Long-Term Care Scheme - Maison St Brelade - Transcript - 25 July 2017

STATES OF JERSEY

Health and Social Security Scrutiny Panel Long-Term Care Scheme

Maison St. Brelade

TUESDAY, 25th JULY 2017

Panel:

Deputy G.P. Southern of St. Helier (Vice-Chairman) Deputy T.A. McDonald of St. Saviour

Deputy J.A. Hilton of St. Helier

Witnesses:

Head of Home, Maison St. Brelade Finance Officer, Maison St. Brelade

[11:44]

Deputy G.P. Southern of St. Helier (Vice-Chairman):

... is in front of you, if you would like to peruse that. My apologies from our Chairman, Deputy Renouf , who is detained in the U.K. (United Kingdom) at the moment with family matters, so I am chairing this meeting, Deputy Geoff Southern . What we normally do is announce ourselves around the table so we can identify the voices on the record. Go on.

Deputy J.A. Hilton of St. Helier :

I am Deputy Jackie Hilton, panel member.

Deputy T.A. McDonald of St. Saviour : I am Terry McDonald, panel member.

Scrutiny Officer:

I am Kellie Boydens , Scrutiny Officer.

Finance Officer, Maison St. Brelade : Mel Churchill, Finance Officer.

Head of Home, Maison St. Brelade :

Pearl Thebault, Head of Home at Maison St. Brelade .

Deputy G.P. Southern :

Welcome to this hearing on the L.T.C. (Long-Term Care) fund. I suppose the opener is could you tell us a little, give us a brief overview of the services you offer and what your dealings with the L.T.C. scheme have been?

Head of Home, Maison St. Brelade :

We are a care home for 50 elderly residents, male and female, over the age of 65. The home is owned by the Parish of St. Brelade , but we run it completely as a business and we are self-funding as a business.

Deputy G.P. Southern :

That is a non-profit making business or ...

Head of Home, Maison St. Brelade :

No. Well, when we say "non-profit" we have to obviously meet our costs and obviously our biggest cost is our staffing costs. After that, it will be about maintaining our standards in the accommodation that we provide. We are regulated, so we do have a clear criteria in what standards we have to meet.

Deputy J.A. Hilton:

Is it a combination of nursing and residential beds?

Head of Home, Maison St. Brelade :

We have 5 nursing beds, 45 residential. Residential beds are high dependent, standard placements now is what they are known, and then high dependent residents. Five nursing beds: this has been allowed by our regulator to provide nursing care for people already living within the home. I cannot take people who have nursing needs directly from the community or a hospital.

Deputy J.A. Hilton:

So those 5 beds are designated in that way so that they can stay within the home, basically, so they are not moved somewhere else?

Head of Home, Maison St. Brelade :

Yes, as their care needs will change. As people get older, and care needs to change within the home environment, it will allow me ... and people can live and die within the home with us as well.

Deputy J.A. Hilton:

What sort of occupancy rate do you have at your home?

Head of Home, Maison St. Brelade : Normally 100 per cent.

Deputy J.A. Hilton:

So have you got a waiting list?

Head of Home, Maison St. Brelade : Yes, we do.

Deputy J.A. Hilton:

Right, okay. That speaks for itself.

Deputy T.A. McDonald: It does.

Deputy G.P. Southern :

How are you finding the L.T.C. scheme so far?

Head of Home, Maison St. Brelade :

I think the initial rollout with the L.T.C. scheme, because it was very new, it was problematic in the fact that documentation and the application for it was weighty, complex. People coming to access ... I felt that the initial rollout could have been better, but that was the initial and it was something new that people had. I do think it is a good thing, I think it is a good scheme and I think it is a good benefit for everybody within the Island. This has sorted itself out, I would say, in the main. It was just the initial, but we have found in the last year, the last few months, things have really improved in how the scheme has benefited.

Deputy G.P. Southern :

How many of your clients, your residents, are self-funding and how many are reliant on L.T.C.?

Finance Officer, Maison St. Brelade : Probably 75 per cent.

Deputy G.P. Southern : Self-funding?

Finance Officer, Maison St. Brelade :

Self-funding, yes, and 25 per cent are wholly funded by L.T.C.

