Social care planning reporting arrangements for cross-border placements
Step one of four
Identifying the potential need for a cross-border placement
The possibility of a cross-border placement may first be raised by the person themselves or by a family member or carer. For instance, in the assessment or care planning process the person may express a wish to move to a care home in a different country within the UK because they were born or lived in that country, and have friends and family still living there. The potential for a cross-border placement may also be identified by a practitioner who considers that an individual may benefit from such a placement (e.g. because of the availability of particular facilities, or because the practitioner has identified that the person has strong family or cultural links to the relevant country). If so, the practitioner should discuss this with the individual and any other person appropriate (such as family members, carers and representatives). In general terms, when making any placement, the authority in question should be seeking to promote the person’s wellbeing.
Exploring the possibility of a cross-border placement
Moving to a new area – let alone a new country – can be a daunting prospect. It is important that the practitioners discuss generally what might be involved, including the advantages and disadvantages, and what support might be available for the person to help them to make decisions. It is important for practitioners to be clear with all those concerned about the realistic options and the potential issues that might arise. These potential issues will normally include being clear that the first authority will continue to be responsible overall for the person’s care, including the care plan. It should also be explained that some aspects of the person’s health and social care needs may be met in a different way when the adult moves to the new country.
Such discussions will need to be tailored according to the adult’s level of knowledge and understanding of the placement process, and take into account any communication needs that the person has. In some cases, the provision of advocacy support for the person will be important and give rise to related duties. Most importantly, sufficient time should be allowed for people to reflect on the various options.
The possibility of a cross-border placement should be discussed with carers and anyone else the person asks to be involved, such as family members. If the person lacks capacity to consent to a cross-border placement, it will be particularly important to consider the role of an advocate, proxy decision-maker or a family member in raising the question of a cross-border placement.
People considering a cross-border placement should also be able to visit the home and, ideally, stay for several days or longer. It should be borne in mind that some people may take some time to settle into a new environment. However, it would also be important to explain any charges which might apply. The trial stay should be arranged by the placing authority (unless the person or their family would prefer to make the arrangements themselves). Similarly it is desirable, if so wished by the adult, that the manager of the home should contact potential residents to establish a personal relationship, gain information about their way of life and advise them about what possessions (including pets) can be taken with them into the home. This may be undertaken in person or through other means such as online video chat and voice calls.
Some cross-border placements will be located some distance away from where the person is situated, which may make it difficult for some people to visit the home in person (for instance, if they are too frail). One way of overcoming this problem may be for practitioners to arrange for a virtual tour online, or a recording to be made which can be played back to the person. Full information about the home should be provided in writing if requested and access to the relevant website should also be facilitated. Before making the final decision, the person and the practitioner may want to look at a recent inspection report for the home.
The individual should also be informed of the likely arrangements between the first and second authorities (e.g. any assistance in the conduct of needs assessments and reviews), and what will be involved (for instance, the giving of a notification of the placement to the second authority and the sharing of information or the gathering of information by the second authority on behalf of the first in order to inform the review process). The individual should be informed of this at the outset and their consent sought.
A cross-border placement should only be pursued with the informed consent of the person concerned. The individual’s views, wishes, feelings and beliefs will be critical to a person-centred process. If a person may or does lack capacity to decide where they should live, consideration should be given to providing support to enable a ‘supported decision’ to be made. Supported decision-making refers to the process of providing support to people whose decision-making ability is impaired to enable them to make their own decisions wherever possible. If it is confirmed that the person lacks capacity, it will be crucial to involve, as appropriate, family, friends, carers, an advocate and authorised decision-makers (including anyone authorised legally to make decisions on a person’s behalf).
Deciding whether a cross-border placement should be arranged
Should the person wish to pursue this option, the practitioner will need to consider carefully the pros and cons. Questions the practitioner may wish to address could include the following.
- Would the support network in the area of the proposed new placement improve (or at least maintain) the individual’s wellbeing?
- What effect might the change of location have on the individual’s wellbeing? How well are they likely to adapt to their new surroundings?
