Residential and nursing care for adults and older people
Residential or nursing home for elderly people and people with disabilities who are unable to manage at home.
Charging for residential and nursing accommodation is set by guidelines issued regularly by the Department of Health (1.31MB PDF document).
You may wish to seek independent advice regarding residential homes and charging. Other organisations such as Age UK and Mencap are able to provide advice.
This page tells you about your right to choose the care home that you will live in once your needs have been assessed as best met by living in a care home. It also explains what you will have to do if you wish to choose a care home that is more expensive than the “cost” that the council is able to pay.
A care home could be a residential care home or a residential care home that also provides nursing care. Social work staff will tell you which will meet your care needs.
Your right to choose
You have the right to choose to live in a care home anywhere in England and Wales. You can obtain a list of care homes from the Care Quality Commission’s website at www.cqc.org.uk. If you have problems obtaining this information, your social worker or care coordinator will be able to assist. You may wish to live near to where you are living now or move to a different area to be closer to your family, or in a specialist home such as one run by a faith organisation.
There are four conditions that need to be met for you to have your choice of care home.
Suitability of accommodation
The care home you choose must be registered to meet your assessed needs. Social work staff will advise whether a care home is suitable to meet the needs that are set out in your care plan.
Cost
The council has agreed a “usual cost” that it is able to pay to meet your care needs and it will not usually be able to pay for your care home place if the home charges more than this.
If you wish to choose a care home that charges more than the council’s maximum level of support, your family or someone else such as a charity must pay the difference between this figure and the care home’s weekly charge. This difference is called a ‘third party top up’ and is explained later on this page.
Availability
The care home that you choose may not have a room available and if you do not want to choose another care home it may be necessary for you to go on a waiting list until a place becomes available. In the meantime, an alternative placement may be arranged by either NHS Waltham Forest or the Council.
Terms and conditions
The care home that you choose must be prepared to accept the Council’s contract for providing care.
If you are in hospital
You have all of the rights set out on this page if you are going to move from hospital to a care home, but there are some special rules for this.
Once the medical staff confirm you can be discharged from hospital then this should happen as soon as possible. The hospital will not be able to allow you to stay in hospital until a place becomes available. You will have the opportunity to talk with your social worker about what alternative arrangements can be put in place.
Your right to choose more expensive accommodation
Care homes have the right to set a weekly fee that is more expensive than the maximum level of support that the council has agreed. The care home may have chosen to do this for commercial business reasons or because it considers that it provides accommodation of a superior standard.
You can choose to live in that care home but only if there is a third party such as your family, a friend or a charity that is prepared to pay the difference between the care homes fees and the council’s “usual cost”. This is called a “third party top up”.
It is very important that you are aware of the following:
- You cannot normally pay the difference yourself from your income or savings, as all of your income is taken into account in your financial assessment for your weekly contribution toward the cost of the home
- Any change to your income, such as pension increases, will not change the amount of the third party top up. These will be taken into account when calculating your weekly contribution
- The council will review its maximum level of support each year to recognise increased costs but cannot guarantee that the care home will increase its costs at the same rate
- The third party top up will always be the difference between the care home’s fees and the council’s maximum level of support
- The third party will need to sign an agreement that they are willing and able to meet the difference in cost and will continue to do so throughout your stay in the care home
- If the third party is unable to continue to pay the difference you may have to move to another room within the care home or to another care home that charges fees that are within the cost that the council is able to pay
- Any move to another care home will only happen after a community care and risk assessment of your needs to make sure that the other care home is right for you
Other information
If you or your family have any other questions about your rights to choose a care home, please talk to your social worker.
There are a number of organisations who can provide independent advice and support to you. These include:
Age Concern Waltham Forest
Peterhouse Community Centre
122 Forest Rise
Upper Walthamstow E17 3PW
Advocacy 020 8558 5512
Hospital discharge service 020 8558 0455
www.ageconcernwf.org.uk
Counsel and Care
Twyman House
16 Bonny Street
London NW1 9PG
Advice line 0845 300 7585
Email www.counselandcare.org.uk
You can download the third party top up fee agreement by clicking here.
This document is produced in PDF format. To view it you may need to download a free copy of Adobe Acrobat Reader.