Deputy G.P. Southern :

Okay. In terms of dealing with the L.T.C., you say you have understood the forms now. What sort of turnaround have you got nowadays when you make an application for somebody coming into the home?

Head of Home, Maison St. Brelade :

I think there is still an improvement to be made with regards assessments. I think that is where the problem is. Social Security have ironed out with regards ... there is 2 assessments that have to take place to access this benefit. There is a financial benefit and there is a care needs assessment. The care needs of the resident has to be established as to what level of benefit they can receive. I think that, for me, would be where I would see it becoming a little bit problematic. I would put that down to the fact that we ... and as a care home provider, I know what needs a person has, in my own assessment, and what we can provide and what level of care I can meet in regards our carers and how we look after somebody. With the assessment, I do not see and I do not have access to that document. We have asked for that recently at a Care Federation, because I am part of a Care Federation group, and we have asked if we could have clarity so that we can see how they base their assessments. That I think for me is the biggest glitch. I would like to see that improve.

Deputy G.P. Southern :

I see. Is that about inconsistency in terms of the assessment or is it about the fact that the assessment is made on the person by Social Security and the funding that comes with that assessment goes to them and you are a third party?

Head of Home, Maison St. Brelade :

I would not see it as Social Security, I see it more as Health and Social Services, because it is a care assessment I will be looking at and it is looking after somebody and being able to meet those care needs. That is the bit that I find that it is difficult. I feel that we should have access to that document and we have raised that now and brought that up. There is a new Director of Social Services. With the residents' permission, because of everything with data protection, I cannot see that being an issue from ... I have never found it an issue personally if I need to share information. When I ask somebody, a resident, when it is in relation to their care: "Can I share with somebody, your G.P. (general practitioner)?" and they have always been okay with that. I think that would bring a lot more clarity.

Deputy J.A. Hilton:

Have there been many instances where a person has been assessed at a lower level than what you think they should be?

Head of Home, Maison St. Brelade :

Not really for me personally. I cannot say I have experienced that really. I think what I have experienced, for me personally, I go to hospital and we assess somebody. I had this recently, I went to assess a person in hospital and I really felt, no, I would not accept ... I would be unable to take this person into my home, because I felt that person's care needs were nursing. That is a discrepancy I have found, because the social worker who assessed that person assessed them as high needs dependent, but I felt there was a cusp there that where they are able to do certain things, I felt that could really just change like that. This person had real underlying medical health problems that very quickly ... well, to me it would have been nursing.

Deputy J.A. Hilton:

So that would be level 4, would it, of the L.T.C.?

Head of Home, Maison St. Brelade :

Level 3. I think it is level 3. This is where it needs more clarity and this is where I feel if we had a look at how they do their assessment ... whereas prior to the L.T.C., we did use a document that was sort of universal. I always based my assessments on that document.

Deputy G.P. Southern :

You say you have a waiting list. How people access your services? Do they come recommended by their G.P.?

Head of Home, Maison St. Brelade :

It is mainly word of mouth, to be honest. They will just pop in. They will know somebody who has been living in the home, usually a relative or a friend who has come to live and they have heard

about Maison St. Brelade . They will pop in and they will ask if they could see around the home. Yes, that will be ...

Deputy J.A. Hilton:

Presumably that is a self-funder, yes, so the other 25 per cent are wholly supported by L.T.C. funds?

Finance Officer, Maison St. Brelade : Yes.

Head of Home, Maison St. Brelade :

They will come through. Again, if I have got a vacancy, we let everybody know there is a vacancy and phone calls, social workers looking for a placement. It will be a person's first choice, it is Maison St. Brelade , and they will try and accommodate that.

Deputy G.P. Southern :

Because of local connections. We were just talking to people in St. Helier earlier and they were talking about lengthy times waiting for the funding to arrive from L.T.C. and inconsistencies in the way in which it was delivered and sometimes by direct debit, sometimes by other mechanisms. Has that been a problem for you at all in your home?

Finance Officer, Maison St. Brelade :

I am sure it could be done better, as you say. Some of the payments are made directly to the clients and some are made directly to us. From my point of view, and surely from L.T.C.'s point of view, it would be easier to direct all payments to the home rather than have 2 systems going on. That is the way it used to be and it worked very well. It is not causing me a problem, but I have to be very aware of who is collecting this money or who is receiving the money and be quite on the ball about it too.

