Long-Term Care (General
Provisions) (Jersey) Order 2014
part 1
interpretation
1 Interpretation
In this Order –
“adult” means a person aged 18 years or over;
“approved registered person” shall be construed in
accordance with Article 12;
“benefit” means a benefit under the Law;
“Benefits Order” means the Long-Term Care (Benefits)
(Jersey) Order 2014;
“claim” means an application for a benefit;
“claimant” means a person who makes or has made a claim;
“claimant’s agent” has the meaning in Article 8(8);
“Health Care Law 1995” means the Health Care (Registration)
(Jersey) Law 1995;
“Law” means the Long-Term Care (Jersey)
Law 2012;
“Medical Practitioners Law 1960” means the Medical Practitioners
(Registration) (Jersey) Law 1960;
“partner” has the same meaning as in the Benefits Order.
part 2
Claims and Benefits
2 Manner
in which a claim is to be made
(1) Every claim must be
made to the Minister on a form approved by the Minister, or in such other
manner as the Minister may accept as sufficient in the circumstances of the
case.
(2) Subject to paragraph (3),
a claim is treated as having been made on the day on which it is received by
the Minister at an office approved by the Minister for the receiving of claims.
(3) A claim may be treated
as having been made on a date that is not more than 6 months before the
date it is received by the Minister if, in the opinion of a determining
officer, there are sufficient reasons to justify why the claim was not made at
an earlier date and, in such circumstances, the claim will be treated as having
been made at that earlier date.
(4) If a claim is defective
at the date when it is received or has been made in a manner otherwise than as
required by paragraph (1), the Minister may refer the claim to the
claimant or, as the case may be, supply him or her with the form, and if the
form is received properly completed within 14 days from that date on which
the claim is so referred, or the form is so supplied, to the claimant, the
Minister shall treat the claim as if it had been duly made in the first
instance.
(5) A claimant may amend a
claim at any time before the claim is determined by notice in writing to the
Minister, and the Minister may treat the claim as if it had been made as so
amended in the first instance.
3 Information
and evidence in support of a claim
A claimant or partner of a claimant must furnish such certificates
and other documents and information as a determining officer may require and
within such reasonable time as the determining officer may require for the
purpose of –
(a) establishing whether
the claimant is entitled to a benefit and if so, the amount of such benefit;
(b) any other matter in
connection with a claim which requires to be determined for the purpose of this
Order or the Benefits Order,
and, if reasonably so required, must for that purpose attend at such
office or place as a determining officer may direct.
4 Assessments
of long-term care needs and approved care packages
(1) A claimant is not
entitled to a benefit unless –
(a) an
approved registered person assesses that the claimant needs a level of standard
care specified in column 2 of the table in Article 8 of the Benefits
Order; and
(b) except
where those needs are met by an approved care package, those needs are met in
an approved care home.
(2) A claimant is not
entitled to a benefit comprising payments for or towards the costs of an
approved care package unless –
(a) an
approved registered person has assessed that the care package is suitable for
the long-term care needs of the particular claimant having regard to the level
of standard care specified in column 2 of the table in Article 8 of
the Benefits Order that the claimant has been assessed as needing; and
(b) any
person responsible for providing care or assistance as part of the approved
care package meets the conditions in paragraph (2A).[1]
(2A) The conditions referred to in
paragraph (2)(b) are –
(a) if
the care package includes any care, provided in return for remuneration, that
is regulated under the Regulation of Care (Jersey)
Law 2014, the person responsible for providing the care is –
(i) registered under
Article 7 of the Regulation of Care (Jersey)
Law 2014, and
(ii) approved
under Article 13A of this Order; and
(b) if
the care package includes arrangements for assistance that is not personal care
or nursing care (in both cases as defined in the Regulation of Care (Jersey)
Law 2014), the person responsible for providing that assistance is assessed
as suitable to provide it by the approved registered person.[2]
(3) A determining officer
may, at any time following a determination under Article 5 that a claimant
is entitled to benefits, require an approved registered person to assess any of
the following –
(a) if
there is a change in a claimant’s needs having regard to the level of
standard care specified in column 2 of the table in Article 8 of the Benefits
Order;
(b) if a
change is required in the arrangements comprised in an approved care package
for meeting the long-term care needs of a claimant; or
(c) if a
claimant’s long-term care needs can no longer be met by an approved care
package.
(4) A determining officer
shall notify the claimant in writing –
(a) of
the approved registered person’s assessment for the purposes of paragraph (1)(a),
(2)(a) or (3) as the case may be, including the reasons for the assessment and,
where applicable, the arrangements, or change in arrangements, comprised in the
approved care package that is assessed as being suitable for the claimant;
(b) of
the right to a reassessment of the matters which the assessment addresses and
the time within which such right must be exercised; and
(c) that
if the right to a reassessment is not exercised, there is no further right of
appeal.