Residential Care for people with Learning Disabilities:
People with learning disabilities are sometimes placed in residential homes run by private and voluntary organisations. Some of these places are in the borough and others are outside the borough. The service's approach is not to place people far from their community, wherever possible. Click here for a list of approved residential homes.
Supported Housing Team
The Supported Housing Team provides training and support to adults with learning disabilities, who would like to move into long term supported accommodation and have a home of their own. Click here for more information.
Respite Care
Information on the Respite Care Unit and the Adult Placement scheme. Click here for more information.
This information is for people over 65 years, who may be considering living in a residential or nursing home. It is also for carers, social and health care professionals. It outlines how Waltham Forest Council advises and assists people who are assessed as needing residential or nursing care, to move into a care home.
Any person living in Waltham Forest who considers that they would benefit from community care services can request an assessment of their needs. As a local authority we are committed to enabling older adults to remain living in their own home, and offer a range of support services to assist and maintain safety. If following an assessment it is felt that support services cannot appropriately meet your, or your relative’s, needs then we will discuss alternative options, this might include residential or nursing home care.
If you have sufficient capital to fund your own care, you may choose to identify a care home of your choice and not approach the local authority for an assessment or support. Whatever your, or your relative’s, circumstances the following information is designed to assist you with making a decision. Individual situations are different, and you may need to get more information or request clarification.
Your questions
- What is the difference between residential and nursing home care?
- How can I move into a home?
- If Social Services agree to help what are the options?
- How much will I have to pay towards the cost of the home?
- How can I arrange my own care home?
- Can homes provide for my religious, cultural or language needs?
Contact us
You can contact us by:- Calling Waltham Forest Direct on 020 8496 3000
- Visiting your local Social Services office
Residential homes and nursing homes must be registered with the Care Quality Commission. Homes can only admit you if they are registered to meet the sorts of care need you have:
- Any home wanting to take people over 65 years must be registered for the category ‘Old Age’. People over 65 who are physically frail can be admitted to these homes
- Any home wanting to take people with other conditions, eg. dementia, mental illness, learning disability etc., must have the appropriate registration, ie. ‘Dementia’, ‘Mental Disorder’, ‘Learning Disability’ etc
Similarly, care homes providing nursing care (known as nursing homes) must be registered for the appropriate categories of care needs.
If you or your family want to search for a care home, check it’s registration or look at it’s inspection reports, you can visit the Care Quality Commission website and use the ‘advanced search’ option.
Level of care needs
Every person going into a care home will have a variety of needs and some people will need more care than others, and therefore the cost of placements will also vary. In Waltham Forest we have two levels of dependency for residential homes and for residential homes for people with dementia/mental illness.
Likewise people going into a nursing home will have different levels of need. In Waltham Forest, Social Services will pay a standard rate for your accommodation and board and the Primary Care Trust will pay a contribution to cover your assessed nursing needs. The RNCC (Registered Nurse Care Contribution, formerly known as "free nursing care").is assessed by health service staff and has three levels: low, medium and high band. The banded level of financial support provided is reviewed on an annual basis.
You, or your relative, will receive a letter from the panel advising you of the way in which the local authority can meet your assessed care needs.
If you have any concerns please feel free to discuss this with us.
Can care homes look after people with various religious, cultural and language needs?
Waltham Forest is a very diverse community, with people from many parts of the world. You may be from one of these communities but now need to live in a care home. The local authority accepts that these individual needs must be met if you are to be cared for properly in a home and will try to find a home for you that will meet these needs.
At the start, when we are assessing your need for a service, we will take into account those needs. Our social workers and managers come from a wide range of backgrounds, cultures and religions. Therefore we can understand and accept your individual needs.
The care homes, owned and managed by Waltham Forest council, have managers and care staff from the various communities living in our area. They will be able to provide the personal and social care that you require to meet your individual needs.
If we cannot meet your needs in this way, we will discuss with you alternative placements in the independent sector. Some care homes provide care only to people from a particular background, e.g. Jewish, Muslim, Christian, Irish, Afro-Caribbean or Chinese people. Not all homes are located in the Borough.
Social Services contracts with care homes
If you need our help to live in a care home we may offer you the option of moving to an independent care home. We will need to agree a contract with the home before you move into that home. This contract sets out the services you will get and how much the home costs. Once we release funds for your care home, we will start this process. You should not move into a home until you have been informed that this contract is agreed.
