Disability Related Expenditure - updated March 2024 v4
Disability Related Expenditure
Definition statutory guide page 1
Letter to send to Local Authorities for reassessment of DRE page 2
Letter to send to local authorities to dispute care charges page 2A
DRE List Statutory Guide page
3
DRE Advocacy List page
4
AGE UK DRE List page
7
DRE Case Law page
10
Norfolk Judicial Review easy read link ` page
13
Local Government circular link page
13
Personal Expense Allowance (care home) page
13
Minimum Income Guarantee page
13
NAFAO doc link page 15
Diagram of Social Care Needs page
15
Mid Map of DRE presentation
training notes page 16
Dre pictorial guide annex c page 17/18
Definition: Disability Related Expenditure
Statutory Guidance (RV Islington)
39) Where disability-related benefits are taken into account, the local
authority should make an assessment and allow the person to keep enough
benefit to pay for necessary disability-related expenditure to meet any needs which
are not being met by the local authority.
40) In assessing disability-related expenditure, local authorities
should include the following. However, it should also be noted that this
list is not intended to be exhaustive and any reasonable additional costs
directly related to a person’s disability should be included:
Disability Related Expenditure Resource
Here’s a
letter you can use to send asking for your social care department to review
your Disability related expenditure. After which you'll find a list that you
may wish to go through and see if relevant add to the letter.
Search: Email (County or Borough name) social care in search bar.
Email address:
Date:
Dear (Local Authority) Social Care.
I am writing to enquire about having my financial assessment redone. The
reason for my request is that I have been recently informed by other people
with disabilities what their Disability Related Expenditure is. Specifically,
the items (not full list) that are included in Annexe C treatment of income of
the Statutory Guidance under the Care Act 2014. I would also like you to
consider these items that I believe fits the criteria for disability
expenditure as they relate to my needs. Some of these items may seem standard
and this may be correct for non-disabled people, however I believe that these
are very specific to me and my conditions.
List: …
Any costs that are taken off must also be backdated as I believe I was
incorrectly assessed, the authority is also responsible under the guidance on
ensuring that the advice is provided.
I look forward to receiving your response.
Regards
(Names)
(Address)
-----------------------------------------------------------------------------------------------------------------------------
ADDRESS of Authority & person’s name (from letter received)
[DATE]
[REFERNCE NUMBER]
Dear Local Authority Social Care/Finance Department – [NAME]
Dispute
of Social Care Charges Owed
I am writing to you with regard to the letter received from
you dated [ ]. The letter
is asking for a sum of [
] for charges calculated by yourselves for my Social Care Provision.
Please acknowledge that this matter is in dispute, due to
the following Disability Related Expenditures (DREs) which haven’t been deducted
from my charges since [start of assessment date].
List of DREs cost
of items x by weeks [if relevant].
Should you wish to not accept these DREs please give a
written explanation as to why not, considering the items relate to my
disabilities, as detailed in the Statutory Guidance of the Care Act Annex C. Please
also take this as a Statutory Complaint which I would like investigated, and
within the times frames and stages imposed within The Local Authority Social Services and National Health
Service Complaints (England) Regulations 2009.
Until such investigations
have occurred, I would like the matter to be on hold, any further
communications could lead to a potential incident under the harassment of debtor’s
provisions under the Administration of Justice Act section 40, as continuous
letters without going through the statutory complaints process and legal avenues will potentially
cause me distress.
After the investigation if
the authority continues to feel the money is owed, I will be happy for you to
send me an appropriate county court summons, which I will then institute the
right to dispute, via legal representation along the lines of this letter. If
successfully challenged this could lead to a claim for legal costs against the authority.
Yours sincerely [if sent to
a named person]
[Your name]
Disability
related expenditure (Not exhaustive list)
Disability Related Expenditure
(DRE)
Additional
Clothing Such as extreme wear and tear of clothing because of your impairment bedding
Such as incontinence
Additional
Footwear Such as footwear being ruined due to your impairment
Community
Alarm Such as a pendant worn around your neck to keep you safe
Gardening
Costs Such as pruning, weeding and keeping your garden tidy
Heating
Costs your heating costs are higher due to your impairment Bills from energy
provider/bank statements
Home
Shopping Delivery Supermarket delivery or paying somebody to deliver shopping
House
Maintenance DIY, repair and general maintenance of the property
Treatment
to support Well-being Such as hydrotherapy and massage session
Personal
Hygiene Incontinence pads/pants Such as incontinence pads/pants
Laundry
Costs Higher laundry costs because of your impairment medical condition Details
required about number of loads of washing each week
Privately
Purchased Care costs not met by the Council
Specific
Diet Extra food costs specific to your impairment Receipts or invoices
Short
break whilst your carer is away Such as staying in accommodation to suit your
Transport
Costs Taxis, petrol or local transport costs because of your impairment Amounts
over Disability Living Allowance/Personal Independence Payment Mobility
Purchase
& Maintenance of Equipment includes hoists, powered and turning beds,
scooter/wheelchair and stair lifts Invoices or bills from provider (excluding
any Council funding)
Wheelchair insurance
Community Alarm Electric and gas
30 % (Heating, Laundry due to arthritis/pain/health)
Electrical
Gadgets – all of which use more electricity than non-disabled people would need
to use
Recliner chair/Bed
DRE Advocacy List
Mobile – needed for safety
reasons
Computer/Broadband –
social/voluntary activities /computer equipment (mouse/dropped regularly and
needing replacement)
NHS Bed?
