« Previous | Contents | Next »
Listen
CHAPTER 8 CONCLUDING COMMENTS
Conclusions
8.1 As outlined in the introduction to this report, DPAs were introduced in 2002 under the Community Care and Health (Scotland) Act 2002, in order to extend the choice available to care home residents about how to fund their care home place. Additionally, many local authorities were already using discretionary powers under section 23 of HASSASSA 1983 to offer deferred payments via the use of Charging Orders. Overwhelmingly, those who took part in the research were supportive of this extended choice and the principle of allowing care home residents to defer payments. However, both the surveys undertaken by the Scottish Executive and the research undertaken by RP&M Associates has shown that the choice to defer care home payments is not offered in all local authority areas. Although most authorities do offer residents the opportunity to defer payment of care home costs, some authorities only offer the limited option of deferring payments on an interim short-term basis, whilst others offer no option to defer care home payments at all.
8.2 Amongst those authorities offering the option to defer payments, most do so via Charging Orders rather than DPAs. The research has confirmed many of the comments made by local authorities in the 2 surveys that were undertaken by the Scottish Executive; that is, that the Charging Order regime, operated by many local authorities, is an efficient and effective method of allowing residents to defer care home fees. The setting up of a Charging Order requires no input from the resident, and there are no up-front costs to be paid by the resident. The DPAs themselves appear to offer no obvious significant advantages over Charging Orders, and indeed, they appear to have some major drawbacks, 2 of which have been discussed in the previous section; namely, the up-front costs incurred by the resident in setting up the DPA, and the bureaucracy involved in establishing the DPA with the local authority.
8.3 Charging Orders appear to be favoured by the majority of local authorities, work well for residents and largely fit in with the priorities of relatives of care home residents as well as community-based older people, some of whom will become future care home residents.
Emerging issues
8.4 The support for the principle of deferring payment and the relatively low uptake of either option available to defer payments, namely DPAs or Charging Orders, may indicate a level of unmet need in this area. However, evidence gathered from local authority representatives from the research would also suggests that the need amongst care home residents to defer payments may have been affected by the fact that it has become more common place for prospective care home residents to transfer their properties to other family members prior to needing a care home place, in an attempt to remove the asset from the financial equation when calculating the individual's contribution to their care home costs. If the resident is deemed to have no property, deferring the sale becomes irrelevant, regardless of the mechanism to be used ( DPAs or Charging Orders). Irrespective of possible lower levels of need resulting from the rise in transfer of ownership, the research has identified a number of obstacles that have prevented more residents from entering a deferred payment arrangement, whether through the use of a DPA or a Charging Order. These include: the reluctance of a minority of local authorities to offer either of these options to care home residents because of the resource implication for the local authority; the lack of public awareness about DPAs or Charging Orders; and lack of full and accurate information provided to the resident about the options that are available.
Policy implications
8.5 To date, guidance provided to local authorities from the Scottish Executive has strongly recommended that local authorities do not use Charging Orders as a substitute for DPAs, but use them solely for the purposes of debt recovery when a resident has refused to pay for their care home fees. However, the research would suggests that Charging Orders appear to be a good option for providing choice to residents in this area as they are both free from up-front costs and free from significant bureaucracy, and therefore avoid 2 of the off-putting features of DPAs.
8.6 However, to ensure that an adequate level of choice is afforded to all care home residents across Scotland, it is important that the Scottish Executive address the issues that have been identified above. In particular, the need for good quality information and advice to care home residents and their families is paramount. To this end, it is important that all care home residents receive detailed, accessible information in a written format. If this were produced at a national level, this should ensure all residents receive the same information about options available to them, irrespective of where they reside. It is also important that good communication from the local authority to the care home resident and their family supplement this information. Care home residents and their relatives also have to be confident that the local authority is acting in their best interests; whatever option for deferral is pursued, good levels of information, communication and involvement will assist with this issue.
8.7 The research has reported a perceived resource issue for some local authorities that deters them from offering deferred payments. This may have to be investigated further to ensure that all local authorities can adequately meet the demand or need that may exist amongst care home residents wishing to defer care home fees.
8.8 Finally, if DPAs are to continue to be pursued as a valid option for deferring payments, the DPA process itself would have to undergo a significant transformation. Any revamp of the DPA process would have to address the issue of cost and time involved in setting agreements up. The establishment of a national standardised contract to be used by all local authorities could assist with both of these issues. Such a contract should reduce dramatically the time taken to set up a DPA, and also its associated costs.
« Previous | Contents | Next »