Some of the care homes in Waltham Forest and surrounding areas have existing contracts with the department. Your social worker or care manager can advise you about this.
If you are making your own arrangements, we will not be involved in the placement but you and your family should ensure that you get a written agreement about the services you will receive and their costs now and in the future.
Contact us
You can contact us by:
- Calling Waltham Forest Direct on 020 8496 3000
- Visiting your local Social Services office
There are both registered residential care homes and nursing care homes in Waltham Forest. Some of these are run by Waltham Forest Council and others by independent private owners.
The Care Quality Commission can provide you with up to date information on the residential care and nursing care homes in Waltham Forest and elsewhere in the country.
This includes details such as inspecting ratings and reports. You can search by the type of care you or your relative need, by post code and how it is rated.
Residential care homes run by Waltham Forest Council
Waltham Forest Council owns and runs seven residential care homes within the Borough. These homes are registered to care for frail, older people and older people suffering from dementia or other mental disorders. A number of the homes are registered to care for more than one group. The homes are:
- Alliston House
- George Mason Lodge
- Francis House
- Flaxen Road
- Mapleton Road
Residential care homes run by independent providers
There are 21 independent, privately run residential care homes in Waltham Forest. These homes are registered to care for frail older people, older people suffering from dementia or other mental illnesses. A number are registered to care for more than one group. You can search the Care Quality Commission's web site for details of independent residential care homes in Waltham Forest.
Nursing care homes
There are three nursing care homes in Waltham Forest, all independently owned. These homes are registered to care for older people with general nursing needs, and for people with nursing and dementia needs. You can search the Care Quality Commission's web site for details of nursing care homes in Waltham Forest.
Contact us
You can contact us by:- Calling Waltham Forest Direct on 020 8496 3000
- Visiting your local Social Services office
How much will I have to pay towards the cost of my care home?
The Residential and Nursing Home Panel will have decided the category and level of care you need. This will determine the ‘weekly contract cost’ of the care home. You will be financially assessed to contribute towards the cost of your care from your income and capital. The balance of the cost will be paid for by Social Services, and in the case of nursing homes a contribution from the local Health Service RNCC (Registered Nurse Care Contribution, formerly known as "free nursing care").
If you have enough weekly income to pay the full cost of the home and still have the government defined ‘weekly personal allowance’ left over, then you will be expected to pay the full cost of your care home fees.
Your income from state benefits, private pensions, dividends, etc will be taken into account in working out your contribution. However, if you have capital above £23,000 you will be expected to pay the full cost of the home (this figure is for 2009-10 and subject to yearly change). Also, some of your savings below this figure will be taken into account. If you have a spouse, then we will take their financial needs into consideration. Financial assessments are carried out by our Financial Assessment Unit in accordance with the Government’s ‘Charging for Residential Accommodation Guidelines’.
Top-up payments
If you identify a home that is above the maximum level of financial support a top-up payment must be made to the home.
If you have a property to sell and are only entitled to the property disregard of up to 12 weeks, then you yourself are allowed to pay the top-up from the start of the placement.
However, if you have no savings or property and are relying solely on your personal contribution and Social Services to pay, then the top-up can only be paid for by a third party, e.g. family, friend, charity etc – you cannot pay the top-up yourself. If you do not have a relative who can meet a third party top-up then we would advise that you identify a home that comes within the Local Authority fee levels.
Property disregards
There are exceptions to the above guidance:
12 week disregard of property
If you have no savings above the agreed limit, but have a house then you are entitled to some financial help during the first 12 weeks of your stay in a care home. The value of your house is disregarded (not taken into account in the financial assessment) for a maximum 12 weeks after you go into a home. However, if you a little savings/investments above the nationally-agreed capital limit, or if you sell you property before the 12 weeks are up, then you will not be entitled to the full 12 weeks disregard. After the property disregard period, you will be expected to meet the full cost of your care home.
If you have enough savings to pay for the full cost of your home for the first 12 weeks and have a property to sell, then you should arrange your own care.
Total Disregard of Property
The value of your home will be totally disregarded if:
- Your stay in residential care is a temporary one, eg. if your carer has to go into hospital for a period of time. This will have to be agreed with us before you move in
- Your spouse or partner, who lived with you as if you were married, still lives there
- A close relative, who is over 60 or who is disabled, still lives there
- A close relative, who is under 16 and whom you are legally liable to support still lives there
- Your ex-spouse or partner is a lone parent and still live there
If your home becomes vacant, then all or some of it’s value will be taken into account in assessing how much you will pay toward your care. This will apply from the point that the house became vacant and not backdated to the start of your stay in a care home. However, the 12 weeks disregard rule does not apply, as that only relates to the first 12 weeks you were in a home.