(5) If the claimant is
dissatisfied with the assessment for the purposes of paragraph (1)(a),
(2)(a) or (3) as the case may be, he or she may require a reassessment of the
matters addressed by the assessment provided that he or she makes an
application to a determining officer for a reassessment no later than
21 days after receipt of the initial assessment.
(6) An application under
paragraph (5) must set out the reasons for requiring a reassessment.
(7) A reassessment
following an application under paragraph (5) shall be made by an approved
registered person other than the approved registered person who made the
initial assessment.
(8) A determining officer
shall notify the claimant in writing of –
(a) the
reassessment and the reasons for it; and
(b) the
claimant’s right to appeal to the Medical Appeal Tribunal for a review of
the reassessment and the time within which such a right must be exercised.
5 Determination
of claims
(1) A determining officer
shall determine –
(a) whether
a claimant is entitled to a benefit and, if so, the amount of such a benefit;
(b) whether
any change to a benefit is required; and
(c) any
question or matter arising from a claim other than a matter which falls to be
assessed or otherwise determined by an approved registered person under Article 4.
(2) A determining officer
who has made a determination under paragraph (1) shall notify, in writing,
the claimant and, where applicable, the claimant’s partner –
(a) of
the determination and the reasons for it;
(b) if a
benefit has been granted, the amount of benefit and method of payment;
(c) of
the right to a redetermination and the time within which it must be exercised;
and
(d) that
if the right to a redetermination is not exercised, there is no further right
of appeal.
(3) If a claimant or the
claimant’s partner is dissatisfied with a determination made under
paragraph (1), he or she may require that the matter is redetermined provided
that he or she makes an application to a determining officer no later than
21 days after receipt of the initial determination.
(4) An application under
paragraph (3) must set out the reasons for requiring a redetermination.
(5) A redetermination following
an application under paragraph (3) shall be made by a determining officer
other than the determining officer whose determination is to be redetermined.
(6) A determining officer
who has redetermined any matter under paragraph (5) shall notify in writing
the claimant and, where applicable, the claimant’s partner –
(a) of
the redetermination and the reasons for it;
(b) if a
benefit has been granted or adjusted, the amount of benefit and method of
payment; and
(c) of
the claimant’s right to appeal to the Social Security Tribunal for a
review of the redetermination and the time within which such right must be
exercised.
(7) Subject to any decision
by the Social Security Tribunal or the Royal Court, where, following a
determination or redetermination under this Article –
(a) a
determination is made that a claimant is entitled to a benefit, a determining
officer shall arrange for payment of that benefit to the claimant; or
(b) a
determination is made in respect of a benefit in payment that the claimant is
no longer entitled to such a benefit, or part of such a benefit, a determining
officer shall arrange for payment of the benefit to be adjusted accordingly.
6 Appeals
(1) The Schedule shall have
effect with respect to appeals to a tribunal.
(2) A person who is
aggrieved by a decision of a tribunal may, on a point of law only, appeal to
the Royal Court.
(3) An appeal under
paragraph (2) may only be made with leave of the tribunal or the Royal
Court, and must be made before the end of the period of 28 days beginning
with the date of notification of the tribunal’s written decision to the
person who was the appellant before the tribunal.
(4) An application for
leave to appeal under paragraph (3) may include an application to stay a
decision of the tribunal pending the appeal.
(5) No appeal shall lie
from a decision of the tribunal refusing leave for the institution or
continuance of, or for the making of an application in, proceedings by a person
who is the subject of an order under Article 1 of the Civil Proceedings (Vexatious
Litigants) (Jersey) Law 2001.
(6) A tribunal, a
determining officer or an approved registered person may refer any point of law
to the Royal Court for the Royal Court to give a ruling on the point.
7 Notification
of change of circumstances and furnishing of information
(1) Where a claimant or a
claimant’s partner knows or suspects that there has been a change of
circumstances that might affect entitlement to, or the amount of, a benefit, he
or she must, as soon as practicable, notify the Minister in writing of the
change of circumstances.
(2) The person mentioned in
paragraph (1) must furnish to the Minister, in such manner and within such
time as the Minister may specify, such information as the Minister may require
as a consequence of the change of circumstances in order to determine whether a
claimant’s entitlement to, or amount of, a benefit is affected by the
change.
8 Persons
acting on behalf of a claimant
(1) In this Article,
“claimant” includes a person who is unable to make a claim.
(2) In the case of a
claimant in respect of whom none of the circumstances in paragraph (3)
apply and who is unable to act in relation to a claim, the Minister may appoint
a person (which may include the Minister or a determining officer) to act on
the claimant’s behalf in relation to any matter relating to a claim or
benefit including making a claim and receiving a benefit on the
claimant’s behalf.