Stair lifts?
Door opener/Intercom/remote
control door opener & batteries
Closimat toilet uses extra
electricity and water
Wheelchair charging
Mobile phone charges
Adapted Car – uses extra diesel -
Replacement
Equipment aids Costs
Heat pads
Hot water bottles
Bedding
Cushions
Lap Trays –
activities/meals/computer
Pillows
Special mattress/ covers for
incontinence, replacement due to lifting mechanism
Charging of hoists
Clothes – underwear /jeans –
without seams for pressure sores and comfort
Shoes and socks due to swelling
and DVT
Wheel chair covers
Wheelchair bags
Portable urine bottles
Extendable Knife fork spoon
Bibs
Tens Machine – Batteries &
Pad
PA Costs
– Hand wash
– Alcohol gel
– Toilet roll
– Hot water
– Kettle
– Drinks
– Protective/medical gloves and
aprons
– Transport costs in order to
escort on public transport
– Breakages (insurance for
accident or damage)
– Holiday costs of taking PA as
well – 1 week allowed
Live
in Carer potential costs
Carpet
Electric costs
Gas costs
Laundry
Showers
Bedding
Food
Heath/Medical
Travel to
GP, Nurse and hospital appointments
Hospital– Neurology
- Blood clinic visit x
approx. 12 a year
– Eye Clinic
– Euro gynaecology
– Pain clinic
– Operations
– Chiropody
-Massage/physio
– Antiseptic Creams
Heart clinic
Breathing clinic
Eye clinic
General
Outgoings
Electric
Gas
TV costs
Shopping – internet deliveries
Food costs and dietary needs
including more frequent small meals or meals which may need to be left for
people to reheat.
Extra costs of things like
clothes and shoes – the difference between cheap ones -from-Primark and
something-which-actually-works.
Extra washing powder, more
expensive washing powders or fabric softeners.
Pet insurance if an assistance
dog
Rent above levels paid in
benefits
Mortgage payments if property is
larger than a non-disabled person would need. ie. Room needed for PA or
equipment storage
Water rates
Household insurance for
appliances relating to impairment
Servicing of any aids or
equipment
Wheelchair insurance
Gardening
Decorating
Cleaning
Having to put money aside for
future needs e.g. Repairs to equipment, deposit for Motability vehicle etc. (look
at last 2-3 years).
There is advice on the Age UK website,
of which this is an extract:
Taking disability-related
expenditure into account
If the local authority decides to
take into account your disability-related benefits, it must also take into
account your disability-related expenditure in the means test.
This is confirmed in Annex C of
the statutory guidance where it is stated that you should be allowed to
keep enough benefit to pay for necessary disability related expenditure to meet
any needs that are not being met by the local authority. A similar requirement
is made in the charging regulations.
Some local authorities
disregard set amounts to take account of disability- related expenditure
partly to avoid having to ask questions that might be considered intrusive. The
amount that is disregarded varies from authority to authority. However if you
consider your disability related costs are greater than this set amount you can
ask for a full assessment of your costs.
The statutory guidance
provides an indicative list of disability-related expenditure examples. It is
not possible for the list to be comprehensive as it will vary from person to
person. When being assessed to see how much you can pay, you should consider
everything you have to buy because of your disability. This could, for example,
include:
Extra washing, or special
washing power and conditioner for delicate skin;
Community alarms (pendant or
wrist);
special diet;
special clothing or footwear (or extra wear and tear);
Additional bedding;
Extra heating costs;
Gardening;
Household maintenance (if you
would normally have done it yourself);
Any cleaning (if not part of your
care plan);
Internet access;
Any care that social services do
not meet;
Buying and maintaining
disability-related equipment;
Factsheet 46 April 2015
paying for care and support at home
22 of 48
Any transport costs (both for
essential visits to the doctor or hospital, but also to keep up social
contacts).
It can be difficult to
prove you have extra costs if you have not actually incurred those
expenses, for example, if you have not put the heating on for fear of large
bills, or are not following a special diet because of the cost. Local
authorities should work out an amount considered to be normal expenditure on
heating, for example, for your area and type of housing to assist them in their
response to if you claim disability-related expenditure in this context, or
what you would spend if you weren’t avoiding it out of fear of high
expenditure.
There may be other
costs that should be accepted.
