CONTENTS
1. Introduction
This policy sets out Lancashire County Council’s duties under Section 30 of the Care Act, and the Care and Support and After-care (Choice of Accommodation) Regulations 2014 in supporting adults to make an informed choice where the care and support planning process has determined that they require a specific type of accommodation to meet their needs.
2. Policy Aims
This policy aims to support adults in their own homes and local communities to:
- live as independently as possible in their own home, or close to home, with safe and appropriate care and support if needed.
- have a say about where they wish to live, which will be responded to as far as reasonably possible within the context of the supply of suitable housing, affordability, and their housing rights.
3. The Legal Framework
An adult’s ability to make an informed choice is a key element of the care and support system. This includes where the care and support planning process determines that an adult’s eligible needs will be best met in a specific type of accommodation. Lancashire County Council is committed to providing a genuine choice wherever possible, and must provide for the adult’s preferred choice of setting within that type, subject to certain conditions.
The care and support planning process will identify the adult’s needs and preferences and determine what type of accommodation will best suit these needs. This could be, for example, a care home, shared lives, supported living or extra care housing.
In other cases, the adult’s assessed needs will best be met in their existing setting through the provision of other services such as occupational therapy and/or equipment provision, reablement (or other forms of intermediate care), homecare, or through the providing information and advice.
If accommodation is required to meet needs, Lancashire County Council must ensure that the adult has a genuine choice of accommodation, subject to certain conditions. At a minimum, this means that at least one type of accommodation is available and affordable within the adult’s personal budget and that there is more than one setting available.
4. Principles
Lancashire County Council will have regard to the following principles:
- Good communication of clear information and advice to ensure that well informed decisions can be taken.
- Clear and transparent arrangements for choice and any ‘top-up’ arrangements.
- Clear understanding of the potential consequences should ‘top-up’ arrangements fail. The Residential Care Charging Policy has more information on the implications of these types of arrangements.
5. What do we mean by ‘choice’?
“Choice” in this context only applies between providers of the same type of accommodation. Choice extends to the following types of accommodation: Care homes (whether residential, nursing or both, depending on the adult’s assessment) Shared Lives, care and support in shared housing and Extra Care housing settings.
What this means in practice is that Lancashire County Council must offer a choice between available accommodation providers. Where possible it will focus on options within Lancashire (or in neighbouring authorities, which may actually be nearer to the person’s current residence than other parts of Lancashire) within the same type of accommodation (e.g. more than one care home provider). It does not mean that Lancashire County Council must offer an extended choice of different providers across different types of accommodation (i.e., a choice of more than one care home and more than one Shared Lives setting, etc.). “Choice” in this context only applies between providers of the same type of accommodation.
Care and support planning will determine the most appropriate type of accommodation and will then give the adult an opportunity to express a preference about the setting in which their needs are to be met.
The regulations and guidance on choice of accommodation and additional costs apply equally to those entering care for the first time, those who have already been placed by Lancashire County Council; and those who have been self-funders, but because of diminishing resources are on the verge of needing support from Lancashire County Council.
6. Top Ups
The adult must also be able to choose more expensive accommodation if someone else – known as a “third party” (or in certain circumstances the adult themselves, known as the “first party”) is willing and able to pay the additional cost.
This additional cost is known as a ‘Top-up’.
Any additional payment must always be optional and never as a result of limitations in the local market which have led to a lack of choice. Detailed information on ‘Top-up’ fees is available in the Residential Care Charging Policy.
Arrangements to pay these ‘Top-up’ fees are subject to a full, legally binding written agreement between Lancashire County Council and the relevant party.
Only when the adult has chosen a more expensive accommodation can a ‘Top-up’ payment be sought. If no suitable accommodation is available at the amount identified in a personal budget, Lancashire County Council must arrange care in a more costly setting and adjust the budget accordingly to ensure that needs are met. Lancashire County Council must offer a reasonable alternative in this situation, it will not necessarily offer to meet the full costs of a chosen accommodation where there are less costly options available, albeit at a greater cost than the personal budget. In such circumstances, Lancashire County Council must not ask for the payment of a ‘Top up’ fee. When a ‘Top-up’ arrangement has been agreed, the placement cannot commence without the written agreement being returned to Lancashire County Council. See the Residential Care Charging Policy for more information.
7. Ordinary Residence
If the adult is assessed as requiring specified accommodation and they choose to be placed in a setting that is outside the Lancashire area, Lancashire County Council must still arrange for their preferred care. In doing so, Lancashire County Council should have regard to the cost of care in that area when setting the adult’s personal budget. See the Ordinary Residence guidance for more information.
