COMMUNITY CARE / The user's guide: what the policy will do, who it will help, who pays: Rosie Waterhouse outlines the aims of the Government's legislation and explains how the changes will work

What is community care?

THE aim is to provide services and support to enable vulnerable people to live as independently as possible in their own homes or in a nursing or residential care home. It is an extension of an earlier policy of closing long-stay psychiatric hospitals to care for more people in the community.

Why is it being introduced?

DREAMT up in 1988 by Sir Roy Griffiths, the policy was outlined in the 1989 White Paper, Caring for People: community care in the next decade and beyond. It aims to reduce the numbers of people in residential or nursing homes when they could be cared for in their own homes. Its underlying purpose is to reduce the Department of Social Security's costs - which for people in independent homes had risen from pounds 10m in 1979 to pounds 1bn in 1989 - and transfer responsibility to local authorities.

Who does it cater for?

PEOPLE with problems of ageing, mental illness, mental handicap, physical or sensory disabilities, or drug or alcohol problems. Those with progressive illnesses such as Aids may also need community care. Councils must acknowledge that people from ethnic minorities may have different needs and problems. It is intended to provide 'respite' care to allow carers a break. A survey by the Office of Population Censuses and Surveys suggested that more than 6 million adults have some physical, mental or sensory disability, 4 million of them aged over 65.

How will people be affected?

PEOPLE who are already in homes before 1 April will not be affected. They will have 'preserved rights' to receive a higher level of income support to pay towards their accommodation. Disabled people who receive DSS benefits will still receive them. Those most affected by the new system will be people who need care or services for the first time after 1 April. New users could be elderly people who go into hospital after a fall or for an operation and need accommodation or home care on discharge; people who have become mentally ill or suffered a relapse or disabled people who need adaptations or equipment to enable them to live in their own home.

What happens after 1 April?

PEOPLE requiring community care services will apply to be assessed or be referred for assessment (by a GP, a social worker or hospital authorities) by a 'care manager' employed by the local social services department. The care manager will assess the needs, in collaboration with the 'user', other carers, the GP and any nursing or other caring agency. A care plan will be drawn up and the council will purchase services such as a home help or residential or nursing home accommodation. The client may have to pay a contribution depending on their income.

Who provides what?

THE local social services department will be the lead agency but the existing responsibilities of the NHS, housing and social services departments will remain much the same. Councils must spend 85 per cent of their grant on services and accommodation from the private sector. People being cared for at home may be assisted by a district nurse, a social services care assistant or a home help. The main types of services for those at home will include home helps, meals on wheels or luncheon clubs, day-centre facilities and adaptation or special equipment.

What do you pay?

HEALTH care is free. For social care there will be a charge. A nursing home bed arranged by a health authority comes free; if it is arranged by the social services either the council, the resident or family must pay. Someone in a nursing or residential care home with capital of more than pounds 8,000 will be liable to pay the full cost of accommodation until that capital falls to pounds 8,000 or less. Councils must disregard the value of a resident's own home if accommodation is not permanent or if the resident's spouse, child under 16 or elderly or infirm relative is still living in the home. Capital of pounds 3,000 or less will be ignored; an income of pounds 1 a week for every pounds 250 over that amount will be assumed, and contributions sought towards costs. For home care services, most councils will charge a weekly fee depending on income.

Does everyone have a right to be assessed?

NO. Anyone may ask to be assessed but the local authority will decide whether a person is in need of community care services. If you disagree with their decision, or you disagree with the care package of services drawn up by the care manager, or you are not happy with the quality of service provided, you may go to a complaints officer designated by the council, or to a review panel of three people, at least one of whom must be independent of the council.

How will it be funded?

THE Government has made available to councils in England a total of pounds 565m - pounds 399m special transitional grant to cover the sum that the DSS would have paid for residential care for about 110,000 new residents this year; and pounds 166m for additional responsibilities such as services for disabled people. Scotland is allocated pounds 61m, of which pounds 41m is the transitional grant, and Wales pounds 37.5m, of which pounds 27.5m is for the transfer. The Commons select committee on health says 20 per cent of authorities, mainly in inner cities and in London, will be under-funded and 80 per cent of social services directors say they will not have enough cash.

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