The courts have confirmed that
local authorities should not be inflexible but should always consider
individual circumstances. For example, an authority should not adopt a blanket
policy of refusing to acknowledge any payments made to close relatives, as
there may exceptional reasons for a particular arrangement. In one case the
local authority was criticised for not properly carrying out an assessment of
the person’s disability related expenditure by doing a home visit, and for
rejecting some items of expenditure such as swimming lessons and paying the
carer to accompany him on holiday. Such costs should be considered if they are
reasonable expenditure needed for independent living.’2
Additional suggestions
Communication aid configuration, mounting,
unmounting and charging up
Private therapies including
massage for either pain relief or anxiety
Dressings for self-injury and
extra water (OCD)
Ready meals when unable to cook
Pets – insurance and food – for
companionship and to feel safe.
CASE LAW
Local Government & Social Care Ombudsman cases
Lincolnshire County Council (21 007 887)
https://www.lgo.org.uk/decisions/adult-care-services/direct-payments
Summary: Mr B complains about the Council's decision not to allow him to use direct payments to employ his mother, who he lives with, as his personal assistant. We found fault as the Council has not properly considered whether there might be exceptional circumstances. The Council has agreed to re-consider Mr B's request and review its procedures.
London Borough of Croydon (21 001 174) – as per Norfolk Judicial Review
Council’s care charging policy is
discriminatory. She also complains the Council failed to properly consider her
disability related expenditure during a financial assessment. We find fault
with the Council for the delay in accepting her disability related expenditure.
We also find fault with the delay in the Council completing its review of its
care charging policy.
Differential impact of its charging policy on
the most severely disabled people. The council’s policy had set its Minimum
Income Guarantee (MIG) at the bare minimum.
Cambridgeshire
C Council not taking DRE in to account
PTSD, OCD –Not re assessed for
years food/caravan hobby/ DRE form difficult to understand not have relevant
info for him- so should have helped changed it. Also use light touch approach
as suggested by statutory guidance. And not do continuous yearly paperwork.
https://www.lgo.org.uk/decisions/adult-care-services/charging/18-019-337
Central
Bedfordshire Council in which a woman, who has significant disabilities, was
left without proper care and support because of a lack of proper information.
Clearer advice needed to help
service users negotiate benefits payments
It should also reconsider the
woman's disability related expenditure (DRE) and provide a clear
explanation of why it does not consider some costs arise from
her disability. The council should also pay the woman £5,000 to
acknowledge the impact on her being without adequate care and support for more
than two years and a further £2,000 to acknowledge the avoidable distress and
frustration caused.
N North Yorks County
Council has failed to carry out a financial assessment following Ombudsman investigation
htthttps://www.lgo.org.uk/information-centre/news/2020/mar/council-fails-to-carry-out-financial-assessment-following-ombudsman-investigation
The council had agreed to complete
the disability related expenditure assessment of a young woman, to
include her housing and transport costs, following her complaint to the
Ombudsman in 2018. However, despite
visiting the woman to assess her needs in July 2018, the council then failed to
share the assessment with the woman or her parents until the Ombudsman
intervened again in October 2019.
Essex County
Council to reconsider assessment of Disability Related Expenses
h https://www.lgo.org.uk/information-centre/news/2021/jun/essex-county-council-to-reconsider-assessment-of-disability-related-expenses
Essex County Council to reconsider
assessment of Disability Related Expenses the Local Government and
Social Care Ombudsman has found Essex County Council at fault in how it
considered two separate women's Disability Related Expenses (DREs).
The women both have Court Appointed Deputies to make decisions about their
financial affairs, because their disabilities mean they cannot do this for
themselves. Think of individual circumstances no good enough for council to say
we can do cheaper
Nottinghamshire man's care package reduced because of financial pressures,
Ombudsman finds
htt https://www.lgo.org.uk/information-centre/news/2020/jan/nottinghamshire-man-s-care- package-reduced-because-of-financial-pressures-ombudsman-finds
It should complete a new financial
assessment and consider all relevant Disability Related
Expenditure (DRE). It should also make a further symbolic payment of
£1,000 to the man's mother to acknowledge its failure to provide allocated
respite funds, review her carer's assessment and produce a support plan setting
out how her needs will be met. The Ombudsman has the power to make
recommendations to improve processes for the wider public.
C Cornwall Care
cost calculations criticised
htt https://www.lgo.org.uk/information-centre/news/2021/mar/cornwall-care-cost-calculations-criticised
Asking person to use personal expenditure to
a restrictive personal expenses allowance, rather than allowing him to spend
his money as he wished, within reason. Personal expenses allowances only apply
when the council itself is paying for care, not for people who fund their own
care. The Ombudsman is also reminding councils that they must disregard half of
a person's work pension when calculating how much they must contribute towards
their care,
North
Yorkshire 19 010 955
Lgo
ombudsman Feb 2020
15 month response for DRE
expenditure to long. Should consider at financial assessment stage.