(3) Those circumstances are
that the claimant –
(a) has
been received into guardianship in pursuance of a guardianship application
under Article 29 of the Mental Health (Jersey)
Law 2016;
(b) does
not have, acting on his or her behalf –
(i) a delegate
appointed under Part 4 of the Capacity and
Self-Determination (Jersey) Law 2016, or
(ii) a
person acting under the authority of a lasting power of attorney conferred
under Part 2 of that Law; or
(c) has a
tuteur.[3]
(4) An appointment under
paragraph (2) shall terminate –
(a) if
the claimant is received into guardianship, or has appointed, in relation to
him or her, such a person as mentioned in paragraph (3)(b) or a tuteur;
(b) at
the request of the person who has been appointed;
(c) if
revoked by the Minister; or
(d) if
the claimant becomes able to act.[4]
(5) A claimant who does not
have another person acting for him or her under paragraph (2) and none of
the circumstances in paragraph (3) apply, may appoint another person to
act on the claimant’s behalf in relation to any matter relating to a
claim or benefit including making a claim and receiving a benefit on the
claimant’s behalf.
(6) An appointment under
paragraph (5) shall be in writing and copied to the Minister.
(7) A person appointed
under paragraph (5) may act on the claimant’s behalf until whichever
of the following happens first –
(a) the
claimant revokes the appointment;
(b) the Minister
makes an appointment under paragraph (2); or
(c) one
of the circumstances described in paragraph (3) apply to the claimant.
(8) A person who is
appointed to act on behalf of the claimant in accordance with this Article, or
who is acting on behalf of the claimant by reason of any of the circumstances
referred to in paragraph (3), is referred to in this Order as the
claimant’s agent.
(9) Where a person is
appointed to act on behalf of a claimant under paragraph (2), the Minister
may deduct any weekly amount that the claimant is required to pay under this
Order or the Benefits Order towards the costs of long-term care from the weekly
amount of any of the benefits specified in Article 12 of the Social Security (Jersey)
Law 1974 payable to the claimant and shall pay, in accordance with Article 9(1)(c),
a weekly amount of the same amount that has been deducted to the approved care
home in which the claimant is residing or a provider of the approved care
package which the claimant is receiving.
9 Payment
of benefits
(1) Where a claimant is
entitled to a benefit, payment may be made directly to any of the
following –
(a) the
claimant;
(b) the
claimant’s agent; or
(c) the
approved care home in which the claimant is residing or a provider of the
approved care package which the claimant is receiving.
(2) A determining officer
may, having taken into account the views of the claimant or, if applicable, the
claimant’s agent, decide which of the persons referred to in paragraph (1)
is the most appropriate recipient for payment of a benefit and make payments to
that recipient accordingly.
(3) If a claimant dies,
benefits calculated in accordance with paragraph (5) may continue to be
paid for a period of 2 days starting the day after the date of death.
(4) If a claimant leaves an
approved care home for any reason (other than in the event of death), without
prejudice to any benefits that may be payable in respect of long-term care
provided to the claimant elsewhere following his or her departure, benefits
calculated in accordance with paragraph (5) shall continue to be paid
towards the costs of long-term care that the claimant would have expected to
receive in that care home for a period of 2 days starting the day after
the date of departure, if, in the opinion of a determining officer, the
claimant was unable to give reasonable advance notice of the departure.
(5) For the purposes of
paragraph (3) or (4), the benefits shall be calculated and paid on the
basis of the weekly costs referred to in Article 9(b), (c) (disregarding
the amount for incidental expenses) and (d) of the Benefits Order chargeable to
the claimant immediately before the date of death or departure, as the case may
be.
10 Recovery of benefits
wrongly paid
(1) If it is found at any
time that any benefit has been paid that was not properly payable, the Minister
may require it to be repaid by the person to whom it was paid or, in the case
of the death of such a person, by either of the following –
(a) a
person charged with the administration of the deceased recipient’s estate;
or
(b) the
claimant’s partner, if applicable, where the benefit was paid directly to
the claimant.
(2) Proceedings for the
recovery of any sum which is required to be repaid under paragraph (1) may
be instituted by the Treasurer of the States and notwithstanding any enactment
or rule of law to the contrary, any such proceedings may be brought at any time
within 10 years from the time when that sum was paid, or, where the
proceedings are for the recovery of a consecutive series of sums, within 10 years
from the date on which the last sum of the series was paid.
(3) Any sum which is
required to be paid under paragraph (1) may, without prejudice to any
other remedy, be recovered by means of deduction from any other payment due
under the Law to the person who is required to repay the sum.
11 Notices
(1) For the purpose of this
Article “notice” means any of the following –
(a) notification
of an assessment or a reassessment under Article 4;
(b) notification
of a determination or a redetermination under Article 5.