Deputy J.A. Hilton:

Have you ever been in a situation where L.T.C. funds go into somebody's bank account but they have gone and spent it before they have paid for their ...

Finance Officer, Maison St. Brelade : No.

Deputy J.A. Hilton: That has not happened?

No. I would be chasing them.

Head of Home, Maison St. Brelade : But it could happen.

Finance Officer, Maison St. Brelade : It could happen, yes.

Head of Home, Maison St. Brelade : There a potential, yes. There is a risk.

Finance Officer, Maison St. Brelade :

You are quite right, it could easily happen, whereas if it was offered to the home only, you are not going to have ...

Deputy J.A. Hilton:

Yes, that removes that risk.

Finance Officer, Maison St. Brelade :

It completely removes the risk. I have got one outstanding now, which does go back to November, but I think we are nearly through it. It is someone who is going to be funded fully by L.T.C. until the home is sold. That is my only one that it is a little bit outstanding, but I have had good feedback with who I am dealing with and hopefully this ... I am just back from holiday, so I was hoping to have a nice surprise, but it has not quite happened. But I am sure it will be along fairly shortly, but I have some good feedbacks from the girls or the guys that I deal with L.T.C. and usually anything I ask for I will get an answer from them. But I would like also to see the payments which are made to the clients. I do not get an insight into all the payments, but I would like an insight into what everyone is receiving for my files.

Deputy G.P. Southern :

Because you have to bill and everything else, yes.

Finance Officer, Maison St. Brelade :

Yes, so I know exactly. If they come with queries, I can say: "Well, you are getting this" but I cannot unless I can see the full picture.

Yes, of course. Your level 1 clients, do you charge the same for a client who is totally supported by the L.T.C. fund against a self-funder? Is it the same fees?

Finance Officer, Maison St. Brelade :

No. We pay your fees that you pay them. We have got our private fees and if it is a long-term funder who you are paying in full, we go with your rates.

Deputy J.A. Hilton:

I see, okay. What currently is the rate for a level 1 under the L.T.C. fund? Because I know clients who are self-funders can top up, can they not?

Finance Officer, Maison St. Brelade : Yes.

Deputy J.A. Hilton:

They can pay extra to have different services.

Head of Home, Maison St. Brelade :

From our home, what it means when you are talking about additional services, it will not change the level of care you will receive, but what it allows a person to do is make a choice of where they want to live and which care home they will go, because every care home has got their own fees.

Deputy J.A. Hilton:

Yes, of course. So do you cater for the ones that come in at the sort of lowest level?

Finance Officer, Maison St. Brelade : Yes.

Head of Home, Maison St. Brelade : Yes, standard.

Finance Officer, Maison St. Brelade :

Yes, so at the private residential it is £952 and your L.T.C. award and care payment is £696.15. That is what we would charge them, if we knew they were on those rates.

Deputy J.A. Hilton:

So that is for a level 1 then, £696.15?

Care is expensive, yes.

Deputy J.A. Hilton: Yes.

Head of Home, Maison St. Brelade : Income support is what I would call it.

Finance Officer, Maison St. Brelade : Well, that is what I used to call it, yes.

Head of Home, Maison St. Brelade : L.T.C. is £696.

Deputy J.A. Hilton:

All right, thank you. For those people being financed totally by L.T.C., they have an allowance, do they not, a personal allowance of £30-something a week?

Finance Officer, Maison St. Brelade : £35.70.

Deputy J.A. Hilton:

Yes. In your opinion, do you think that is enough money?

Finance Officer, Maison St. Brelade : No.

Head of Home, Maison St. Brelade : No, no.

Deputy J.A. Hilton:

How do you think it needs to change? What experience have you had ...

Head of Home, Maison St. Brelade :

The experience I have had is we had somebody who was totally income supported and they want just little basic things in life, get their hair done, have a chiropodist, go to the dentist. I know they will have X amount of dental treatments, but any little thing outside of that, if you wanted a little

luxury, if somebody wanted to treat themselves, they would have to save. They would have to save up to buy a nice coat. It is as simple as that. To buy themselves underwear, toiletries, yes.