If you have a second property that is not your main home, then the above disregards do not apply, and it’s value will be taken into account from the start of your stay in a care home.
If you are unable to access your income and capital
You may have enough money to pay for your own care. However, due to physical or mental incapacity, you may not be able to manage your finances. In such cases, the local authority can provide short-term assistance to enable you to move into a care home. We can provide you with a place in one of our homes, or if this is not possible we can place you in an independent home. The local authority will pay for the home, but will invoice you for the cost of care, and once your money becomes available the local authority will expect that you pay back the care costs in full and then start paying the care home directly.
There are four main ways you can be helped if you cannot manage your own finances:
- Appointee-ship: This is used to collect benefits. If you are physically unwell you can appoint someone to collect and manage your state benefits
- Power of Attorney: If you are physically unwell, but mentally well, you can appoint someone to deal with all your financial affairs. However this stops if you become mentally unable to manage your affairs
- Enduring Power of Attorney: If you are physically unwell, but mentally well, you can appoint someone to deal with all your financial affairs. However, this form continues even if you become mentally incapable of managing your affairs. Your Attorney should at that point register with the Court of Protection
- Court of Protection: If you are mentally unable to manage your own affairs and have not appointed anyone to do so, someone can apply to the Court of Protection to become your receiver. This allows them to manage your affairs under supervision of the court but does not transfer ownership of property to them. A relative, friend or solicitor can become a receiver. If there is no-one available, the local authority, through it’s Finance department can be appointed as receiver
Click here for more help and advice from Counsel and Care.
Please note: It is always advisable to seek proper financial and legal advice when dealing with your own or other’s people’s finances.
Paying for your care home yourself
If you have any or all of the following you will pay the full cost of your care home or be able to organise your own care home:
- If you have savings/investments and/or property above the government defined amount then you will be expected to pay the full cost of your care home
- If you have enough income from pensions, interest, dividends etc. to pay the cost of home, leaving you with the nationally agreed personal allowance, then you will be financially able to organise your own care home
- If you have enough capital, i.e. savings, shares, other investments etc. above the nationally agreed limit, (in 2009-10 £23,000) then you will pay the full cost of your care home and could arrange your own care. If you only have a little above this limit, it would be advisable to get information and advice about how to proceed.
Contact us
You can contact us by:- Calling Waltham Forest Direct on 020 8496 3000
- Visiting your local Social Services office
We will offer you a placement in a home that meets your assessed needs. Also, the home must be registered with the Commission for Social Care Inspection to meet your needs. All residential homes and nursing homes are registered and inspected by the Commission. Click here for more information.
If you need a place in a residential home we can offer:
- A place in a residential home owned and run by Waltham Forest Council
- A place in an independent home
- Funding for a placement in an independent residential home
In some circumstances we will discuss with you the possibility of transferring to a transitional or intermediate care placement.
If you need a nursing home we can offer:
- A place in an independent nursing home, purchased by Waltham Forest Council, as part of a ‘block’ contract, or
- funding for care commissioned in an independent care home
Prior to the local authority funding care in a registered care home, the following would need to be confirmed:
- The home must be registered with the Commission for Social Care Inspection
- The category of home is suitable for your assessed care needs
- The home does not cost more than the agreed maximum levels of local authority support
- A contract, setting out the conditions of your placement is agreed
If a placement costs more than the local authority maximum levels of support, a ‘top-up payment’ can be paid by a relative, but this must be agreed in writing.
You may not need to ask Social Services for help to go into a care home. However, if you are undecided or if you are not sure about your options or the alternatives you can ask for information and an assessment of your needs. This can help clarify the best way forward for you in the immediate and longer term.
If you are likely to need nursing home care then you may be entitled to a continuing care assessment. Most people who require a nursing home should be entitled to some help towards the assessed nursing level of care, RNCC (Registered Nurse Care Contribution, formerly known as "free nursing care").
However, not everyone is entitled to local authority financial support to go into a care home. If you can make your own arrangements, then the local authorities will have no legal responsibility to assist you.
