Ten ways to bring the cost of care down without cutting the care

Nothing on that list asks anybody to accept less care, or asks a carer to work below the rate they have set. The rest of this page takes the three groups in turn.

Attendance Allowance is the one to start with. It is for somebody over State Pension age who has needed help with personal care or supervision for six months or more, and it is judged on how much help they need rather than on a diagnosis. There is no restriction on what it is spent on, so it can go onto the weekly care bill. The form asks about a typical day, and it is worth describing the days your relative manages least well. Age UK helps people fill it in.

Pension Credit tops a single person's weekly income up to £238, or a couple's joint income up to £363.25, with an extra £86.05 a week where somebody has a severe disability. It also opens the door to other help, so it is worth checking even where the sums look borderline.

The fourth is the council tax bill rather than a benefit. An adult medically certified as severely mentally impaired, which includes many people living with dementia, and receiving a qualifying benefit, can be left out of the count of adults in the household, which can mean a discount or no bill at all. Separately, a home with an extra room, an extra bathroom or space for a wheelchair because somebody is disabled can be charged one band lower, or 17 per cent less if it is already in the lowest band. Both go through the council and both can sometimes be backdated.

1. 1

   Ring adult social care and ask for a care needs assessment

   Free

   It is free and anyone can ask for one, whatever their income or savings. Someone from the council, often a social worker or an occupational therapist, looks at how your relative manages washing, dressing, meals, medication and getting about. Have somebody with you to take notes, and answer for a difficult day rather than a good one.
2. 2

   Take the financial assessment even if you think you know the answer

   Free

   The council looks at income and capital. In England the upper capital limit is £23,250 and capital below £14,250 is effectively ignored, with a tariff income assumed in between. The house your relative lives in is not counted at all when the care is at home.
3. 3

   List the disability-related expenditure

   Lowers the contribution

   Where the council counts Attendance Allowance as income, it must leave your relative enough to meet disability costs it is not paying for itself. Extra laundry, higher heating, a community alarm, a special diet, gardening and transport to appointments can all count. Ask for the council’s list and keep the receipts.
4. 4

   If any funding is agreed, ask for it as a direct payment

   Ask at the assessment

   A direct payment is the council’s contribution paid to you or your relative instead of the council arranging the care, so you choose the carer and keep the same one. Say at the assessment that this is what you want; you can change your mind later either way.

Two other routes sit alongside this. If your relative's needs are mainly health needs rather than help with daily living, because the care is complex, unpredictable or intense, NHS Continuing Healthcare can pay for the whole package at home, and it is not means tested. Ask the GP or the hospital discharge team for a checklist. The family carer is also entitled to something of their own: a carer's assessment is free, anyone over 18 who cares for somebody can ask for one, and it can lead to replacement care so they get a break. What a carer's assessment is explains how to ask, and how to fund respite covers where the money comes from.

If the council does agree to fund care, direct payments sets out the paperwork, and how local authority funding works explains the assessment in full.

These belong on a list about cost because of what they do to the hours. A grab rail and a perching stool that let somebody wash at the basin can take fifteen minutes off every morning visit, and a level-access shower can be the difference between needing one carer and needing two. The costs people forget covers the other side of this.

Two of those come from the contract. A visit you cancel is payable in full, the exceptions being unplanned hospitalisation, illness, or another reason you and the carer agree, and the carer may waive part or all of it. Bank holidays are charged at one and a half times the carer's normal rate and Christmas Day at twice, so a bill that jumps in late December is usually the calendar rather than a rate change. PrimeCarers charges nothing of its own to cancel and does not set these terms; they sit in the contract between you and the carer, and deposits, cancellation and notice explains them.

The other question is whether the arrangement itself is still the right one. A week that has grown to three visits a day plus the weekly jobs can pass the point where live-in care costs less and covers more, which on PrimeCarers is roughly 35 hours a week. When live-in care becomes cheaper than hourly visits works it through, and the cost of care by type puts one week of each side by side.

Three things look like savings and cost more than they save. Asking a carer to work below the rate on their profile is the first, and a carer who agrees once tends not to stay. Paying outside the platform is the second, because the insurance that covers a carer while they work and the contract that sets out notice and cancellation both belong to the booked arrangement. Cutting the visit that keeps somebody eating or taking their medication is the third, and it is the one that ends in an ambulance.

What is in the hourly rate breaks down what the carer takes home and what our fee covers. For a figure for your own week, the care cost calculator gives a local estimate from the hours you have in mind, and searching carers near your relative shows the rates being charged in that postcode today.