PAYING FOR CARE - St James's Place

PAYING FOR CARE
Helping you to make the right choices
PARTNERS IN MANAGING YOUR WEALTH
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Few of us will make major financial decisions without consulting an
experienced and professionally qualified adviser. For example, when
arranging a mortgage or planning for retirement most of us will have taken
the advice of an expert.
It’s amazing to consider that when it comes to paying for care there is so
little help and advice available; and yet for many families this will be one of
the most expensive commitments they make.
At St. James’s Place our Partners are selected for their professionalism,
knowledge and experience in advising families about their choices when it
comes to paying for care. This guide can help you to understand a little more
about paying for care, but it cannot replace the advice of our Partners.
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Introduction
Entering care or choosing care for an elderly relative is not something most
of us have very much experience in; indeed for most of us it is something
we will only do once. Your thoughts will inevitably be to make certain that
the right care is provided in the best setting, but you will also be aware that
the cost of care is an important factor.
Over the years care fees can quickly mount up and often this can have a
depleting effect on available funds. It would not be the choice of most
families for an individual’s entire wealth to be spent on care fees, if this
could be avoided. Indeed, the worst time to find out that you had choices
about paying for care is when the money has run out!
Choosing a care home
There are many factors to take into account when choosing the right
setting for care. A search on the Care Quality Commission website will
quickly reveal that there is often a bewildering choice of care homes in a
small radius of where you live.
If you need help in understanding the different care providers and what
they have to offer, we can introduce you to an organisation who can help.
They are experts in helping families find the right care. They will gain an
understanding of your care needs and personal preferences and help you to
narrow your search accordingly.
Types of care
There are two types of residential care homes, those with and those without
nursing. Care homes are suitable for those who need help with daily tasks,
and nursing homes are for those who also require medical attention.
For those with less acute needs, it may be possible to receive care at home.
This is known as ‘domiciliary care’.
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Care assessments
An assessment of the individual’s care needs will be carried out to determine
the level of care required. If medical care is needed an assessment as to
whether you qualify for full funding by the NHS or for a contribution to
the nursing care costs.
Having assessed the medical needs, a financial assessment will be carried
out to determine whether there is an entitlement to have your care partly
or fully funded by the local authority. A care package will then be drawn
up, recommending the most appropriate form of care and who will be
responsible for meeting the cost of the care required.

Who pays for care?
The financial assessment carried out by the local authority will determine
who is responsible for paying for care. A questionnaire will need to be
completed, detailing all of the capital and income available to you.
It is important that you take advice so that you know that the financial
assessment has been completed correctly.
When assessing how much capital you have, certain assets are ignored. In
particular, the value of your home is ignored if:
• Your spouse still lives in the property
• A relative over 60 resides there
• A disabled relative lives there
• A child under 18 lives there
• You are in the first twelve weeks of needing permanent care (please see
the twelve-week property disregard section later)
• Care is being provided on a temporary basis.
When considering the cost of care, it is important to note that the cost
is normally expressed as an all-inclusive cost. Although it may sound
expensive, it will include all food and drinks and bills like gas and electricity.
So when you deduct the costs of daily living from the cost of care, you
will have a clearer picture of the net cost. Once you deduct from this any
pension or other regular income, including certain state benefits, you will
then see whether there is enough regular income to meet the cost of care,
or whether there is a shortfall to be funded.
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State benefits and financial assistance
There are currently (2010/11) several state benefits and other sources of
financial assistance that may be available to you.
Attendance Allowance
This is payable when the individual has a disability, which means that they
require help caring for themselves. It is not means tested and is tax free. It
is payable at two rates: the lower rate is £47.80 per week and the higher is
£71.40 per week; this depends on the level of disability. This continues to
be paid even if the recipient enters a care home. It is important that this is
claimed and regularly assessed.
Twelve-week property disregard
Where there is a property and other assets of less than £23,250 (in England
and Northern Ireland with different limits applying in Scotland and Wales)
its value should be ignored for the first twelve weeks of entering care. The
individual will, however, be expected to give up all of their income, less a
personal expense allowance of £22.30 per week (in England and Northern
Ireland – again, different allowances apply in Scotland and Wales) to pay
towards the cost of care. If their income exceeds the local authority rate,
they will receive no assistance. Also, if the care home rate exceeds the local
authority contribution, they may be expected to make up the difference
during the twelve weeks.
Once the twelve weeks is over they will be expected to meet all the
care costs less benefits.
Deferred Payment Scheme
Once the twelve-week property disregard period is over, the local authority
may offer their Deferred Payment Scheme, whereby they will provide an
interest-free loan to meet the care fees until a house is sold or resident dies
if sooner. The local authority does not have to agree, but if it does, then it
would place a charge on the property for the amount of the loan.
The local authority is not allowed to charge interest on the loan during
the resident’s lifetime, which does make the option worth considering.
It can, however, result in a significant debt against the property over the
longer term.
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Registered Nursing Care Contribution (RNCC)
If you are entering a care home with nursing provision, you may be eligible
for RNCC, which is a contribution towards the cost of providing nursing
care. The RNCC is paid directly to the care home. It is important to check
whether the cost quoted to you includes the RNCC contribution or not.
Depending on the level of need, it is also possible that you may qualify for
NHS fully funded care. This is decided by the local primary care trust and
can be assessed at the same time as RNCC.
Cost of care
Laing & Buisson, the leading provider of market intelligence in the care
sector, has researched the cost of residential and nursing home fees across
the UK. The survey was conducted between April and June 2009 and was
based upon over 2,100 of the 14,000 registered private and voluntary care
homes for older people in the UK.
The costs of care outlined below are based on forecasts relating to the
period from 1 April 2009 to 21 March 2010.
Region
Average Nursing Care Fees
£ per week
England 715
Northern Ireland 554
Wales 611
Scotland 614
Region
Average Residential Care Fees
£ per week
England 495
Northern Ireland 453
Wales 422
Scotland 531
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Paying for care
Using capital to meet care fees
One option for meeting care fees is to place a lump sum on deposit and
withdraw funds to meet the care fees. While this is a viable option for some,
the main disadvantage is that, over time, the funds may become exhausted
in meeting the fees.
Once the capital has reduced to £23,250 (in England and Northern Ireland),
the local authority will then undertake an assessment to possibly provide
some financial assistance, but this will only be at the local authority rate.
Furthermore, the resident will be expected to give up all but a small amount
of income to meet these fees and if the income exceeds the local authority rate,
there will be no financial assistance. Also, some care homes may no longer be
prepared to keep the resident in their home if only the local authority rate is
being paid, meaning that they may have to move to another home (perhaps
to one run by the local authority). This can be a very distressing experience
and it is sensible when choosing a home to ask what the home’s policy is if the
money runs out and the home only receives the local authority rate.