Deputy J.A. Hilton:

Where you have instances where people have no savings and they are being funded totally by the L.T.C. fund, have you had to resort to charities to purchase items for individuals, whether it be clothes or any sort of ...

Head of Home, Maison St. Brelade :

While we have not resorted to charities, what normally happens, people within the home - already in the home - may have passed away, so they will leave some nice clothing that we will keep behind. We have a social amenities fund for our residents and if I really felt that there was somebody that needed something, we would use that money and subsidise. Somebody who is smoking, for example, and they have smoked all their lives - bless her - and they still want their odd fag, and I will ...

Deputy J.A. Hilton:

So you have got an amenities fund, so you do not generally go outside of the confines of the home, you sort it out yourselves?

[12:00]

Head of Home, Maison St. Brelade : Yes, we have not needed to.

Deputy G.P. Southern :

The waiting list that exists among the clients, do they also exist among your staff? How is your staff recruitment and your turnover? Because obviously we have got a competitive market in care.

Head of Home, Maison St. Brelade :

Recruitment for us, it has always been good, because we are a well-established parish home and the pay rates are good. They are your States wages, so already that will attract a good number of people. We keep our staff.

Finance Officer, Maison St. Brelade : We do.

Head of Home, Maison St. Brelade :

There is not a huge changeover, so we have not needed to. I have found that things have shifted a little in the last few weeks, obviously because care in the home is taking place. Recruitment all over for care assistants is becoming more difficult; nursing staff is difficult. For us going forward, it is where I will see what is needed within the home is more nursing, because people are living longer. We do understand that and I see it every day. People already living within my home, their needs are escalating and more care, and I would find that nursing staff is difficult to recruit, but I have not really seen that. We are taking it slowly, so I have not done any major drive with regards recruitment.

Deputy G.P. Southern :

There is stable staff for the moment?

Head of Home, Maison St. Brelade : Yes.

Deputy G.P. Southern :

They are quite content, okay. But nursing is a potential problem, you think.

Deputy J.A. Hilton:

So your staff are employed under the same terms and conditions, including pension obviously?

Head of Home, Maison St. Brelade : No pension.

Deputy J.A. Hilton:

No pension. Right, okay. I was just surprised, because when you said the same as the States, I just assumed they were in P.E.C.R.S. (Public Employees Contributory Retirement Scheme), so they are not in P.E.C.R.S. Okay, but employed on the same terms and conditions as the States workers, other than pension, okay.

Deputy G.P. Southern : I will give you the topic.

Deputy J.A. Hilton:

Respite. Yes, as far as respite goes, do you provide respite? With 100 per cent occupancy, that would be quite difficult.

Head of Home, Maison St. Brelade :

You see, I do not use the current 50 rooms. When we were refurbishing Maison St. Brelade to bring it up to modern-day purposes, in the process of doing that we had one room, which was a small little quiet room that we use for temporary accommodation and that had a sink and a mirror. It is a lovely room with a lovely view and it is nice and spacious. Because people were knocking on my door and asking could they please have respite, I asked my regulator if we could use this room temporarily. Yes, so at the moment I am allowed to use it, but it is only on a yearly, but we have had full occupancy with that.

Deputy J.A. Hilton:

Okay. So is this private clients coming in asking ...

Finance Officer, Maison St. Brelade : It does not have to be private.

Deputy J.A. Hilton:

So you have had respite clients under the L.T.C. fund?

Finance Officer, Maison St. Brelade : Yes.

Head of Home, Maison St. Brelade : Yes.

Deputy J.A. Hilton:

Right, okay. Are you ever approached by the hospital or any social workers to provide immediate respite care to somebody that may be in hospital and they need to get out?

Finance Officer, Maison St. Brelade : Yes.

Head of Home, Maison St. Brelade : Yes, I would have a phone call.

Deputy J.A. Hilton:

Has there ever been any difficulty over who was going to pay for that? If it is not L.T.C. fund, we understand the hospital does sometimes fund respite care. Have you ever had the experience that the hospital has just funded the care?

No, no.

Deputy J.A. Hilton:

So it has always been through the L.T.C. fund, has it?

Head of Home, Maison St. Brelade :

It is either private and the majority of people are private.

Deputy J.A. Hilton: Private, yes.