- Is the individual in receipt of any specialist health care? Will the locality of the proposed new placement allow for the satisfactory continuation of this treatment?
Where the person lacks capacity to decide whether or not to pursue this option, the authority will still need to consider carefully all of the above. With the permission of the individual concerned (if they have capacity to give permission) the authority should approach the friends, carers and family of the individual who are resident in the area of the proposed new placement (and any friends, carers and family in the area of their current residence) to seek their views on the perceived benefits of the placement and any concerns they may have.
If a cross-border placement is in the interests of the individual’s wellbeing, the authority should take appropriate steps to investigate the range of providers in the proposed new placement area and which are likely to be able to meet the needs of the individual. Authorities should strive to offer people a choice of placements. The authority should conduct all necessary checks and exercise due diligence, as it would with any other care home placement.
The decision to offer a cross-border placement is one for the authority to a take, in accordance with public law principles. This means that the authority will need to take into account all relevant considerations, including the individual circumstances of the case and the total costs of different potential options for meeting needs. Cost may well be a relevant factor in deciding between suitable alternative options for meeting needs (although the focus should be on ensuring an individual’s needs are met effectively). Other factors will also be relevant, including the views of the person. Where possible, the person should be offered choice in respect of placements. The use of ‘top-up payments’ or ‘betterment fees’ may also need to be considered.
Ultimately, the offer of a cross-border placement cannot proceed unless the person gives their consent. Where the person lacks capacity to give their consent then someone will need to make the decision on their behalf in accordance with the relevant mental capacity legislation that applies in the country. In respect of cross-border placements, decisions might be made by an authority, guardian, attorney, deputy, family member or someone else.
It is possible that the person (or someone on their behalf) will disagree with the authority’s decision. For instance, the person (or their decision-maker) may seek a cross-border placement but the authority considers that it will impact negatively on the person’s wellbeing. Alternatively, the offer of a cross-border placement may be rejected by the person (or their decision-maker), but the public authority does not think that an alternative care package would be appropriate. In England, Wales and Northern Ireland, the person (or their decision-maker) will need to consider whether an alternative care package could be privately funded elsewhere, or seek to negotiate with the authority. In England, when preparing a care and support plan, the local authority has to involve the adult, any carer the adult has and any person whom the adult asks the authority to involve, or, where the adult lacks capacity to ask the authority to do that, any person who appears to the authority to be interested in the adult’s welfare. In involving the adult, the authority has to take all reasonable steps to reach agreement with the adult about how the authority should meet their needs. Information should also be given about the relevant complaints process and ombudsman. As a last resort, an issue relating to the provision or non-provision of a specific care package may need to be decided by the courts.
However, in Scotland the situation would be different and it would be for the local authority to find alternative accommodation and not for the individual to consider the extent to which they could privately fund an alternative care package.
In all UK countries, if the dispute is about whether or not arrangements for accommodation which were made cross-border should have been made by a particular authority as a matter of legal obligation, then these are to be resolved with reference to the dispute resolution regulations (see below).
The placing authority should ensure that satisfactory arrangements for services are in place before the placement begins. This includes ensuring that any necessary support services have been set up, such as day care arrangements, and that clear agreements are in place for funding all aspects of the person’s care. For example, the placing local authority may negotiate for support services to be provided by the host authority and reimburse the costs. Authorities should consider developing standard checklists and forms to assist practitioners in negotiating these matters.
In making arrangements, practitioners must have regard to the views, wishes, feelings and beliefs of the individual. Practitioners should (and sometimes must) also involve the individual, carers, family members and any other relevant persons. In involving the individual, the authority should (and sometimes must) take all reasonable steps to reach agreement with the individual about how the authority should meet the needs in question. The individual should be kept informed and involved throughout the process. Their views on suitable providers should be sought and their agreement checked before a final decision is made.
The authority should also ensure that the provider is aware that this will be a cross-border placement and that the placing authority will be responsible for meeting costs.