Care fees plans
These are a specific type of investment, designed to meet the costs of care
where an income is provided in exchange for a lump sum. However, unlike
other types of annuities, the returns are based on the age and health of
the annuitant and they have many features and advantages specific to the
care market.
The main benefit of buying a care fees plan is that it will provide a guaranteed
income for life, irrespective of how long you live. This means that even if you
live longer than expected the income will continue; and you will therefore
have set a limit on the amount you will have to spend on care fees. On the
other hand, if you die earlier than expected then you will lose some of the
money you have paid for the care fees plan.
Many families are prepared to take the risk of a care fees plan because it
gives long-term financial certainty and peace of mind. For a given lump sum
investment you can protect the rest of the estate from the impact of care fees.
For some families the risk of early death is more than offset by the advantage
of financial certainty and peace of mind. It is a choice only you can make.
There are other features and benefits of a care fees plan:
Capital protection: This allows you to protect part of the cost of the
care fees plan in the event of death in the early years. If, for example,
50% capital protection is selected, then upon death 50% of the cost of
the care fees plan will be paid to the estate, less the total monthly care
fees already paid; if these payments exceed 50% then nothing is paid.
Tax free income: Where the care fees plan is paid directly to the care
provider, it is paid tax free.
Indexation: You can choose to increase the level of a care fees plan
each year by a set percentage, or in line with an index such as the Retail
Prices Index. Some care providers may agree to cap the annual fees
increase to the level of indexation you have built in to the care fees
plan. It is worth discussing this possibility with the care provider before
buying the care fees plan.
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Bed guarantee: Payments will continue to be made to the care
provider in the event of entering hospital for treatment. This guarantees
the care place in this situation.
Deferred option: This reduces the cost of the care fees plan, as the
income only commences after a deferred period, usually between one
and five years.
Flexible payment frequencies: This allows you to choose how often
the income is paid and is often designed to fit in with the care provider’s
requirements: for example, monthly, every 4 weeks or quarterly.
Inheritance tax advantage: If the estate will be subject to
inheritance tax, the amount of the investment required to buy the care
fees plan is in effect reduced by the 40% tax, which would have been
due, provided capital protection has not been selected.
Investment bond
An alternative to buying a care fees plan is the option to invest a lump sum
to generate an income to meet the care fees. Investment bonds can be used
for this purpose as they provide an easy-to-understand product with the
ability to take regular tax-deferred withdrawals of up to 5% of the amount
invested for up to 20 years. These withdrawals will be taxed when the
bond is eventually brought to an end, but they provide an income during
the 20 years without any immediate tax liability.
As with all investments used to fund income, there is always the risk that
the funds will be exhausted, especially if the level of income taken exceeds
the growth in the investments. In addition, there is the risk that care costs
could exceed 5% of the investment amount. This could result in you having
to make up the difference from other resources, or that larger withdrawals
need to be taken from the investment bond, which may be taxed.
Unit trusts
As an alternative to an investment bond, you may wish to consider
unit trusts instead. Unit trusts have a wide range of funds available for
investment and also have the benefit of paying income, with no additional
liability to income tax for basic rate tax payers.
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Combination
An alternative approach might be to combine two or more of the options
listed above. A care fees plan could be purchased with a three-year deferred
period, and the first three years’ care fees could be paid from capital.
Another option would be to consider using a care fees plan for some of the
fees and pay the balance from capital.
Whatever method you choose, you should be presented with all the facts
and choices in order that you can decide the right one for you. It is also
important to understand the care provider’s attitude if the funds run out
and the fees become payable by the local authority. Will they insist that the
family makes up the difference? Will they accept the local authority rate or
will they ask you to leave?
Inheritance tax planning
What to do with property
If you have a property to sell in order to meet the cost of care, there are a
few things to think about.
Firstly, renting the property out might be a better option than selling it.
The rental income could contribute to the care costs. One of the problems
with rental income is that it is not guaranteed and once tax, management
fees and repairs are factored in, the net return could be insufficient to meet
the shortfall in care fees.
You should also be aware that some buildings and contents insurance
policies become invalid if a property is empty for a certain period, often
31 days. Also, if the property is empty during the winter, you may need to
take action to prevent the pipes freezing, such as draining the water system
or leaving the heating on a very low setting.
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If you do wish to sell the property, we have links with two specialist
property management and funding companies who can help. They can
assist you with all matters associated with property sale and management
and can also provide funds over the short term to help meet care costs until
the property is sold.
If you are unsure whether you want to sell the property immediately, we
can arrange a loan secured on your property, which would enable you to
purchase a care fees plan. The loan and interest due on the loan are repaid
on death or earlier sale of the property.
We can help you make the right choices in relation to property.