Older people in
Solihull could be refunded incorrectly calculated care charges
ht https://www.lgo.org.uk/information-centre/news/2016/jun/older-people-in-solihull-could-be-refunded-incorrectly-calculated-care-charges
In this case, the LGO found Solihull Metropolitan Borough Council may have demanded charges from 63 older people in the borough after assessing their finances incorrectly. The LGO was contacted by the family of a man who had been charged the full cost of his care by Solihull Council because it had i
London Borogh of Enfield 20 Aug 24
Not giving enough support to family
London Enfield DRE 13 Feb 24
Didn't consider Dre properly or respond approaotely to care charges owed.
https://www.lgo.org.uk/Decisions/Archive?t=both&fd=2022-03-31&td=2023-03-31&c=1%2bAssessment+and+care+plan&dc=c%2Bnu%2Bu%2B&sortOrder=descending
Durham 02 jan 24
Distress caused not provided with care it assessed appropriately, failed to review and provide proper personlised budget, no choice but direct payments. Human rights not considered as part of complaints
https://www.lgo.org.uk/decisions/adult-care-services/direct-payments/23-003-726
Parliamentary and Healt ombudsman cases
Trust took too long-year to start
PHB complex learning disability child
1136
ic2 2016
Discharge from hospital of
dementia patient led to £4000 in care charges as incorrect assessment from
hospital
8
October 2019
Missed calculation of care plan
led to paying back £250,000 in care costs
Hardy
V Sandwell 2015 housing benefit case using
disability living allowance to say use that:
“In my judgment the Council’s
approach is an example of indirect or Thlimmenos discrimination because it
treats disabled applicants and their disability-related income in exactly the
same way as it treats others and their non-disability related incomes, giving
rise to unfavourable treatment to the disabled applicants. DLA(c) is not the
same as any other income, but is awarded specially to enable disabled persons
in need of personal care to cope better with their disabilities in the way they
see fit. Equally, the pattern of expenditure of a disabled person may well be
different and more difficult to predict than that of an applicant without a
disability, the needs of the disabled may not be consistent or regular and may
require considerable one-off expenditure, sometimes at short notice.
Stephenson,
R (on the application of) v Stockton On Tees Borough Council
England and Wales Court of Appeal
(Civil Division) Jul 26, 2005
Whether family payment rule should
be adhered to as a policy or rule. Policy - only must look at individual circumstances
DRE payable to daughter due to 80 mile round
trip travel and gave up part time job. Not just religious or –opens separate blog
Norfolk case - easy read https://haloabletec.blogspot.com/2020/12/lessons-from-norfolk-social-care.html
Suffolk Case: re Holiday costs for parent carer (mother) and sons pre judicial review application successful case is:
https://www.bailii.org/ew/cases/EWHC/Admin/2021/3368.html
simplified version of above
https://haloabletec.blogspot.com/2022/07/simplifid-read-of-pre-judicial-review.html
Rw v RBWM 2023 simplified read re DRE
https://haloabletec.blogspot.com/2024/03/disability-related-expenditure-case.html
Bolton DRE Case, other expenditure ie carers meals andentrance fees are DRE. Also re using pip as charges - is a choice They dont have to
https://www.bailii.org/ew/cases/EWHC/Admin/2024/699.html
Birmingham DRE - difernce in charging people who can't work- is discrimination however court decided against as Birmingham had just gone bankrupt.
https://vlex.co.uk/vid/r-w-v-birmingham-793916669
Compare above with this later article
https://amp.theguardian.com/uk-news/2024/may/01/birmingham-city-council-accused-of-making-cuts-based-on-imagined-data
Advocacy - if family member paying rent whilst living with family? If on going and can show.
NAFAO GUIDE TO
DISABILITY RELATED EXPENDITURE 2024/2025
NAFAO GUIDE TO DISABILITY RELATED EXPENDITURE 2024/25
HEATING ALLOWANCES
Annual inflationary update based on RPI Fuel index for November 2023. At this date fuel
prices had decreased by 23.1% in the last 12 months.
The figures are obtained from Consumer price inflation tables - Office for National Statistics
from the download "consumer price inflation detailed reference tables”. The figures are found
in Table 41 detailed reference tables - % change over 12 months.
Figures for 2024/2025 Standard
N East / E
Midlands
N West / W
Midlands
Single person - Flat/Terrace £2,123.77 £2,302.16 £2,571.57
Couple – Flat/Terrace £2,801.99 £3,034.24 £3,389.15
Single person – Semi
Detached £2,255.73 £2,445.22 £2,731.39
Couples – Semi Detached £2,977.92 £3,220.12 £3,597.26
Single – Detached £2,744.38 £2,972.95 £3,325.97
Couples – Detached £3,617.69 £3,919.77 £4,379.51
ALTERNATIVE HEATING ALLOWANCE
Ofgem published annual estimates of average energy usage by house size, which can then
be extrapolated to find the average energy bills by house size.