8. Conditions on the Choice of Accommodation
Certain conditions govern the right to choose a specific setting. The adult must have the right to choose between different providers of the same type of accommodation provided that:
- The accommodation is suitable in relation to their assessed needs.
- To do so would not cost Lancashire County Council more than the amount specified in the adult’s final personal budget for accommodation of that type.
- The accommodation is available.
- The provider of the accommodation is willing to enter into a contract with Lancashire County Council to provide the care at the rate identified in the adult’s personal budget on Lancashire County Councils’ terms and conditions.
8.1 The suitability of accommodation
In exercising a choice, Lancashire County Council must ensure that the accommodation is suitable to meet the adult’s assessed needs and identified outcomes established as part of the care and support planning process.
Adults can express a preference about the setting in which their needs are met through the care and support planning process. This process considers both the adult’s needs and preferences. Once this is agreed, the choice is between different settings, not different types. For example, an adult cannot exercise the right to a choice of accommodation to choose a shared lives scheme when the care and support planning process, which involves the person, has assessed their needs as needing to be met in a care home.
8.2 The availability of the accommodation
Lancashire County Council has a specific duty to shape and facilitate the market of care and support services locally, including ensuring that there is a sufficient supply.
Lancashire County Council is committed to ensuring adults will have a say about where they want to live, which will be responded to as far as reasonably possible within the context of the supply of suitable housing, affordability and their housing rights.
As a result, the adult should not have to wait for their assessed needs to be met. However, in some cases, a short wait may be unavoidable, particularly when the adult has chosen a particular setting that is not immediately available. This may sometimes involve putting temporary arrangements in place – after taking into account the adult’s preferences and securing their agreement – and placing them on the waiting list for their preferred choice of provider. Such arrangements can be unsettling for the adult and should be avoided wherever possible.
8.3 Temporary arrangements
In such cases, Lancashire County Council must ensure that adequate alternative services are provided in the interim and be clear on how long the interim arrangement may last for.
In establishing any temporary arrangements, Lancashire County Council must provide the adult with clear information in writing on the detail of the arrangements as part of their care and support plan. As a minimum this should include the likely duration of the arrangement, information on the operation of the waiting list for their preferred accommodation and any other information that may be relevant.
If any interim arrangement exceeds 12 weeks, the adult may be reassessed to ensure that both the interim and the preferred option are still able to meet their needs and that this remains their choice.
8.4 If the adult wants to remain in the interim setting
In some cases, an adult may decide that they wish to remain in the interim setting, even if their preferred setting subsequently becomes available. If the setting where they are temporarily resident is able to accommodate the arrangement on a permanent basis this should be arranged and they should be removed from the waiting list of their original preferred setting.
Adults who contribute to the cost of their care (following a financial assessment) must not be asked to pay more than their assessment shows they can afford, Lancashire County Council must make clear the consequences of this choice to remain, including any financial implications, before making the interim arrangements permanent.
8.5 When choices cannot be met
While Lancashire County Council should do everything it can to meet the adult’s choice, there will inevitably be cases where choice cannot be met (for example if the relevant provider does not have capacity to accommodate the adult). In these cases, Lancashire County Council must set out in writing why it has not been able to meet that choice and should offer suitable alternatives (some elements of hospital discharge, such as the Avoiding Long Stays in Hospital Policy (Lancashire & South Cumbria Integrated Care Board, under development), may be exempt from this). The Complaints Procedure should be made available as well as how the decision may be reviewed.
8.6 When the person refuses the setting
Lancashire County Council must do everything it can to take into account the adult’s circumstances and preferences when arranging care. However, in all but a very small number of cases (such as where an adult is being placed under guardianship under Section 7 of the Mental Health Act 1983), the adult has a right to refuse to enter a setting whether that is on an interim or permanent basis.
Where an adult unreasonably refuses the arrangements, Lancashire County Council is entitled to consider that it has fulfilled its statutory duty to meet needs and may then inform the adult in writing that as a result they need to make their own arrangements. This should be a step of last resort, and any risks posed by such an approach, for both the adult concerned and Lancashire County Council, should be considered. Should the adult contact Lancashire County Council again at a later date, their needs should be reassessed and the care and support planning process reopened.
8.7 Contractual terms and conditions
In supporting an adult’s choice of setting, Lancashire County Council may need to enter into a contract with a provider that they do not currently have an arrangement with. In doing so, they should ensure that the contractual conditions are broadly the same as those they would negotiate with any other provider whilst taking account of the individual circumstances.
9. Sourcing and Arranging Accommodation
For more information and assistance in sourcing and arranging accommodation contact Lancashire County Council Care Navigation Service (see Local Contacts).
