Care home providers in Wales have been criticised for charging top up fees to residents for taking them to medical appointments.
Sue Simms, whose dad is in a care home, said: "It feels mean and underhanded." Ms Simms, from Cardiff, cares for her father 78-year-old Peter Faint. Mr Faint, who was a research and development scientist, requires full-time nursing care as he has Parkinson's Disease, vascular dementia and multiple sclerosis.
Ms Simms, a nurse, said she was "astonished and furious" when his care home told her she would have to start paying £18 an hour for every hospital appointment that she could not take her father to.
"You could come away with a bill of hundreds of pounds," she said.
Ms Simms said she always tried to take her father to appointments, but she worried about other people who may not be able to do the same for their relatives. "We all think that everybody's got somebody but there are a lot of people who don't have anyone," she said.
What the provider said
A spokesperson for the home where her dad lives, said: "We do charge an escort fee for hospital appointments as standard at our home.
"We ask for the fee because when a carer is needed to accompany a resident, it means they are away from the home and the other residents under their care. In some cases, we will need to ensure an extra team member is on shift to cover their duties.
“In Sue’s case, we apologise that the escort fees were not communicated to her and her family.”
The care home added, these fees were paused during the height of the pandemic and when charges restarted this should have been clearly communicated to everyone.
What the Welsh Authorities said
The Older People's Commissioner for Wales, Helena Herklots, said that it was not always clear how much extra people might have to pay. She added that some of the examples they had heard were "extraordinary".
"We've heard of one example where someone was being charged to get access to go into the garden. That's at the extreme end," she said.
She said the worry about extra costs was causing families and older people "a lot of stress". "It's affecting their mental health, it's making them anxious and worried because they're not sure they can afford these additional costs," she added.
What the Welsh Government said
The Welsh government said it was committed to creating a National Care Service. Chief executive of Care Forum Wales, Mary Wimbury, explained that the financial situation for care homes was "really challenging".
She added that accompanying someone for a long hospital visit meant backfill staff would be needed in the home which would cost providers.
The Welsh government said it expected care home providers to be clear and upfront about the fees they charge.
"They are required by law to set out this information in their written guide for the service as well as an individual's service agreement," it said.
Unravelling the confusion
There seems to be a great deal of confusion between costs of care home fees which are seen as inadequate and what should be included in a legal contract between the provider and a private paying family or local authority.
These are to entirely separate issues. It is incumbent on the provider to provide a legal care home agreement (contract), that includes all charges. In Sue Simms case the hospital appointment charge was not communicated to her by the provider.
It seems to me that any amendment to the providers contract should include the acceptance signature of the party paying the bills. Using this process would avoid any ambiguity.
Care homes in Wales are struggling to make ends meet. Hospital appointment charges taking staff away from the home for frequently lengthy periods seems reasonable to me. But charges for accessing the garden seem way over the top.
There is no doubt that the extra charges being made by providers are having a detrimental effect on people’s mental health. Nor is it helpful for providers to bring in new charges that were not part of the original legal care home agreement. To avoid any misunderstanding; prior to any amendment to the contract the agreement of those paying the bills should be sought. It is essential the agreements state clearly what is being paid for.
Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy