Old people are paying widely different charges for essential home help because of where they live, causing many to live below the poverty line.
An Audit Commission report today shows for the first time how elderly and disabled people, with similar needs and equal ability to pay, could be charged anything from nothing to £120 for 12 hours of personal care depending on their postcode. In nearly one-third of local authorities, home care charges can leave people with less to live on than income support, the report shows.
Campaigners for the elderly said the post-code lottery of charges was unjust and discriminated against some of the most vulnerable people. They want the Government to issue clear national guidelines on charges and to stop putting people at risk.
"It is unacceptable that in a third of the country the most vulnerable elderly people are being forced to live in poverty simply to pay for the most basic care services," said Paul Burstow, Liberal Democrat spokesman for older people.
"As with the NHS care, home care is reduced to a lottery. The system robs people of their dignity and drives them into residential care. It is time the Government ended the uncertainty and put in place a system that is based on principles of equity and dignity."
In England and Wales more than 500,000 people have home care, which includes shopping, cleaning and personal services, such as help with bathing, dressing and night-sitting.
Nearly all councils, 94 per cent, now charge some fee for home care services, which raises £225m a year. In 1992, only 72 per cent of councils levied charges. The most common charging policy, covering 55 per cent of councils, combines means-testing with an hourly-based system.
The report authors said the Government and the Welsh Assembly should provide more guidance to councils on how to treat social security benefits, disability allowances, savings and partners' assets when setting charges.
"Many of the users of home care services are among the poorest and most vulnerable groups served by councils but the system means some may be put off from seeking services which would improve the quality of their life," said Andrew Foster, controller of the Audit Commission. "Clearer guidance is needed."
Gail Elkington, Help the Aged policy officer, said the report had finally helped to lift the lid on the "appalling discrepancies". She added: "We believe it is totally unacceptable that most disabled people often face the highest charges. It is a scandal that older people have been left in the lurch precisely at the time when they most need help."
Simon Wright, who chairs the Coalition on Charging and is Mencap's campaigns officer, urged the Government to take immediate action. "It is a disgrace that people have to make desperate choices between food, heating or care such as a weekly bath or help getting up in the morning," he said.
John Hutton, a Health minister, said the Government was committed to making the system of home charging fairer and more consistent, and called an urgent meeting with the main organisations.
"This report makes clear the way in which councils charges for social services needs to be improved," he said. "This report gives us the information we need to overhaul the system. We shall set out full proposals as part of the White Paper this summer."
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