The body representing most care homes in Scotland has questioned government plans to keep some fees for residents under a National Care Service.

Scottish Care warns people who have need residential care because of a clinical condition such as dementia would be ‘doubly penalised’ under the proposals.

The organisation is calling for a ‘wholly independent’ review of the funding and charging of residential and nursing care to ascertain the ‘true costs’ of high-quality support.

Scottish Care made the call in its response to a wide-ranging government consultation that closed this week.

The Feeley review, which set out the blueprint for a National Care Service and associated reforms, said social care in Scotland should be “free at the point of need”.

But this did not include accommodation charges for care home residents, on the grounds they might face similar costs if they were at home.

The government consultation continued in this vein, saying self-funding care home residents could be charged to ‘ensure fairness between those who live in residential care and those who do not’.

Respondents were presented with a list of potentially-chargeable items including food preparation, leisure and entertainment, and rent.

In its consultation response, Scottish Care says the National Care Service ‘needs to address, for instance, the different way in which people with an Alzheimer's diagnosis are charged for support compared to how someone with cancer might be’.

‘...It is simply not true to say that the cost of living on your own, including energy and food costs, is the same as the costs incurred for the same services in a group environment such as residential care.

‘The latter is significantly more expensive. Therefore, people having to access residential care to support their clinical needs are being doubly penalised.’

Age Scotland chief executive Brian Sloan voiced similar concerns, telling healthandcare.scot “there should be much more parity between accommodation costs in residential care and for those who live in private residences than we have at the moment, as this would help ensure greater fairness.

“It’s also important that the costs of services in care homes are reasonable, competitive and transparent, with a detailed breakdown of costs made available.

“Discussion around care costs feeds into the ongoing debate around those with advanced dementia still being required to pay for nursing care that would be free for any other terminal illness.

“The fact that people living with dementia are assessed as requiring social care rather than health care is a deep-rooted issue and one which has been effectively highlighted by Alzheimer Scotland’s Fair Dementia Care campaign and Scottish Care, and we would support and echo their calls for action.”

Currently anyone with assets of more than £27,250 is expected to contribute towards their own fees.

Below this level, the council steps in to cover some or all of the costs but care home providers have consistently complained rates for publicly-funded residents do not equal what they spend on delivering the service.

Self-funders pay an average of £977 a week for nursing care while £739 is provided for publicly-funded residents, a gap that has widened over the last decade, according to Public Health Scotland.

Scottish Care said: ‘We recommend the establishment of a wholly independent review of the funding and the charging of residential and nursing care which assesses both the true costs of rights-based, dignified, person-led care and explores different [contribution] models...regardless of where it is delivered and by whom.’

The disparity was also raised by the Health & Social Care Alliance, which carried out engagement for the Feeley review on behalf of the government.

The charity, which represents health and social care organisations alongside people with long-term conditions said in its consultation response that free delivery of residential and in-home support should not be presented in ‘binary opposition’.

‘In the long term, Scotland should be working towards making all social care universally free at the point of use,’ it said.

Read more: Government review admits care home ‘search for blame’; Double standards claim over NHS & care home deaths; Insight: Care homes key in preventative care

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