Definition of ‘Care Home’ and Daily Living Component in PIP

Reg 85 of the WRA 2012 seems to have quite a vague description of a care home for PIP. A lot fo the clients that I work with live in extra care schemes. They have self-contained flats and pay rent with HB and/or their own income. It’s not a care home, but the provisions in Reg 85 seem to include any accommodation which provides help with personal care. Most of the tenants in the extra schemes receive personal care from staff based in the building, and I believe that in some cases this care is paid for by the local authority.

P952 of CPAG (2014/15) describes services paid for under the ‘Specified Provisions’, but p951 suggests that any accommodation is treated as a care home if personal care is provided.

Which of the above factors is the key to deciding whether the Daily Living Component in PIP should be paid? And are there any significant differences with how this issue is dealt with for DLA?

The care home definition for other benefits is pretty clear (Reg 3 Care Standards Act 2000), so it’s looks like extra care schemes are care homes for those - and probably for PIP too. But if anyone can clarify any of this for me I’d be really grateful, it obvioulsy has a big impact on the claimants’ income so I’d like to be sure that they’re getting the money that they should be getting.

this thread has a bit more discussion on this issue:

http://www.rightsnet.org.uk/forums/viewthread/4360/

Thank you, tbidmead. I’ve now read that thread and it’s still as clear as mud!

In general, if support staff are based on site and the claimant makes use of those staff for personal care, should we assume that they should be getting the care component/DLC of DLA/PIP? I guess this wouldn’t apply if the claimant receives no subsidy from public funds for that care due to having too much income/capital?

If they receive floating support for personal care I guess it wouldn’t exempt them from the care component/DLC because the building they live in wouldn’t fit the definition of providing personal care?

The DWP reinstated the DLC for one of my clients when we disputed it, and they didn’t request any further documentation about the services received by the client or how they were paid for. The DWP doesn’t seem awfully concerned about this issue from my experience so far, but I’m now worried that the wrong advice could lead to overpayments for clients.

Correction below!

‘In general, if support staff are based on site and the claimant makes use of those staff for personal care, should we assume that they SHOULDN’T be getting the care component/DLC of DLA/PIP?’

Around these parts, in Supported/Sheltered accom although there might be staff on site they are not employed by the landlord but another company. It is only if the landord is providing the care that a claimant would lose their Care/Daily Living comp.

Now that Supporting People has gone and such support is becoming chargeable under FACS I suspect that there will be a lot of these queries; however I also suspect that the arrangement I detail above will be quite common; thus ameliorating the problem.

Hi Dan, is there anything in any regs which clarifies the arrangement you have described? I’ve read a few bits around this and they seemed to focus on what care was provided in the claimant’s uilding, not who provided it. I can see a case for arguing that floating support lies outside the definition of sheltered/supporting, but if the staff are based onsite I wonder whether the building still fits the definition in Reg 3 Care Standards Act 2000…

I think the DWP needs to clarify this issue. Any ideas what the best way of getting them to do that is?

S85(3) WRA 2012; C&P from the other post…

“an establishment that provides accommodation together with nursing or personal care”

If the “establishment” isn’t providing the care, rather a third party organisation; then that escapes the exclusion.

Thanks, Dan. I guess that’s how caselaw arises, because I would interpret that regulation differently to the way that you have :)

I don’t suppose you know of any caselaw which mentions this issue?

Just spoke to the DWP about this and they suggested that it comes down to whether the personal care received by the claimant includes the tasks in the PIP descriptors for the Daily Living Component (cooking, dressing, washing etc.), and whether or not the care is partly/fully paid for by the LA. However, they are going to ask a decision maker to get back to me to clarify this. I’ll let you know when I hear something.

I saw another case recently in which the client was charged for care by the local authority. She is receiving the care component of DLA but the amount she is being charged for care by her LA is very close to the amount that she receives from the care component of DLA. Is it likely that LAs and the DWP are liaising to create this arrangement rather than stopping payment of the DLA care component?

Just a bit of an update on this topic. I’ve dealt with a few of these cases recently and the DWP seems to accept a tenancy agreement as proof that the accommodation is not a care home. The customers I’ve been helping have self-contained flats in buildings which have support staff on site, but they have individual tenancy agreements and usually claim HB to pay their rent. The DWP hasn’t requested any proof about care arrangements, they only wanted a tenancy agreement. It’s possible that they are contacting the LA about care arrangements but I don’t think it would change the decisions because we are not concealing the fact that these customers live in supported housing with onsite support.

One thing that has become clear to me is that the DWP sometimes assumes that claimants are in care homes and stop paying the care component even when they haven’t got any proof that it’s a care home. This is obviously unfair to claimants who don’t know the rules and don’t have support from someone who does know the rules.

geep - 29 June 2015 10:41 AM

Is it likely that LAs and the DWP are liaising to create this arrangement rather than stopping payment of the DLA care component?

Just spotted this

It’s not that sophisticated. Govt says “we will pay you £55.10 for your personal care”, LA says “we’ll have £50 of that please”. There’s not much liaison goes on beyong reading the uprating orders each year.

There are regulations about the maximum an LA can charge but they’re at discretion whether, and how, to charge less than the statutory scheme.