Other matters
Looking after the financial affairs of another person
If the management of the financial affairs of an individual requiring care is
best given over to another person, then provided the individual is able to
give his or her consent, the most effective way of achieving this is through
a Lasting Powers of Attorney (known in Scotland as a Continuing Power
of Attorney). This document allows the legal power to act on behalf of
someone who is mentally or physically incapacitated. There are two types
of Lasting Powers of Attorney: Property and Affairs and Personal Welfare.
All Lasting Powers of Attorney must be registered with the Office of the
Public Guardian before they can be used.
Arranging a Lasting Power of Attorney is the only way to ensure that the
individual’s affairs will be looked after by the people they would wish, when
they are no longer able to do so. If no Lasting Power of Attorney is in place
before they become mentally incapacitated, an application would need to
be made to the Court of Protection for the appointment of a deputy to
act on their behalf. This could be both time-consuming and expensive and
their powers may be more limited than under a Lasting Power of Attorney.
Making a Will *
It is sensible to have a Will and to make sure that it is up to date and reflects
your current circumstances and wishes. It is extremely unlikely that the
laws of intestacy will distribute your estate in the way you would wish and
dying without a will imposes burdens on the family which can be avoided.
* Wills are not regulated by the Financial Services Authority. The writing of a Will
involves a service that is separate and distinct to those offered by St. James’s Place.
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Case study
Mr Dean contacted us after his 89-year-old mother was about to move
into a care home. She was about to be discharged from hospital following
a stroke and a fall and Mr Dean felt that she was too frail to live alone now.
Mr Dean helped us to establish the following facts:
Mrs Dean’s savings (mostly the proceeds from the sale of her house)
totalled £270,000.
She had a total net annual income of £14,124.
The care home fees were £675 per week (£35,100 per annum).
This left Mrs Dean with a shortfall of £20,296 – the amount between her
income and fees.
After assessing the facts and researching the options available Mr Dean
decided to purchase a care fees plan at a cost of £89,000.
While this is not refundable, the care fees plan guaranteed to pay Mrs Dean’s
care fees every year for the rest of her life. The family was aware that they
were in effect taking a financial gamble, but what was important to them was
the financial certainty and peace of mind that the care fees plan gave them.
The family also asked for our advice regarding investing the remaining
£181,000.
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What you can expect from
St. James’s Place
We will:
• Explain the care system and help you understand more about paying
for care
• Explain the benefits system and help you to claim the right benefits
• Advise you on the responsibilities of an Attorney
• Verify that the local authority has carried out the correct
financial assessment
• Advise on the twelve-week property disregard
• Advise in relation to nursing care and what to do if you feel that the NHS
should be paying for your care
• Advise in relation to the care contract, in particular helping you to
understand what will happen should the money run out and also the
implications of increases in care costs
• Advise on options for paying for care including:
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Paying directly from capital
Investing capital
Care fees plans
A combination of the above
• Help you to increase your income net of tax
• Protect age allowance (saving nearly £700 each year in tax)
• Simplify administration of the estate (avoiding the need to complete a
tax return each year, saving costs and keeping management simple)
• Provide investment advice
• Advise on inheritance tax planning.
Some of the above may involve services that are separate and distinct to those offered
by St. James’s Place.

Members of the St. James’s Place Wealth Management Group are authorised and regulated by the Financial Services Authority. The
St. James’s Place Partnership and the title ‘Partner’ are the Marketing terms used to describe St. James’s Place representatives.
St. James’s Place Wealth Management Group plc: Registered Office: St. James’s Place House, 1 Tetbury Road, Cirencester, Gloucestershire, GL7 1FP, United Kingdom
Registered in England Number 2627518
SJ 323
SJP3393-VR1 (10/10)