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PIP and the Shared Life Scheme

 

Ruth_T
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We have been asked for assistance with an appeal against a decision that the client cannot be paid PIP daily living component because of the nature of her accommodation.  DWP have cited PIP Regs reg 28, and are treating the client as a care home resident.  PIP mobility component remains in payment.

The client lives in her carer’s home under the Shared Life Scheme, and the carer receives payment from the local authority.  The client has a proper tenancy agreement and receives housing benefit.

We have asked the local authority for the statutory basis of the Shared Life Scheme, and for details as to how it is funded, but they were unable to provide that information.

Does anyone have experience of the Shared Life Scheme, or know anything about the way it is funded?

     
Dan Manville
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Is this Shared Lives?

The fact that Housing Benefit is in payment should be enough to put to bed any concerns that it might be res’ care. The council’s contribution comes from the same budget that general care funding comes from; direct payments and the like.

     
HB Anorak
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Reg 28 is made under s85 of the WRA 2012.  A prerequisite for s85 to bite is that the “person is a resident of a care home” - without that, the funding of services provisions listed in Reg 28 aren’t engaged in the first place.

Section 85(3) defines a care home as “an establishment that provides accommodation together with nursing or personal care”.  This form of words is borrowed directly from s3 of the Care Standards Act 2000.  The 2012 Act does not specifically reference the 2000 Act; nevertheless I think my first argument would be that since the definition exactly matches that in the 2000 Act then the registration status of the accommodation determines whether it is a care home for PIP purposes.

Failing that, the words I have emphasised in bold ought to exclude shared lives from the definition: a family home is not an “establishment”, nor are the care and accommodation provided “together” as a package.

The whole point of shared lives is that it is legally and qualitatively different from residential care.  It won’t be registered by CQC as a care home because it doesn’t match the s3 definition of a care home, therefore it doesn’t match the s85 definition either.

     
Ruth_T
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Grateful thanks for the helpful responses.

     
Dan Manville
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HB Anorak - 11 January 2017 09:40 AM

The whole point of shared lives is that it is legally and qualitatively different from residential care.  It won’t be registered by CQC as a care home because it doesn’t match the s3 definition of a care home, therefore it doesn’t match the s85 definition either.

Bump

I might regret saying this out loud but hey yho

The home isn’t registered but pursuant to the Health and Social care Act 2008 the scheme is registered as a whole and carries Registered Managers analagous to care homes under CSA 2000.

However, funding might be an issue; the client in question is a care leaver; was under 18 for the majority of the period in dispute and might be exempt if their funding came under S17(10)(b) of the Children Act 1989. I’m not sure whether that would be the case; it feels like it should be -especially reading 28(4) but I don’t know my childrens’ stuff.

Funding now should be coming under aftercare rather than Care Act so might not fall under the list at reg 28(2)...

     
Surrey Adviser
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I can never understand why, these days, so many things which are essentially simple and straightforward come to be so contorted, confused and over-complicated!

This client is living in a house or apartment, has a tenancy & gets housing benefit.  How on earth can (s)he possibly be considered to be in a care home?  If (s)he is so considered, the law is - as so many times before - an ass!

     
Ruth_T
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It took an eternity, but this matter has now been sorted.    PIP made enquiries regarding the nature of the Shared Lives Scheme from the local authority and revised their decision.    Cl was paid arrears of benefit and is now receiving ongoing DL component payment.

     
Dan Manville
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Surrey Adviser - 13 July 2017 09:16 PM

This client is living in a house or apartment, has a tenancy & gets housing benefit. !

Mine is a care leaver and the tenancy was funded (probably) by S22 of the Children Act 1989 rather than from HB. As it was entirely funded by the LA PIP have sat up and taken notice and suspended the award of the DLC.

Now… do we think there’s a right of appeal against a payability decision at S85 WRA? I’ve looked at Sched 2 SSA and Sched 2 of the UC, PIP etc (D&A) regs and the jury’s still out; my gut says no but my head can’t see an explicit exclusion.

I really hope there is as otherwise I’ve got a potential JR brewing for someone who’s quite a long way out of area.

     
Dan Manville
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Bump

They took my word for it that it wasn’t res’ care and arrears are to be paid any day.

There is A Very Big Cheque in the offing…