The estimate is calculated by multiplying the kWh use by the current average unit rates and
adding in the current average standing charges (correct as at)
Gas 7.51p per kWh
Gas 29.11p per day (£106.25 per annum) standing charge
Electricity 30.11p per kWh
Electricity 52.97p per day (£193.34 per annum) standing charge
Number of
Bedrooms
Gas usage
(kWh)
Electricity
usage (kWh)
Estimated
average
annual dual
fuel energy
bill
Low 1 – 2 7,500 1,800 £1311.96
Medium 3 – 4 11,500 2,700 £1833.71
High 5+ 17,000 4,100 £2595.56
INCOME / DISREGARDS
Mandatory minimum income disregards for non-residential care and support are published in
the Care and Support (Charging and Assessment of Resources) Regulations 2014, replacing
fairer charging allowances. Rates for 2024/25 can be found at
https://www.gov.uk/government/publications/social-care-charging-for-local-authorities-2024-
to-2025/social-care-charging-for-care-and-support-local-authority-circular
Disability Related Expenditure 2024/25
Residential Care
Personal Expenses Allowance £30.15
Single Adults
Allowance 18 – 24 25 – Pension
Age
Pension Age Lone Parent
Not entitled to
any premium
£87.65 £110.60 £228.70 £110.60
Entitled to CP £140.00 £162.95 £281.05 £162.95
Entitled to DP £136.45 £159.40 N/A £159.40
Entitled to DP +
CP
£188.80 £211.75 N/A £211.75
Entitled to DP +
EDP
£160.30 £183.25 N/A £183.25
Entitled to DP +
EDP + CP
£212.65 £235.60 N/A £235.60
Couples
Allowance Under Pension
Age
Pension Age*
Not entitled to
any premium
£86.85 £174.60
Entitled to CP £139.20 £226.95
Entitled to DP £121.65 N/A
Entitled to DP +
CP
£174.00 N/A
Entitled to DP +
EDP
£138.80 N/A
Entitled to DP +
EDP + CP
£191.15 N/A
** Where one partner is over state pension credit age the Pension Age MIG applies whether
the person being assessed is under or over that age.
Children
For each child the adult is responsible for that is a member of the same household an
additional allowance of £101.25
Non means tested disability benefits
Disability Related Expenditure 2024/25
Attendance Allowance - High £108.55 Lower £72.65
DLA Care - High £108.55 Middle £72.65 Lower £28.70
PiP (Daily Living Costs) - Enhanced £108.55 Standard £72.65
If local policy on DLA/AA disregard applies on higher rate DLA/AA, disregard difference
between higher and lower rate £35.90, unless in receipt of both day and night care.
DLA or PiP Mobility Components - Disregard fully
Armed forces and war pension payments to veterans
War pensions and Guaranteed Income Payments under the War Pensions and Armed Forces
Compensation schemes are disregarded in full apart from constant attendance allowance.
Armed forces and war pension payments to war widows and widowers
£10 a week disregard of War Widows and War Widowers pension, survivors Guaranteed
Income Payments from the Armed Forces Compensation Scheme, Civilian War Injury
pension, any War Disablement pension paid to non-veterans and payments to victims of
National Socialist persecution (paid under German or Austrian law)
ASSETS
Capital below £14,250 fully disregarded.
Tariff Income of: £1 per week for every £250 (or part of £250) above £14,250 and up to
£23,250 (if the upper capital limit is applied.). N.B. These are the minimum limits required by
guidance and councils can set higher.
EXPENSES
Mortgage payments/Rent - allow full amount less any means tested benefit
paid
Council Tax - allow full amount less any Local Council Tax reduction
applied
COSTS OF DISABILITY
Figures were only attached to fuel costs in the FC Guidance and the following are
recommended allowances for possible identified items and examples of reasonable evidence
requirements prepared by NAFAO. A 3.9% uplift has been applied based on the November
2023 CPI rate.
ITEM AMOUNT EVIDENCE
Community Alarm
System
Actual cost , if reasonable Bills from or payments
to provider
Privately arranged
care
Private domestic
support
Actual cost where this is not provided
as part of the care plan but the amount
is reasonable and necessary for their
care and support
Evidence of
employment
arrangement and/or
legally correct
payments to an
employee under UK
Disability Related Expenditure 2024/25
employment and tax
law. Where agency
arranged evidence of
billing and payment.
Specialist washing
powder or laundry
£4.74 per week The assessment or
care and support plan
may identify a need. If
not evidence from
other sources and
consideration of the
nature and impact of
any health problem or
disability may provide
a guide.
Identify more than 4
loads per week
Special clothing or
footwear/additiona
l wear and tear to
clothing and
footwear.
Additional cost for
bedding
Reasonable amount for extra cost
caused by disability
The assessment or
care and support plan
may identify a need. If
not evidence from
other sources, which
may include medical
evidence, and
consideration of the
nature and the impact
of any health problem
or disability may
provide a guide.
Evidence of purchase
and payment.
Internet access Reasonable amount for additional cost
due to disability
Evidence that costs
are higher due to
disability.
Evidence of purchase
and payment.