You can make your own arrangements if -
- you have enough available income and/or capital to pay for the home, and
- you can make the practical arrangements yourself, either alone or with help of your family, friends, voluntary organisations etc
Your finances
If you have enough income from pensions, interest, dividends etc. to meet the cost of a care home, leaving you with the nationally agreed personal allowance, then you will be financially able to organise your our care home. If you have enough capital, i.e. savings, shares, other investments etc. above the nationally agreed limit, (in 2005-2006 £20,500) then you will be expected to arrange and pay the full cost of your care. If you only have a little above this limit, it would be advisable to get information and advice about how to proceed.
How do I arrange residential or nursing home care
If you are able to make the practical arrangements yourself, either on your own or with the help of family, friends, voluntary organisations etc., then you may not need help from Social Services.
The tasks involved will include, finding a suitable home, visiting it yourself or getting your family to visit, agreeing a weekly cost and agreeing what services are covered, looking at the inspection reports and agreeing a written contract with the home.
Here are some organisations that can help with these tasks:
- Care Quality Commission - Information on how to find a care home and homes inspection reports
- Counsel and Care - Information on care in a home, particularly paying for and choosing care homes. Tel 0845 300 7585 or email advice@counselandcare.org.uk
- Age Concern Waltham Forest - General advice and information for the elderly. Tel 020 8558 0455
- Housing Care - This site aims to help older people make decisions about where to live, and any support or care they need. It will help you maintain, adapt or improve your home; find care or home help services; or move to retirement, or extra care housing, or to a care home
Contact us
You can contact us by:- Calling Waltham Forest Direct on 020 8496 3000
- Visiting your local Social Services office
What is residential and nursing home care?
These are services for people who can no longer stay in their own home safely, even with the support of family and social services, e.g. home care, meal on wheels, day care.
What is the difference between residential and nursing home care?
A residential care home will provide accommodation, meals and personal care. This includes help with washing, dressing, toileting and help getting up from bed and chairs. Community nurses, e.g. district nurses, will carry out any nursing tasks.
A nursing home provides the same services but has registered general nurses present at all times to supervise nursing tasks. Residents are usually more dependent than those in residential care.
You will be financially assessed to contribute towards the cost of care in a residential or nursing home. If you are assessed as needing nursing home care you will receive a contribution towards the cost of care from RNCC (Registered Nurse Care Contribution, formerly known as "free nursing care").
There is a third form of care called NHS Continuing Care. This is for people whose health needs are complex and unpredictable and require regular supervision by a member of the NHS multi-disciplinary team. Accommodation, personal and health care are provided by the Health Service. This type of care is a provided free of charge.
Moving into a care home
You can move directly into a residential or nursing home if:
- you have enough income or capital, i.e. savings and/or property, and
- you can make the arrangements yourself, with support of family/ friends
If you require help with either making the arrangements or with paying for your care home then you may be eligible for help from Social Services. You or someone acting on your behalf can request a community care service by contacting their local First Response Team, Hospital Social Work Team or older people's mental health team.
The team will carry out an assessment of your needs. This means we will find out what you can do for yourself, what you have difficulty doing and what activities you need help with.
Can anyone apply for an assessment or service from Waltham Forest Social Services?
In order to apply for any service you must be a resident of Waltham Forest. Visitors from another area must contact their local social services. Similarly, if you have moved out of Waltham Forest to live elsewhere you must apply to your new local authority.
If you are a resident of Waltham Forest, but are in hospital elsewhere, you can still apply to Waltham Forest Social Services for an assessment. Click here for more information on assessment of needs.
If we agree that you need to live in a care home what are the options?
We will offer you a placement in a home that meets your assessed needs. You will not be offered a place in a nursing home if an assessment determines you have needs that could be met in a residential care home. Also, the home must be registered with the Commission for Social Care Inspection to meet your needs. Click here for more information.
We can meet your assessed needs by offering you:
- Intermediate care
- A place in a residential home owned and run by the London Borough of Waltham Forest
- A place in an independent residential or nursing home as appropriate
In some circumstances we will discuss with you the possibility of transferring to a temporary, transitional placement until a long-term care placement is available.
Contact us
You can contact us by:- Calling Waltham Forest Direct on 020 8496 3000
- Visiting your local Social Services office