Head of Home, Maison St. Brelade :

The other would be through the L.T.C., that they have a carer who is looking after mum or dad, for example, and they book it well in advance and it is a planned thing, they understand.

Deputy J.A. Hilton: Oh, I see.

Head of Home, Maison St. Brelade :

I have not been in an emergency situation or where they needed a bed and we have a room.

Deputy J.A. Hilton:

Okay, so it is always planned well in advance and it is mainly self-funders?

Head of Home, Maison St. Brelade : Yes.

Deputy J.A. Hilton:

A situation where maybe their carers want to go on holiday and it is: "Can you take mum or dad for me for 2 weeks" or whatever?

Head of Home, Maison St. Brelade : That is right, yes.

Deputy G.P. Southern :

We heard earlier, in an earlier session, that there is some worries from the financial people about the cap on below inflation increases and what is going to happen in L.T.C. over the next 2 years. Do you ...

Finance Officer, Maison St. Brelade : Yes. We have had that letter.

Head of Home, Maison St. Brelade :

We were talking about this and of course we have managed our business differently. We have always based it on the lowest from our business model. We will be okay.

Finance Officer, Maison St. Brelade : Yes, we will be fine.

Head of Home, Maison St. Brelade :

But I can understand maybe other people running into difficulties with that, because care ... and I suppose when we are talking about maybe the private sector might run into difficulties or where they have to return a good profit. We are in that unique position, we do not have to return a huge big profit. We have just got to make sure that we can keep ourselves funded, pay our staff and keep our accommodation the best we can.

Deputy J.A. Hilton:

Yes, because you have invested a lot of money recently, have you not?

Finance Officer, Maison St. Brelade : Yes.

Head of Home, Maison St. Brelade : We have, and we are paying that back.

Deputy J.A. Hilton:

Yes, so you made all your rooms ensuite.

Finance Officer, Maison St. Brelade : Yes.

Deputy J.A. Hilton:

So you reduced the number of rooms, but made them ...

Head of Home, Maison St. Brelade : No.

Deputy J.A. Hilton: Oh, you did not?

Head of Home, Maison St. Brelade :

No. We have always had 50 rooms. What we did was to improve the accommodation.

Finance Officer, Maison St. Brelade :

We have our budgets. We set our budgets every year, the budget is set and everything is included and we all go forward and see our percentage we need to raise. We might have to increase more than your 1.5 to cover our fees, but of course if the person is wholly supported by L.T.C. it is not going to affect them. Whatever you are telling us we will charge, but our private people will pay a little extra.

Deputy G.P. Southern : That makes sense.

Deputy J.A. Hilton:

Could I just ask you a question? I have asked you about the allowance. Have you had any experience of a resident of yours that has had to have a property bond on their property? Have you ever been involved in anything like that?

Finance Officer, Maison St. Brelade : Yes.

Deputy J.A. Hilton:

Could you tell us your experience of that?

Finance Officer, Maison St. Brelade : That is the one I have just got.

Deputy G.P. Southern :

That is the one you just mentioned.

Finance Officer, Maison St. Brelade :

Just trying to sort out. Experience? Well, basically the resident came to the office to say her finances were very low, so I contacted L.T.C., they asked for the form to be filled in. It has been sent back with all the details of bank statements et cetera, whatever was the requirement. From there, the property is for sale and I believe your people, the L.T.C. do an evaluation or get the evaluation done. As I said, you are about to start to funding her, but it is not a bad experience. It seems to have flowed well.

Head of Home, Maison St. Brelade :

We had had one prior to this about 2 years ago.

Deputy J.A. Hilton:

But this particular person, had she reached her care cap cost?

Finance Officer, Maison St. Brelade : Yes, she had.

Deputy J.A. Hilton:

But her savings were running really low?

Head of Home, Maison St. Brelade : Absolutely.

Finance Officer, Maison St. Brelade : Yes, that is right.

Deputy J.A. Hilton:

So then she has to continue to pay the co-payment, so the decision was made that ...

Finance Officer, Maison St. Brelade : She would sell.

Deputy J.A. Hilton:

... sell the property, not have a bond put on it?

Finance Officer, Maison St. Brelade : No.

Just sell it. Okay.

