CQC Quality Statements
Theme 1 – How local authorities work with people, including unpaid carers: Supporting people, including unpaid carers, to live healthier lives
We Statement
We support people, including unpaid carers, to manage their health and wellbeing so they can maximise their independence, choice and control. We support them to live healthier lives and where possible, reduce future needs for care and support.
What people expect
I can get information and advice about my health, care and support and how I can be as well as possible – physically, mentally and emotionally. I am supported to plan ahead for important changes in my life that I can anticipate.
CONTENTS
1. Introduction
Disability related expenditure (DRE) is the financial cost that an adult incurs, specifically because they are disabled or have health problems. The local authority must take this expenditure into account in financial assessments to make sure that people who pay towards their care and support have enough money to live on (see Charging and Financial Assessment chapter).
Please note: Where a local authority decides to make a charge, it must comply with the provisions in the Care and Support (Charging and Assessment of Resources) Regulations 2014 and the Care and Support Statutory Guidance, Chapter 8 and Annexes B and C.
A local authority cannot impose charges which would cause a person’s remaining income (after any charge) to fall below a certain amount which is specified in the Regulations, Minimum Income Guarantee (MIG) (section 14(7), Care Act 2014). Regulations 6 and 7 specify the personal expenses allowance for residents or temporary residents provided with accommodation in a care home, and the MIG amount for other adults and carers provided with care and support, or support. See Charging for Care and Support (gov.uk) for more information.
Examples of DRE include additional costs for heating if someone feels the cold because of their impairment and needs extra heating to keep warm and additional laundry costs for someone who is incontinent. See Paying for Care Leaflet and Appendix 1: Disability Related Expenditures and Sources of Evidence for further information.
Salford City Council applies a comprehensive and holistic assessment approach to DRE. The fundamental principle is about whether a cost is incurred on a regular basis as a direct result of the person’s disability for which they have little or no choice but to incur. I.e. it is a necessity not a choice.
2. Eligibility for Disability Related Expenditure
To qualify for DRE, the adult must be in receipt of the care component of Disability Living Allowance, Personal Independence Payment or Attendance Allowance. As part of the financial assessment process, we will provide benefits advice to ensure income is maximised, and all applicable benefits are being claimed.
Their assessment and care and support plan should also identify disabilities or medical conditions which demonstrate their need for DRE. This is extremely important as we cannot make a decision about DRE unless we are guided by the Care Act assessment details completed by the social worker.
The local authority should assess the adult’s DRE as part of their financial assessment.
3. Financial Assessment
At the financial assessment meeting, the adult or their carer will need to provide the local staff member (usually a social worker or financial assessment officer) with the following information:
- the costs they have due to being disabled or having a health condition;
- how much these costs are.
The adult will also need to provide receipts or any other evidence of these costs (see Appendix 1: Examples of Disability Related Expenditure and Sources of Evidence).
When considering DRE, the local authority will:
- look at the information provided, including the receipts and any other evidence;
- check to see if the costs provided relate to the adult’s care needs as specified in their care and support plan (see Care and Support Planning chapter);
- check to see if any income the adult receives already covers these costs.
In Salford, the charging team have discretion when making decisions about how to backdate payments after an adult has submitted relevant evidence.
The local authority will let the adult know the outcome of the financial assessment in writing, including explanations of:
- how the assessment has been carried out;
- what the charges will be;
- how they should be paid.
Any changes in charge after the financial assessment is completed will not be communicated to the adult unless they come back in for a review. The Client Finance team will do this as they are the team responsible for the invoicing and billing.
4. Factors to Consider when Charging
The MIG amount in relation to adults who have needs for care and support or a carer who has needs for support, is the total of the amounts set out in Regulation 7(1). See Salford City Council Charging for home care and other non-residential services policy (opens as a PDF).
Section 17 Care Act 2014 states that where a local authority decides to exercise the power to charge for care and support, it must assess:
- the level of the adult’s financial resources;
- the amount that the adult would be likely to be able to pay towards the cost of meeting the needs for care and support.
Apart from the limit set by the MIG, the regulations impose other constraints on a local authority’s power to charge services. When carrying out the financial assessment of resources under the regulations, in order to set the level of charge a local authority is prohibited from taking into account various items, including:
- earnings from employment or self-employment;.
