How your clients pay for care services - self payers vs Local Authority funded

When setting up your care business, it shouldn't, but does, make a difference as to how people pay for care that they receive. There are effectively three types of client:

• Those who pay for their own care and support
• Those who have the majority or all of their care and support funded by the Local Authority (LA)
• Those who receive a Personal Health Budget (with or without Continuing Healthcare Funding - CHC)

The above factors should make little difference to the quality of your service, but may require you to take slightly different approaches and keep slightly different records.

Personalisation

With the advancement of personalisation, the differences between those who pay for the own care and those who are local authority funded should blur even further. If a client has a Personal Budget and chooses to take it as a direct payment, then they will be the ones shopping around for the services they need. Ultimately, you might not really whether they were paying for it out of their own money or money that had come from the Local Authority.The current reality is that you are likely to know which of your clients are self-payers and which are Local Authority funded. Local Authorities have a duty of care towards their clients and this currently means that they often need lots of information about who's providing any care and/or support, and how it is being delivered.  In different areas of the country this is manifesting in different ways, some Local Authorities are supporting individuals to find their own solutions as long as it's in line with the outcomes identified in their care plan.  However, others are asserting much more control over how a personal budget is spent, sometimes requiring that only certain providers (or paid carers are used), specifying the contracting arrangement (ie all paid carers must be employees), or determining rates of pay.  Time will tell the legalities of such restrictions in relation to the Care Act 2014.  In the meantime it is worth finding out the approach that your local authority [LINK TO POSTCODE CHECKER]  is taking when you're setting up your business as this may determine the approach you take.

Local Authority Pay for Care

• In many cases the Local Authority pay for the service on behalf of the service user, in which case you will need to be aware of any payment terms that they may have
• Some Local Authorities, such as Oxfordshire, are using a payment card - this is a prepaid card (such as Visa) which comes pre-loaded with the individual's Personal Budget for a specific period (ie money is loaded up every four weeks)
• Many Local Authorities pay the Direct Payment of the Personal Budget into a specific bank account that the service user has set up. Service users then pay their paid carers or providers directly.
• Some Local Authorities have decided that Paid Carers must be registered with them prior to a service user using their services.
• Some Local Authorities have taken the decision that paid carers cannot be self-employed and must be employed by the service user.
• Service users and their families can choose to put in additional funding to purchase additional services.

Individuals Pay for Care - Self-Payers

• You invoice and they pay, by whatever method you and they agree upon
• HMRC regulations dictate whether a paid carer is self-employed or employed [LINK]
• In some cases, self-payers choose to purchase their services through the Local Authority, even though they are paying for it themselves. In these instances the Payment by Local Authority section applies

NHS Personal Health Budget - Pay for Care

• very similar to the Local Authority Paying for Care, however individuals or their families are not allowed to 'top-up' the pot.