Head of Home, Maison St. Brelade :

But in the meantime she could not afford her fees. This person became very distressed and it was distress I picked up within the home, because she was totally worried about her finances. When I went and had a conversation, this was the problem. Her property was up for sale, but obviously it still is not sold. You are talking about months now and depending on when the property will be ... and her funds had gone very low. She had doctor's bills that she was really struggling to pay and did not know what to do, basically. But then that was us, with her permission, taking over. I had to take that stress away from her and Mel and I going to L.T.C. and saying: "Look, we have got this person and this is what is happening. The house is up for sale." It did happen before within the home, we did have somebody else, that similar situation, and that was with the L.T.C. team. That was about 2 years ago. They could not afford to pay their fees and they did reach an agreement with the person that L.T.C. paid the fees, but paid at their rate, not at the private rate, so that in the eventuality that the house was sold, the fees that were owing to Income Support went back to them and we actually backdated our fees that were with us.

Deputy J.A. Hilton:

Right, okay. So in the 2 cases you have been involved in, it has been fairly straightforward then?

Finance Officer, Maison St. Brelade : Yes.

Deputy J.A. Hilton:

Because both individuals decided to sell their properties to fund their care rather than have a bond taken out on the home, is that correct?

Finance Officer, Maison St. Brelade : Yes.

Deputy J.A. Hilton:

Yes, so you are just hoping to finalise the arrangement about the last one?

Finance Officer, Maison St. Brelade :

Yes, hopefully. I am expecting it probably within the next week now, yes.

Deputy J.A. Hilton:

It must very difficult for the resident, who has hardly got any money left, like really, really worrying. It is not a nice situation to be in.

Finance Officer, Maison St. Brelade : Yes.

Head of Home, Maison St. Brelade :

I suppose again it depends on their living circumstances, where it may mean the difference in a different type of home, their legal fees and to keep their accounts or whatever. I think it would be a factor.

Deputy J.A. Hilton:

Yes. Have you ever had a situation where you have a spouse remaining in the family home, so you have had one half of the partnership coming into your home, but a spouse has remained, and the difficulties around that?

Finance Officer, Maison St. Brelade : No.

Head of Home, Maison St. Brelade : No.

Deputy J.A. Hilton:

No, you have not had that situation. Right, okay. Thank you.

Deputy G.P. Southern :

You say that one of the changes that you might make was to get access to the assessment of the need and therefore the level of support that is required. Is there anything else that you want to improve in the L.T.C. scheme, any little glitches or hitches that you have noticed along the way?

Head of Home, Maison St. Brelade :

I think they have made improvements, and I think Social Security have worked very hard, so I will say that, in fairness to them they have worked very hard. Initially I think it was very difficult, it just was not rolled out and they did not have enough people on the ground floor dealing with it. I think Health and Social Services could work better. I think they could be more cohesive. There has been a huge ... and I know there is a fluctuation of social workers who are carrying out assessments and they are having to draft people in to carry that out. I think that is really where I would see the weakness. Improvement-wise, it is again about recruitment. It is who you have on the Island. With regards social workers doing the assessments, there seems to be some discrepancy with regards nursing assessments and residential assessments. I think that, for me, would need to improve, but the benefit is a good benefit.

Deputy G.P. Southern :

The problems are one of communication, you would like access for them to talk to you as well as just talk to the clients?

Head of Home, Maison St. Brelade :

Yes, I just think we need more access. I get a lot of questions when I pick up the phone, and people will be asking me about the L.T.C. team: "How does it work and what do I do? How do I access it?" It has got better, it definitely has improved and I think people will just become used to it and will become more used to it. They will have condensed down their documentation, their process, which is better, with more stable staff from Health and Social Services' point of view. If we had more access so that everybody has got a transparency about the actual document and the assessment that takes place, I think it would be better.

Deputy J.A. Hilton:

I do not think we have touched on the subject of reassessments.

Head of Home, Maison St. Brelade : Within the home?

Deputy J.A. Hilton: Within the home.

Head of Home, Maison St. Brelade : They take longer.

Deputy J.A. Hilton:

Yes, we had heard that previously and I think it has been said that is probably due to the fact that because your resident is in a place of safety ...

Head of Home, Maison St. Brelade : Exactly.

Deputy J.A. Hilton:

... if there is demands on the service, obviously doing those reassessments are going to be way down the list if there is pressures elsewhere.