- housing-related costs;
- the mobility element of PIP and DLA (but not the daily living element of PIP);
- any disability related expenditure paid for with disability benefits. In Salford we offset any relevant DRE, maximise the person’s income, then apply the charge.
Otherwise, Regulation 15(2) gives the local authority the discretion to decide what it will or will not take into account when carrying out the financial assessment in order to decide how much to charge a person for care and support.
See Appendix 4: Specific Regulations for further information.
5. Appeals and Complaints
If the adult or their carer/ representative does not agree with the DRE amount they can appeal.
The Charging and Financial Assessment Team should examine the adult’s DRE calculations, to see if the amount is correct. This is a Stage 1 appeal, and will be reviewed by Service Manager of the Fairer Charging Team for Non-Residential Care.
If the outcome of the appeal is that the correct amount has been calculated, but the adult or their representative is still not satisfied with the decision, they can ask the local authority’s Decision Making Panel to review their case (Stage 2 Appeal). The Financial Assessment Team will let them know the process by which to do this. The panel is made up of managers from both financial, social work and legal areas.
If the adult or their representative are not satisfied with the panel’s decision, they can make a complaint (see Complaints), and then the Local Government and Social Care Ombudsman.
6. Further Reading
6.1 Relevant chapters
Charging and Financial Assessment
Appendix 1: Examples of Disability Related Expenditure and Sources of Evidence
| DRE Element | Examples | Evidence |
| Personal hygiene | Incontinence sheets / pads /pants | Receipts or invoices from supplier |
| Laundry costs | Increased washing and ironing due to impairment or medical condition, or specialist washing powders | Details required about number of loads of washing each week |
| Privately purchased care | Care costs not met by the local authority, including night care | Invoices or bills from the provider |
| Treatment to support wellbeing / prevent or reduce needs | Massage, hydrotherapy | Invoices or bills from the provider |
| Specific diet | Additional food costs specific to health needs | Receipts or invoices |
| Additional bedding | Incontinence | Receipts |
| Purchase and maintenance of equipment | Equipment includes hoists, powered and turning beds, scooter / wheelchair and stair lifts | Invoices or bills from provider (excluding any local authority funding) |
| Community alarm | Neck pendant with which to contact call centre in an emergency | Invoices / bills from the provider |
| Gardening maintenance | Pruning, weeding and mowing | Invoices / bills from the provider |
| Heating | Higher heating costs due to impairment | Bills from energy provider / bank statements |
| Home shopping delivery | Supermarket delivery or paying somebody to deliver shopping | Receipts |
| House maintenance | DIY, repair and general maintenance | Invoices / bills from the provider |
| Transport | Taxis, petrol or local transport costs due to impairment | Amounts over Disability Living Allowance/Personal Independence Payment Mobility considered together with receipts / tickets |
Appendix 2: Summary of Disability Related Expenses
DREs are the costs associated with having a disability or medical condition.
The local authority may take into account and reasonable costs of help or support a person needs to live independently.
This cost must also have been identified in the person’s care and support plan.
Allowances for disability-related expenditure will only be made where those costs are:
- met entirely by the person;
- specifically relate to the disability in question;
- supported by documentary evidence – receipts dating back up to six months (dependant on the local authority’s policy.)
- exceed ‘normal’ costs of living expenses (that is, what an adult without the disability would reasonably be expected to spend.)
If the cumulative amount of any disability-related expenditure claimed by a new or existing customer of Adult Social Care Services is in excess of a certain amount (generally £25.00 per week) then the financial approval of the local operations manager is required.
Additional factors considered in relation to a claim for these DREs are:
- will the person be receiving a personal budget that will incorporate some of the identified disability-related expenditure?
- should any of the additional disability-related costs be paid for by the NHS, such as chiropody, physiotherapy, incontinence pads, and transport to attend hospital appointments?
- are any items being provided through, or facilitated by, other directorates within the council?
Appendix 4: Specific Regulations
Earnings from employment or self-employment (regulation 14).
Housing-related costs (regulation 15(1) and paragraph 1 of Schedule 1).
The mobility element of PIP (but not the daily living element of PIP) (regulation 15(1) and paragraph 8 of Schedule 1).
Any disability related expenditure paid for with disability benefits (regulation 15(1) and paragraph 4 of Schedule 1).
