Benefits in hospital - Elderly Client Adviser

Feature

posted 15 Nov 2000 in Volume 6 Issue 1

Benefits in hospital

By Alan Robinson

Complicated rules affect benefit claimants in hospital. This article addresses the position of adults in receipt of the most common benefits paid to older people; if there are children involved, or if there is entitlement to a benefit not covered in the article, further advice should be sought.

The principal rules apply to hospital in-patients, that is those who are being maintained free of charge while undergoing in-patient treatment at a hospital or similar institution under the NHS. The rules include those who are in a nursing home or hospice under NHS or social services contracting arrangements, those in the hospitals of the armed forces, and those in special hospitals. They do not apply to fee-paying patients, whether in an NHS or a private hospital. It is for the patient to prove that they are not being maintained free of charge.

The day of entering hospital does not count as a day in hospital, but the day of leaving does count for all benefits except attendance allowance and disability living allowance (DLA). For attendance allowance and DLA, neither the day of entering nor the day of leaving counts as a day in hospital. Where someone is in hospital for two or more short periods, those periods are added together in determining how many days have been spent in hospital, unless those periods are separated by at least twenty eight days.

Income support

The patient’s income support is subject to a reduction after six weeks and again after 52 weeks. The reduction is made to the applicable amount, that is the amount the person is deemed to need as a minimum amount to live on. Where housing costs are paid with income support, they continue to be met until the patient has been in hospital for 52 weeks.

After six weeks as an in-patient, the patient’s applicable amount reduces to £16.90 in the case of a single person. If the claimant is one of a couple, their applicable amount is reduced by (not to) £13.50 a week, in each case plus their allowable housing costs. If both members of the couple have been in hospital for at least six weeks, their applicable amount is reduced to £33.80 plus housing costs.

After 52 weeks the applicable amount is reduced to £13.50. From this point no further housing costs are payable.

The figure of £13.50 can itself be reduced. This will be to whatever figure appears reasonable, provided that an appointee is acting for the patient, and the income support is being paid to the hospital, either because they are the appointee or because the appointee has requested it, and the doctor treating the patient certifies that no money, or no more than a specified sum less than £13.50, can be used by or for the patient for personal comfort or enjoyment.

Benefit is then reduced to the specified sum, if any. There is a test of reasonableness in making this reduction, and the views of relatives and hospital staff are also taken into account.

Note that there are special rules regarding those going into hospital direct from residential care – see the notes below.

Housing Benefit

A person who is claiming either housing benefit or council tax benefit continues to be entitled to it for up to 52 weeks, so long as their absence is not likely to exceed 52 weeks. Subject to this, where the patient is also receiving income support, they continue to be entitled to housing benefit or council tax benefit for as long as they receive any income support. If they do not receive income support, or if their income support stops, they can claim housing benefit or council tax benefit separately. However, their applicable amount is reduced after six weeks in the same way as for income support, and after 52 weeks there is no further entitlement.

Attendance Allowance and DLA

Attendance Allowance and DLA are both payable for a maximum of 28 days while a person is an in-patient. Where benefit is payable when the patient enters hospital, benefit will therefore stop after 28 days. The “linking rule” referred to above means that, where the patient has been in hospital less than 28 days before the present admission, those days will also count towards the 28 day period.

Where the patient had a severe disability premium as part of their income support applicable amount, this will disappear when their attendance allowance or DLA comes to an end.

There are special rules for the mobility component of DLA. Someone who was receiving the mobility component can continue to receive it after 28 days provided either than they had a Motability agreement on entering hospital (in which case the agreement continues until its termination) or they had been an inpatient and receiving the mobility component for a continuous period of 365 days or more on 31 July 1996. Interruptions of 28 days or less are ignored.

AA and DLA (and the severe disability premium) continue to be paid while the patient is in a hospice.

Invalid Care Allowance

A person receiving invalid care allowance continues to be entitled to it while they, or the person they are caring for, are an inpatient for a temporary period. This applies for up to 12 weeks in any period of 26 weeks. Once the person being cared for loses their DLA or AA care component, the carer’s entitlement to ICA stops. It will resume on discharge provided the qualifying conditions are fulfilled.

If the carer loses their ICA because they have been in hospital for 12 weeks, the disabled person may become entitled to the severe disability premium.

Other benefits

Industrial Injuries benefits are unaffected by a stay in hospital, except for constant attendance allowance which (like AA and DLA) stops after four weeks.

Retirement pension, widows pension and incapacity benefit are all treated in the same way. After six weeks, benefit is reduced by £13.50 if the patient has any dependants, or by £27 if not. After 52 weeks, the rate of all three benefits is reduced to £13.50. This amount can itself be reduced in the same circumstances as apply to income support (see above). If there is a dependant, the patient can apply for the remainder of his or her entitlement, less £27, to be paid to the dependant.

Entering hospital from residential care

Where the patient enters hospital from residential care, special rules apply. Someone with ‘preserved rights’ to the higher rate of income support continues to receive it for the first six weeks. If they do not in fact have to pay an accommodation charge, they will nevertheless receive the allowance for meals and personal expenses. This assumes they are expected to return to the care home. After six weeks, their applicable amount reduces to £16.90. If the patient has a family member still in the accommodation, the patient’s personal expenses allowance and accommodation charge remain payable, less any inpatient’s meal allowances. If not, then any retaining fee payable is paid as part of income support.

A person without preserved rights retains benefit at their normal rate for six weeks. Thereafter their benefit is calculated as for any other inpatient.

Where the inpatient is permanently resident in a local authority home, their applicable amount reduces to £15.45 immediately.

Because of the rules which link accommodation in publicly funded accommodation together, periods spent in hospital as well as in residential care count towards the 28 days after which entitlement to benefit ceases.

Advice points

It is important that the person going into hospital, or their appointee, notify the Benefits Agency or local authority of their admission. Otherwise an overpayment may arise which will need to be recovered at a later date.

Benefit is normally reduced with effect from the pay day following the expiry of the specified period. However, incapacity benefit and severe disablement allowance are reduced from the following day, and do not await the next pay day.

After 52 weeks in hospital, if the patient is one of a couple, the partner outside hospital can claim income support as a single person, including housing costs.

Council tax benefit is not normally payable where absence is expected to exceed 52 weeks, although there may be room for argument that the entitlement should continue beyond 52 weeks if the property is the patient’s sole or main residence.

The reduction in applicable amounts may mean that the patient loses entitlement to income support because of other income (although the rules outlined above for non means tested benefits makes this unlikely if the patient’s income is entirely benefit based). If the patient’s income support stops, but they are still likely to be entitled to housing benefit or council tax benefit, they will need to make a fresh claim. If their own entitlement stops but they have left a partner (spouse or cohabitee) in the home, that person should make a claim in his or her own right.

In the case of attendance allowance or DLA, the patient needs to inform the Benefits Agency that he/she is going into hospital. Providing underlying entitlement remains, the patient also needs to notify the Benefits Agency prior to discharge, so that payment can resume. If there is no underlying entitlement which has continued until the patient is discharged, they should claim again.

If the patient is claiming attendance allowance or DLA for the first time, or if their condition has deteriorated, it may be worth claiming while they are in hospital so that benefit can start on discharge.

The rules on reducing benefit below the minimum (£13.50), which apply to both income support and contributory benefits, may leave the patient with no income at all in those specific circumstances. It is important to make sure that all information with regard to the reasonableness of this step, together with the views of relatives and hospital staff, are made known if there is a proposal to reduce benefit to below £13.50.

Alan Robinson, Legal and Welfare Rights Training