteria for the first time, setting out a minimum threshold to be introduced in 2015, on who should be offered care and support by local authorities in England.

The criteria is being introduced to put an end to the ‘postcode lottery’.

However the national threshold being proposed is for people who are judged to have ‘substantial’ needs.

People are deemed to have substantial needs when they only have a partial choice and control over their immediate environment or in cases of abuse or neglect. Also if there is an inability to carry out the majority of personal care or domestic routines or they are unable to work, or undertake any form of education and sustain relationships.

Charities have been quick to condemn the new criteria fearing it has been set too high and will exclude millions of vulnerable people. Michelle Mitchell, charity director general of Age UK said: “We have always said national eligibility criteria are welcome for reasons of consistency, but only if they are set at a fair level. We believe the equivalent of ‘substantial’ sets the bar too high: ‘moderate’ would be much more in tune with the spirit of the Government's new care legislation, and with what the public has been led to expect.”

George McNamara, head of policy at Alzheimer’s Society said: “'The wholly inadequate levels of care available today reflects the extent of the savage cuts that have left hundreds of thousands of people struggling without any support. To suggest that a national criteria, which aims to maintain this status quo is a positive step demonstrates a worrying acceptance of the substandard.”

Tim Pethick, strategy director for Saga claims the new criteria makes a mockery of the care cap and said: “Whilst the move to standardise the eligibility criteria for care is important, it is masking the big issue here - that it's making a mockery of the cap on care costs. This simply adds another level of complexity to the already widely misunderstood care cap.

“The eligibility criteria is not only about whether you'll receive help to pay for your care, it is also the gateway to the care cap. These regulations will mean that if you have low or moderate needs, the care costs that you do incur will not count towards the overall cap until your needs are assessed as substantial.

“From an individual point of view what this means is that with this system still gives families nothing to plan for, what level or extent your care needs will be assessed at and, more importantly, how much of your estate you will lose before your costs even start to qualify towards the cap.”

The Department of Health will publish the regulations on eligibility for formal consultation once the Care Bill has completed its passage through Parliament, in spring 2014. Following this process, the regulations will be laid before Parliament in autumn 2014. This will provide six months for councils to make practical arrangements, prior to the national eligibility level coming into effect in April 2015.