Transport costs
necessitated by
illness or disability
Reasonable amounts over and above
the mobility component of PiP or DLA.
Where support with costs are available
from other sources but have not been
used this can be taken into account in
considering reasonableness. For
example transport to hospital
appointments or council provided
transport to a day centre.
Evidence of payment
and purchase
Special dietary
needs
Reasonable amount where
demonstrated above average dietary
costs
The assessment or
care and support plan
may identify a need. If
not evidence from
other sources, which
may include medical
evidence, and
Disability Related Expenditure 2024/25
OFFICERS GOOD PRACTICE, TRAININGAND INDUCTION GUIDE VOLUME 5 ASSESSING THE COSTS OF DISABILITY
INDEX
VOLUME 1 Introduction, Legislation and General Guidance
VOLUME 2 Glossary of Terms
VOLUME 3 Charging Policies
VOLUME 4 The Financial Assessment Process
VOLUME 5 Assessing the Costs of Disability
VOLUME 6 Charging for Non Residential Care
VOLUME 7 Charging for Residential Care (excluding Property)
VOLUME 8 Charging for Residential Care – Property Issues
VOLUME 9 Financial Protection of Service Users
VOLUME 10 Information for Service Users and Consultation
VOLUME 11 Performance Management and Benchmarking
VOLUME 12 Fast Track Review and Complaints
VOLUME 13 An Introduction to State Benefits
VOLUME 14 Case Law
VOLUME 15 Counsels Opinion
VOLUME 16 Commissioners Decisions
VOLUME 17 Useful Documents, Sample information Leaflets and
Standard Letters
Contents
1. Introduction and Interpretation
2. The Fairer Charging Guidance
3. Identifying Costs of Disability
4. Dietary Costs
5. Continence Aids
1. Introduction and Interpretation
1.1 A simple interpretation of Costs of Disability would be expenditure that is incurred by a recipient of social care services that would not be incurred by someone who does not require social care services.
1.2 An example of this would be laundry, which is an everyday expense for us all, but if it was necessary to wash more frequently because on a continence problem or to use a commercial laundry then the additional costs incurred “above the norm” could be treated as a DRE.
1.3 That principle should be applied to any consideration for a DRE allowance.
2. The Fairer Charging Guidance
2.1 The Practice Guidance issued for consultation by the Department of Health, together with work commissioned by the Disablement Income Group “Disability-Related Costs and Charges for Community Care” was considered by a group of Local Authorities representing the Association . The intention was to provide a working tool that can be used to assist in calculating disability related expenditure.
2.2 This meets the advice contained within the Practice Guidance which
states:-
“The purpose of this practice guidance is to introduce some ground rules which Local Councils can follow to establish a much greater degree of consistency, quality and equity, than has hitherto been the case”.
2.3 The Practice Guidance tends to suggest a range of items which could be allowed as disability related expenditure but provides little help in the level of allowance that should be made. This will give an immediate risk of significant inconsistency between Local Authorities and the work of NAFAO has been to produce sums that could be allowed in given circumstances. This will be of considerable assistance in providing additional consistency though there will inevitability be a need for discretion to reflect any individuals’ exceptional circumstances. This is emphasised in the Practice
Guidance which states:-
“It is true that no assessment of an individual’s disability related expenditure, which is tailored to the individual’s circumstances, is quite the same as any other assessment because peoples needs vary”. highlight by @haloabletec
2.4 Taking into account the guide should be seen as just that but it does attempt to build on the Practice Guidance setting ‘ground rules’. The use of the work produced by the Disablement Income Group gives added credibility to the working tool as it is based on empirical evidence.
2.5 The statutory guidance states that:-
“Evidence of actual expenditure may be requested at the Council’s discretion. Where receipts have not been kept, a council may request that this be done for future expenditure. It is legitimate for Councils to verify that items claimed for have actually been purchased, particularly for unusual items or heavy expenditure”.
2.6 The Practice Guidance continues by stating:-“Generally the items allowed for should be based on actual past expenditure, though in some cases estimates of annual spending based on available evidence will need to be made. Spending not incurred, as in unmet need, should not be allowed. It is not practicable for charge assessments to take account of expenditure users would incur, if they had more income”.
2.7 The Practice Guidance further suggests that allowances for the cost of disability can be for a fixed period ahead, e.g., for one year, with no retrospective adjustment if circumstances change. Service Users must however, be clearly informed that they may seek a review at any time, if their disability-related expenditure changes. This will of course require supplementary evidence of the change of circumstances.
2.8 It is accepted that reasonable evidence should be produced and Service Users exercise responsibilities, i.e.:-“If despite a request to keep future receipts, users fail to do so, it
may be reasonable, where there is doubt as to whether the expenditure is actually incurred, for Councils not to include this in the assessment. In some cases, where bills cannot be produced, e.g., for heating, it may not be practicable to make an estimate”.
