1 Flashcards
What age does LTC apply to?
Any age
Who is regulator for financial services, sales and marketing?
FCA
FCA definition of LTC insurance
LTC is a long term insurance contract:
A - Provides benefits that are sold or held out as providing if the policyholders health deteriorates to the extent they can’t live independently without assistance and this will not change
B - benefits payable periodically for all or part of the period they need assistance
The benefits are services, accommodation, goods necessary or desirable for continuing care because the policyholder can’t live independently
Two types of LTC benefit
Immediate needs
Pre-Funded
How are all LTC products treated regardless of structure?
Consistently
Who provides cover to LTCI market?
FSCS
What rules book apply in most part to LTCI?
Insurance conduct of business source book (ICOBS)
Different sources of care: (7)
- Domiciled care - self or state funded
Care in individuals own home (social care)
Different sources of care: (7)
- Sheltered accommodation - self or state funded
Retirement village so independent living but support on hand if needed
Different sources of care: (7)
- Immediate care - state funded
- 4 requirements to be sent home
Short period of intensive support (usually at home after leaving hospital) e.g. suffered a heart attack so get nurse care. To be sent home must meet requirements:
- patient would otherwise require extended and inappropriate care
- needs been assessed
- focus on achieving a written outcome to maximise ability to live independently
- time limited, 6 weeks usually the maximum but can be extended by 6 weeks
Different sources of care: (7)
- Respite care - state funded
Gives support to carers or nurses through NHS or LA to give support to carers such as a relative or neighbour to give them a break e.g. cater comes in for a couple hrs every day
Different sources of care: (7)
- Care home without nursing - self or state funded
Old people’s home which provide personal care but not nursing care so for people who need looking after but not medical professionals
Different sources of care: (7)
- Care home with nursing - self or state funded
Nursing home so have access to registered nurses if needed
Different sources of care: (7)
- Hospital- state funded
When needs can’t be met in a care home with nursing then may need to go to hospital but not a long term solution
Different sources of care: (7)
- Elderly mentally ill (EMI) - state or privately funded
Support for those with illnesses such as Alzheimer’s or dementia. May involve clinical commissioning group setting aside certain resources such as hospital beds
Who can request to the LA that their care needs are assessed and under what act?
Anybody
Care Act (2014)
Who must care homes register with and is the independent regulator of ‘health and adult social care’?
Care Quality Commission
4 duties of Care Quality Commission
- Register care providers
- Monitor, inspect and rate services
- Take action and protect people using services
- Speak with independent voice and publish views on major issues
Who is responsible for LTC?
Individual and/or local authority.
Not NHS as they are responsible nursing care and cost, if required
NHS continuing health care (NHSCHC)
Care required for someone after hospital e.g. at home or in a hospice. Cost covered by NHS.
Who is entitled to NHSCHC?
Anyone who meets care needs criteria. Not means tested.
What is the only level of nursing care that the LA can provide?
Incidental nursing care
What level of nursing do NHS provide?
Registered nursing care
An individual should qualify for NHS funded nursing if (2)
They are registered in a care home registered to providing nursing care
And
They don’t qualify for NHSCHC but have been registered as requiring services of a registered nurse
Amount paid for nursing care:
England
Wales
Scotland
N.Ireland
England £209.19pw
Wales £184.32
Scotland £95.80 but social care also funded at £212.85pw
N.Ireland £100pw
Asssesment framework for NHSCHC & NHS funded care (4)
Nature - nature of needs
Complexity - skills required to treat
Intensity - severity of needs
Unpredictability - how hard is it to predict change in needs that could create problems
Who carried out initial assessment which is done to see is individual required full asssessment of framework for NHSCHC & NHS funded care?
Nurse, doctor, social worker or other health professional
Who carries out Asssesment of framework for NHSCHC & NHS funded care?
Multi-disciplinary team
Who carries out Asssessment of framework for NHSCHC & NHS funded care
Multi-Disciplinary team
What is a multi-disciplinary team?
And what tool do they use to complete test for assessment?
2 or more health or social care professionals, but with patients consent can bring in professionals from all areas of required
Decision support tool
What is fast track version of decision support tool if circumstances are severe?
Can they recommend a decision support tool is carried out afterwards?
Fast track pathway tool
Yes, after immediate care provided for. But very rare this is done
Can care commence whilst a decision is being made on a fast track pathway tool?
Yes whilst decision is being made, care will stopped if overturned by a later carried out decision support tool
Personal health budget
Amount of money NHS agree they would have spent on care. Individual can then use to source and fund own care provider
When are personal health budgets reviewed by NHS?
After 3 months once arranged then every 12 months thereafter
Who can discharge a patient?
Named doctor
Who within LA handles reports of neglect or abuse in care?
Safeguarding co-ordinator
Who is responsible for arranging funding for those in care?
LA
Who are care home needs assessed by?
Within what time frame?
Social worker
Reasonable time frame
At what age and who are entitled to a assessment of needs for care under Care Act for care and support plan?
Anyone age 16+
How much does LA pay if you choose your own accommodation for care that is more expensive?
What if top-up payments aren’t paid/are missed?
LA pay upto ‘personal budget’ and someone else pays top-up
LA can then choose to move you to a cheaper home
Capital thresholds for when you will be required to make personal contributions/top-ups to fund care?
England & NI
Wales
Scotland
England & NI - lower limit of £14,250 & upper limit of £23,250
Wales - no lower limit and upper limit of £24k for domicilary care & 50k for resi. care
Scotland - lower limit of £18k & upper limit of £28,750
What is 2 steps for LA to assess care needs?
- Needs assessment
- Financial assessment
What is light touch financial assessment?
When LA are happy that from all evidence available individual does not have resources to meet capital threshold
Or
Where a person agrees to use light touch even though they exceed capital threshold
How do LA calculate capital for capital threshold assessment?
Is benefit income considered?
What assets are not considered?
Assets & income - liabilities
Yes, even if not received but entitled to this
- Some property in some circumstances
- Income from bonds that require withdrawal and not already being taken
- Life insurance
Personal expense allowance
Amount pw
LA must allow for people to retain a small amount of money for things like toiletries, hairdressers, etc.
E - £25.65pw
How is a pension considered for capital threshold with LA?
If income taken - Will consider
If tax free cash taken - will consider
If income not yet taken but entitled to - will consider at rate could have taken using an annuity
When will a property not be considered an asset to fund care? (3)
If in temporary care
If occupied by partner or former partner
Child under 18 or adult over 6 live in property
How many weeks are disregarded when valuing a property?
12 weeks
What is a differed payment agreement to fund LTC?
Can interest be charged?
LA agree to loan funds and fund care until death and recover funds when property is sold
Yes
If an asset is transferred will this avoid care fees?
How many yrs can go back to recall asset value everywhere in UK? Where is exception?
No, can count as an asset if intention was to avoid care fees
6yrs but only 6months in Scotland
Where is two places personal care not charged for by LA, if over certain age and what is that age?
Scotland - If over age 65 for personal care but non-personal care can charge a reasonable amount
NI - if over age 75 & receiving income support