Head of Home, Maison St. Brelade :

But then there can be an urgency about some of those assessments within a care home, because you have somebody ... the care home, okay, it is a priority that they are saying, but a resident's condition may become unsafe within that care home.

Deputy J.A. Hilton:

Yes, okay. Hospitalisation: have you ever been in a situation ... we understand that Social Security for the L.T.C. funded residents will pay 90 per cent for the first 2 weeks and after 4 weeks they stop paying. Have you ever been involved in that situation?

Head of Home, Maison St. Brelade : No.

Finance Officer, Maison St. Brelade : No.

Deputy J.A. Hilton: Never, effectively?

Head of Home, Maison St. Brelade : No.

Deputy J.A. Hilton:

Okay. Have you got a view on that, the fact that L.T.C. fund will stop funding the bed after 4 weeks apparently, we are told?

Finance Officer, Maison St. Brelade :

I did not know that. I thought it was reduced by 10 per cent once somebody ...

Deputy J.A. Hilton:

It is for the first 2 weeks, but we have been told this morning that actually after 4 weeks the funding will be removed.

Head of Home, Maison St. Brelade :

My view would be it would be very awful for that person who is in that hospital bed. Their home is gone.

Deputy J.A. Hilton:

Yes, that basically they have been made homeless.

Head of Home, Maison St. Brelade : Absolutely, so I would think be quite cruel.

Deputy J.A. Hilton:

Yes. Obviously that is something we are going to clarify with Social Security, because it is pretty black then.

Finance Officer, Maison St. Brelade : Yes, grim, it is grim.

[12:15]

Deputy G.P. Southern :

But I can see where the parallel with Income Support comes from. If you are in a hospital bed certainly your Income Support will go down after a fortnight.

Deputy J.A. Hilton:

Yes. That is something we will definitely discuss with Social Security when we have a public hearing with the Minister for Social Security. I just wanted to ask you that question, just to know if you have had experience with that.

Head of Home, Maison St. Brelade : No.

Finance Officer, Maison St. Brelade : No.

Deputy T.A. McDonald:

Again, just while we are on financial sustainability, there is a couple of questions, because it is so important, at the end of the day obviously you have got a job to do, you have got to keep the home open and everything else operating. Do you think that the financial awards are fair and do they

really meet the reasonable demands and needs of your awardees? So in other words, is the money sufficient? We know that the £35.70 is fairly light, but do you think things are fair at the moment?

Finance Officer, Maison St. Brelade :

When you say the award, that is the bigger award, after the £52,000 has been paid? I think it is quite a substantial amount and well-received really.

Deputy T.A. McDonald:

Yes. That seems to be, across the board. Are you satisfied with the support that you are getting from the Government? Are you being told enough, are people approachable, is the system, the service reasonable?

Finance Officer, Maison St. Brelade :

Yes. I would say I think that everyone is approachable and we are able to ask what we want and get what we want. If we are cannot, we are told why and then we are all ...

Deputy T.A. McDonald:

You can go off in another direction or something?

Finance Officer, Maison St. Brelade : Yes, and sort something.

Deputy T.A. McDonald:

Yes, that is fine. Then there is a final question: in many ways, do you think that the L.T.C. scheme relies on the supplementary support of relatives and voluntary organisations? What sort of part do they really play or pay, as far as you are concerned?

Head of Home, Maison St. Brelade : We have not found that, have we, Mel?

Finance Officer, Maison St. Brelade : No.

Head of Home, Maison St. Brelade :

No, we have not found that. For us, once the financial assessment has been completed, it seems to work very effectively. But saying that ...

Of course, private funders, it is not really a concern for them, but it would be for L.T.C. people. Yes, sorry, carry on.

Head of Home, Maison St. Brelade :

Privately, the arrangements between a family, we would not really have access. So if a daughter and a son are supplementing mum or dad, that would be between them.

Deputy T.A. McDonald:

That is right. As long as the bill is paid, that is the important thing. Yes, fully understandable, because at the end of the day, that is what it is all about.

Deputy G.P. Southern :

Do you think the department has achieved the right level of information out there when people come to you about funding care? Are they sufficiently aware of how the system works or do you have to give info on that?