2.9 The statutory guidance states that some Councils may choose to disregard a standard element of disability benefits for all users receiving them. In such cases Councils might be tempted to do this and leave the onus on the Service User to request an assessment if they feel that their individual disability-related expenditure exceeds the standard disregard. The statutory guidance therefore further requires that if this option is chosen an assessment must be carried out to identify whether the individual user’s disability-related expenditure exceeds the level of the disregard.
2.10 Such a system would still incur the administrative costs of assessment but may give a standard disregard that is not necessary at that the level.
2.11 The statutory guidance requires that the process should not be too complex, should not be primarily paper based, and should not be carried out by post. The recommended method is by a personal interview in the Service User’s own home and carried out by staff trained to guide individuals through the process.
2.12 It would be good practice to offer the Service User the opportunity to be supported by a member of the family or a friend.
2.13 The Practice Guidance highlights a range of potential expenditure that should be allowed but only in the case of fuel costs were any figures attached to them. The association has updated these figures annually using the governments ‘’All Fuel Index’’ and using a November price base. (see above)
3. Identifying Costs of Disability
3.1 The work carried out by a group of members in 2003 is circulated in January/February each year with costs updated using RPI and at the November price base. The schedule will be included on the NAFAO Website (not accessible to the public added by @haloabletec) as soon as possible.
3.2 The following were identified as potential costs of disability.
Item Amount Evidence
Community Alarm System.
Actual cost unless included in Housing Benefit or Supporting People Grant.
Bills from Provider.
Privately arranged care.
Actual cost if Social Worker confirms requirement as part of the Care Plan and Council supported care is reduced accordingly. Signed receipts for at least 4 weeks using a proper Receipt Book.
Private Domestic Help.
Actual cost if Social Worker confirms requirement as part of the Care Plan and Council supported care is reduced accordingly. Signed receipts for at least 4 weeks using a proper Receipt Book.
Laundry/Washing Powder.
£2.55 per week. The Care Plan will have identified an incontinence problem. Identify more than 4 loads per week.
Bedding. Covered by NHS Incontinence
Service/Special Sheets. See also Section 3.7
Dietary. Discretionary as special dietary needs may not be more expensive than normal. See also Section 3.6, May seek permission to approach GP.
Details of special purchases.
Clothing. Discretionary depending on an individuals circumstances. Reference within the Care Plan to abnormal wear and tear of clothing.
Water. Excess Costs, where metered supplies, over normal consumption. Research on costs of similar properties.
Gardening. Discretionary based on individual costs on garden maintenance.
As for Private Care Home.
Item Amount Evidence
Powered bed. Actual cost divided by 500 (10 year life) up to a maximum of £2.95 per week. Evidence of purchase if available.
Turning Bed. Actual cost divided by 500 up to a maximum of £5.15 per week.Evidence of purchase if available.
Powered reclining chair. Actual cost divided by 500 up to a maximum of £2.35 per week. Evidence of purchase if available.
Stair-lift. Actual cost divided by 500 up to a maximum of £4.15 per week. Evidence of purchase without DFG input.
Hoist. Actual cost divided by 500 up to a maximum of £2.05 per week. Evidence of purchase without DFG input.
Holidays. Actual additional cost in excess of normal costs for a similar holiday divided by 52.Evidence of actual cost for comparison purposes.
Prescription Charges. Cost of an annual season ticket divided by 52 or actual cost of prescriptions, whichever is less.for those not eligible for free prescriptions.
Transport. Discretionary based on costs that are greater than those incurred by an able bodied person.Note: - Mobility Allowance cannot be included in the normal financial assessment as an income but the statutory guidance states that transport costs should be allowed necessitated by illness or disability, including costs of transport to Day Centres, over and above the mobility component of DLA if in payment and available for these costs. This implies that transport costs do not need to be allowed if Mobility Allowance is considered sufficient to meet such costs. Evidence in the Care Plan for the need for specialist transport.
Communications. Discretionary based on costs that would not usually be incurred Note: - Communication, e.g. telephone or internet access is often a normal part of everyday living and therefore evidence will be necessary to confirm that the cost is disability related. Evidence of exceptional expenditure.
3.3 The above could not possibly be an exhaustive list of disability-related costs and it is also reasonable to expect that relatively few Service Users would qualify for the full range of allowance. The following were identified for possible inclusion at the Conference in October 2008 and
will be added if appropriate.
Chiropody
Clothing
Window Cleaning
Insurance/Maintenance for Disability Equipment
Physiotherapy
Acupuncture
Aromatherapy
Transport
Mobile Hairdressing
Exceptional Holiday Costs
Ironing
Adaptation Costs for Vehicles
IT Costs/Satellite TV/Socialisation
Mobile Telephones
3.4 As stated earlier the assessment of disability-related costs should not involve the Service User simply completing a claim form. The allowances detailed above should therefore be use in conjunction with a tool that will draw on information gathered during the care assessment and identified in the Care Plan and supplemented by a series of questions that will enable the Service User to be directly involved in the process.
