1. Sue Garwood Funding care and support in Extra Care Housing 22 nd April 2013

2. Focus today To highlight the key points on care and support in ECH covered in the Technical Brief To focus in on approaches to funding round-the- clock care To suggest criteria for choosing approach to configuring and funding care and support To highlight future uncertainties Intended to be factual rather than exploring issues 2

3. Some fundamentals Local authorities with responsibility for adult social care (LA ASCR) are the main source of funding for people with unmet care needs which meet the authority’s eligibility threshold. They may charge the person based on their non-residential charging policy following a “Fairer Charging” means test. Personal budgets are the growing “currency” of care procurement in extra care housing. Personal budgets do not necessarily cover the cost of having care available around the clock. There is no duty on local authorities to fund 24/7 care. 3

4. “Core and Add-On” Local authority approaches to funding care in Extra Care Housing range from micro-commissioning (spot purchasing) for individuals at one end of the spectrum to block- contracting the entire care provision at the other. Between these two extremes, a mix of spot purchasing for planned care, and other approaches to cover the availability of care around the clock, is becoming increasingly common. In this Technical brief, this is called the “core and add-on” approach.* Within the “core and add-on” approach, there are many variations around what constitutes the “core” and how it is funded. 4

5. Personal Budgets – the “add-on” The financial aspect of “self-directed support” and “personalisation” – legislation likely to strengthen their role* “...an amount of money that a council decides is necessary to spend in order to meet an individual’s assessed needs” Can be in the form of a direct payment or managed personal budget With Individual Service Funds, a provider can take on the management of a personal budget – rarely used in ECH? Generally PBs form the planned care or “add-on” aspect of care in ECH – for those with assessed eligible needs Of course, those whose needs are ineligible, or who have income or capital above defined limits, have to pay for their own planned care – self-funders 5

6. What about the “core”? Probably as many variations as there are schemes applying the “core and add-on” approach, and revolve around: 1.Who funds the core and on what basis 2.Who charges the residents for the core provision 3.Whether a separate charge or part of an over-arching service charge 4.The level of the charge and how it is decided 5.What services constitute the core 6.How generous the care element of the core is 6

7. 1. Who funds? Provider – risk mitigated by compulsory charge. PBs for planned care probably reduce risk of care home registration Public sector funding Local authority – via procurement contract or grant Health funding – prevention and health promotion - any examples? European procurement and state aid rules to ensure transparency and fairness in selecting providers 7

8. 2. Who charges? LA - If LA has procurement contract, may form part of non-residential charging policy Provider – If provider or grant-funded, provider may make a “wellbeing” or “peace-of-mind” charge 3. Separate or part of service charge? Could be either If non-elective, registration issue 8

9. 4. Level of charge Varies enormously across schemes – examples range from £7 to £130 per week Depends on Basis for deciding the charge – e.g. actual costs or assumed benefits (Attendance Allowance issue*) Whether an element of subsidy What services the charge covers Staffing structure, levels and terms& conditions Number of properties/people it is divided between List not necessarily exhaustive 9

10. 5. What constitutes the core? Again – considerable variations.................... Availability of 24/7cover only – may be skeletal, e.g. night cover only, or include some “floating time” 24/7 cover plus housing-related support, and/or activities facilitation and community development, and/or domestic help, and/or if part of service charge accommodation-related costs such as scheme management catering infrastructure costs 10

11. Potential Funding sources for those with ineligible care and support needs Supporting People for housing-related support – reducing budgets and not always available in ECH Residents’ own resources including Attendance Allowance where entitled Equity Release schemes – see Housing LIN Affordability Guide Insurance type products – provider-specific 11

12. When deciding on the approach to funding care and support... Is the approach transparent and understandable? Is it cost-effective and affordable to all stakeholders? Are charging arrangements lawful, fair and clear? Does it minimise the risk of care home registration? Does it minimise the risk of falling foul of housing benefit regulations? (Extracted from Care Technical Brief) 12

13. Funding choices hand-in-hand with good practice and outcomes Does it offer more than standard sheltered and an alternative to residential care? Is individual choice, control and personalised provision optimised? Does it optimise genuine involvement, co- production and control of on-site services? Does it retain at least the possibility of cohesive, co-ordinated service delivery? Does it enable a flexible, responsive service? (Extracted from Care Technical Brief) 13

14. A word of warning For more information on care and support in ECH see the Care and Support in ECH Technical Brief, much of which still applies Providers and local authorities have had their fingers burnt through cherry-picking approaches and ignoring the regulatory framework Complex legislative and regulatory framework – get legal advice if you’re not sure The legislation and regulation will be changing – discussion document → holding document and updating TB later when provisions of Care and Support legislation clearer 14

15. Funding Quality of Life and Wellbeing Services Activities facilitation and community development – may be funded by any of the following: Service or wellbeing charge Local authority as part of care or support contract Fund-raising activities – small or large scale Charge for taking part in specific activities Health funding may be available for health and wellbeing- related initiatives – need to try and engage with CCGs and H&W Boards 15

16. Care, support and housing crossover issues “Exempt accommodation” and the Turnbull judgement – category continuing for the time being. Has a bearing on whether Housing Benefit will cover the full rent and service charge Scheme Manager posts – funding sources and proportions partly shaped by role’s responsibilities - e.g. between net rent, service charge and Supporting People – and views of relative risks. Changing with SP reductions. Is “intensive housing management” a route to shifting costs to HB? 16

17. Watch this space Care and Support legislation will affect: Eligibility criteria Charging regulations Possibly greater funding integration – Select Committee recommendations Implementation of Dilnot Commission cap on individual contributions (now 2016) – implications for ECH not yet clear. Though many of the changes relate to residential care not domiciliary care, likely to affect incentives Personal health budgets for people with long-term conditions 17

18. C/o EAC 3rd Floor, 89 Albert Embankment London SE1 7TP email: info@housinglin.org.ukinfo@housinglin.org.uk tel: 020 7820 8077 website: www.housinglin.org.ukwww.housinglin.org.uk Twitter: @HousingLIN Thank you! 18 Sue Garwood Extra Care Specialist E-mail: sue@suegarwood.co.uksue@suegarwood.co.uk Tel: 01763 838 179 www.suegarwood.co.uk