Head of Home, Maison St. Brelade :

Initially, they did not. Initially they found it very confusing, but now I think people are really far more informed and they know they can go online, you direct them online, they know they can look it up. Yes, I have had less queries.

Finance Officer, Maison St. Brelade :

Yes, I would be more inclined to tell the people to go down to yourselves to find out, because ... exactly what the requirements or the information you have.

Deputy J.A. Hilton:

In general terms with the families that you are dealing with, your residents and their families, their children, their adult children, is it generally a positive response/feedback you get about the L.T.C. fund?

Head of Home, Maison St. Brelade : Yes.

Finance Officer, Maison St. Brelade : Yes.

Deputy J.A. Hilton:

People think it is better than it used to be, the free L.T.C.?

Head of Home, Maison St. Brelade :

Yes, absolutely, because now the way ... and older people, they have upped their work - I will be there, I have worked long and I have worked hard all my life - and one of the things that is important to a lot of people: "My children will be able to inherit something." That is a lovely positive feel that you get, they know that it is capped at this and: "At the end of the day, my children can still inherit. I am getting looked after well." I feel most people do not mind paying for care, really. They expect to pay for care, but it is the standards that are given to them, really.

Deputy J.A. Hilton:

The care cap cost is currently £52,000, is it not?

Head of Home, Maison St. Brelade : Yes.

Deputy J.A. Hilton:

I have heard that some people believed it was just the care cap was the £52,000 and not the co- payment. Of course you carry on paying ...

Head of Home, Maison St. Brelade :

They did not understand that. That could have been clearer. They had no clarity, that it is just care. There is accommodation, those 2 payments have been ...

Deputy J.A. Hilton:

Yes, they call it hotel costs, do they not?

Head of Home, Maison St. Brelade :

Yes, there are 2 payments that are being made and the L.T.C. will pay for the care component.

Deputy J.A. Hilton:

Yes. Has that provoked comment from your families, the fact that there is this co-payment that carries on regardless or it something that they are quite accepting of?

Head of Home, Maison St. Brelade :

Once they understood what it means, there has been no issues with it.

Finance Officer, Maison St. Brelade : Yes. No, they are more than happy. Head of Home, Maison St. Brelade : No issues with it.

Deputy J.A. Hilton: Good. Okay.

Deputy G.P. Southern : Have you finished now?

Deputy J.A. Hilton: Yes, thank you.

Deputy G.P. Southern :

If there is something you came to say, that you are burning to say that we have not for some reason touched upon, is there anything else you would like to add?

Finance Officer, Maison St. Brelade :

No, I think we have covered everything, have we not?

Deputy G.P. Southern : Yes, go on.

Deputy J.A. Hilton:

I have spotted just one thing, I hope you do not mind. Under: "Expenditure" I notice you have got: "Salaries, wages, Social Security and pension contributions."

Head of Home, Maison St. Brelade :

There is a certain pension when you are talking about staff. That is senior staff. That would be myself and 2 others.

Deputy J.A. Hilton: Oh right, okay.

Head of Home, Maison St. Brelade :

It is just the senior team that was always in place before ever I got the job. With regards everybody else within the home ...

Deputy J.A. Hilton: There is not any.

Head of Home, Maison St. Brelade :

... there is not any pension. The business could not afford it.

Deputy J.A. Hilton:

I notice that your payment contribution to the pre-1987 debt, is that because some of the senior management are in P.E.C.R.S., but not all?

Head of Home, Maison St. Brelade : I am in P.E.C.R.S.

Deputy J.A. Hilton:

Yes. Is that why you have to make a contribution to that? Right, okay. I just noticed it there.

Finance Officer, Maison St. Brelade : You have our accounts there, do you?

Deputy J.A. Hilton:

Yes. Thank you very much. Yes, it has been really interesting talking to you.

Deputy T.A. McDonald:

You do not know how we got those?

Head of Home, Maison St. Brelade : They are online.

Deputy T.A. McDonald: Yes.

Finance Officer, Maison St. Brelade : They are online. Yes, they are.

Deputy G.P. Southern :

Yes, they are. So there we are, all above board.

Beautifully presented.

Deputy J.A. Hilton:

Ten out of 10 for openness and transparency. Yes, thank you very much.

[12:21]