3.5 The following questions could be asked during the financial assessment but would also use information gathered from the care assessment, to prevent unnecessary intrusion for the Service User.
Questions To Be Asked To Assess The Costs Of Disability
Evidence from the Care Plan/Care Assessment
(i) Is the Service User incontinent? YES/NO
(ii) Has privately arranged care been identified? YES/NO
If yes at what weekly level?...................................................
(iii) Has privately arranged domestic help been identified? YES/NO
If yes at what weekly level?...................................................
(vi) Has exceptional wear on clothing been identified? YES/NO
If yes at what level?……………………………………………..
(v) Has exceptional mobility needs been identified? YES/NO
If yes at what level?……………………………………………..
(vi) Does the Service User require a wheelchair? YES/NO
If yes is it manual/powered (delete as necessary) YES/NO
Questions to be asked during the assessment visit.
(vii) Do you feel that your fuel bills are excessively high? YES/NO
NB: still sight of the last 4 bills irrespective of the answer.
(viii) Do you have a Community Alarm System? YES/NO
If yes is the cost covered by Housing Benefit or
Supporting People Payment?……………………………………………….
If no what is the weekly cost…………………………………...
(ix) Do you have any medical problems that require special diet? YES/NO If yes please give details....................................................…
.......................................................................................................………...................................
...............………………………………
(x) Do you have a metered water supply? (explain) YES/NO If yes what are the last year’s costs?...................................
(xi) Do you pay anyone to maintain your garden (if there is a garden)? YES/NO
If yes at what cost...............................………………………..
(xii) Do you have a powered bed? YES/NO
If yes what was the purchase price.......................................
(xiii) Do you have a turning bed? YES/NO
If yes what was the purchase price.......................................
(xiv) Do you have a powered reclining chair? YES/NO
If yes what was the purchase price.......................................
(xv) Do you have a stair-lift? YES/NO
If yes was it privately purchased.......................................….
If yes what was the purchase price.................................…...
(xvi) Do you have a hoist? YES/NO
If yes what was the purchase price.......................................
(xvii) Do you have specialist holidays due to illness/disability? YES/NO
If yes, seek details and costs.................................................
...............................................................................................................................………………
……………………………………………
(xviii) Do you pay for your prescriptions? YES/NO
If yes, how much.................. and how frequently..................
(xix) Do you feel that you have any other costs in your daily living that are caused by
your illness or disability or that help you to live
independently..............................................................……………..
.....................................................................................................................................................
..............................................................................................................................
........................................
4. Dietary Costs
4.1 Advise from Health Authority dieticians suggest that most medical conditions can be dealt with through a healthy diet which does not necessarily involve additional or exceptional costs. These include diabetes, weight reduction or low fat diets.
4.2 Others e.g. Celiac Disease which includes Crohns is managed through special products which are available on prescription through a GP.
4.3 Some e.g. Cystic Fibrosis and certain food intolerance conditions can result additional costs but these are quite easily confirmed through a GP opinion.
4.4 Certain other medical conditions may tend to involve special dietary needs but again not always and will not always be more expensive.This could include:
– people with a heart condition.
– people recovering from strokes.
– people with a physical disability or swallowing difficulties that requires food to be blendered or chopped to enable them to feed themselves.
– people with a food allergy or intolerance to certain foods.
– people with anaemia who might need to increase the amount of red meat into their diet.
– Pregnant women, especially those who are lactating
4.5 Other issues that could be relevant include:
– high protein.
– low fat.
– low cholesterol.
– weight reducing.
– physical ability to visit shops.
– local shops versus supermarkets.
– use of a third party to shop.
– delivery charges.
– availability and cost of special foods.
– ability to prepare and cook meals.
– use of ready meals.
– need to be fed by someone else.
4.6 It may be advisable to get a GP opinion who can refer on to the Dietary Service.
4.7 Annex 2 of the Fairer Charging Practice Guidance suggests using the Family Expenditure on food and non alcoholic drinks, which could be used as a threshold above which excess expenditure due to disability should be allowed.
4.8 Councils may feel that this is too uncertain and will be confused by simple choice of Service Users on what they purchase rather than specifically related to the Costs of Disability.
5. Continence Aids
5.1 There should be a Continence Advisor in each Health Authority, Local Authorities should make contact to determine what is provided in their area.
5.2 Continence Pads are provided free of charge – though the numbers available to individual patients may vary across the country.
5.3 Service Users may choose re-usable products which would require washing,usually for light sufferers and again practise may vary.
5.4 Service Users can have special sheets which are very absorbent but these require washing daily.
5.5 Main problem area is adult Learning Disabilities who may have problems in managing the pads especially overnight.
5.6 The same issues apply to clothing i.e. problem is manageable but may be costs if not managed well – particularly in adult learning disabilities.
5.7 Some people may choose to pay for products e.g. stigma associated with asking for free products. It will require a delicate decision on whether a council is prepared to make a DRE allowance if this is the case.
Mind Map of Training
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