(2) A notice –
(a) may
be sent to the claimant and, if applicable, the claimant’s partner by
post; and
(b) shall
be treated as duly sent if sent to that person’s usual or last known
address.
part 3
approvals
12 Approved
registered persons
(1) Subject to the
following provisions of this Article, the descriptions of registered persons
who may make assessments for the purposes of Article 5 of the Law or for
the purpose of approving care packages under Article 7 of the Law, or
both, are as follows –
(a) nurse;
(b) social
worker;
(c) occupational
therapist;
(d) registered
medical practitioner, and
in this Article, except where specified otherwise, references to
making assessments include approving care packages for the purposes of Article 7
of the Law.
(2) A person who falls
within a description in paragraph (1) may apply to the Minister to make
assessments for the purposes of Article 5 or 7 of the Law or both.
(3) An application under
paragraph (2) must be made to the Minister on a form approved by the
Minister, or in such other manner as the Minister may accept as sufficient in
the circumstances of the case, and accompanied by such information, documents
and evidence as the Minister requires for the purpose of enabling the
application to be determined.
(4) On receiving an
application under paragraph (2) the Minister may –
(a) grant
the application for the purposes of Article 5 or 7 of the Law or
both; or
(b) refuse
the application (either in whole or in part).
(5) The Minister shall
notify the applicant in writing of the decision under paragraph (4) with
reasons and, if the application is granted, whether the person has the status
of being an approved registered person for the purpose of making assessments
under Article 5 or 7 of the Law, or both.
(6) The Minister shall not
grant an application under paragraph (4)(a) unless he or she is satisfied
that –
(a) the
person, if a nurse, social worker or occupational therapist, is registered
under the Health Care Law 1995;
(b) the
person, if a medical practitioner, is registered under the Medical
Practitioners Law 1960;
(c) if
the application is for the purposes of Article 5 of the Law, the person is
competent to make assessments for that purpose; and
(d) if
the application is for the purposes of Article 7 of the Law, the person is
competent to make assessments for that purpose.
(7) A person whose
application has been granted under paragraph (4) shall have the status of
an approved registered person for the purpose stated in the Minister’s
decision.
(8) A person’s status
as an approved registered person under paragraph (7) is suspended
if –
(a) the
person’s name is removed from the register under Article 8 of the Health
Care Law 1995;
(b) registration
of the person under the Health Care Law 1995 is cancelled under Article 10
of that Law; or
(c) registration
of the person under the Medical Practitioners Law 1960 is cancelled or
suspended under Article 9 or 10 of that Law.
(9) If, following a
suspension of a person’s status as an approved registered person under
paragraph (8) –
(a) the
person’s name is restored to the register under the Health Care
Law 1995;
(b) cancellation
of the person’s registration is rescinded under that Law; or
(c) registration
of the person under the Medical Practitioners Law 1960 is no longer
cancelled or suspended under that Law,
the suspension under paragraph (8) no longer applies and the
person’s status is restored as an approved registered person for the
purpose stated in the Minister’s decision under paragraph (4).
(10) If, following a decision to
grant an application under paragraph (4) the Minister determines
that –
(a) in
the case of an application granted for the purposes of Article 5 of the
Law, the person is no longer competent to make assessments for that purpose; or
(b) in
the case of an application granted for the purposes of Article 7 of the
Law, the person is no longer competent to make assessments for that purpose,
the Minister shall notify the person in writing of the
Minister’s determination with reasons and from the date specified in the
notice, subject to paragraph (13), the person shall no longer have the
status of an approved registered person for that purpose.
(11) A notification of a decision
to refuse an application under paragraph (4) or of a determination under
paragraph (10) shall be made only after consideration of any objections or
representations in accordance with paragraph (12).
(12) Before giving notification
under paragraph (4) or (10), the Minister must serve notice on the
person –
(a) giving
the Minister’s reasons for the Minister’s proposed refusal or
determination; and
(b) stating
that within such period as may be specified in the notice (not being less than
21 days beginning with the date of service of the notice) the person on
whom it is served may make objections or representations in writing to the
Minister concerning the proposal.
(13) If a person is aggrieved
by –
(a) a
decision of the Minister under paragraph (4); or
(b) a
determination under paragraph (10),
the person may appeal to the Royal Court no later than 28 days
after the date of receipt of the notification of the decision or determination,
as the case may be, on the ground that the decision or determination of the
Minister was unreasonable having regard to all the circumstances of the case.
(14) Unless the Royal Court so
orders, the lodging of an appeal shall not operate to stay the effect of a
decision under paragraph (4) or a determination under paragraph (10)
pending determination of the appeal.
(15) On hearing the appeal, the
Court may confirm, reverse or vary the Minister’s decision or
determination, as the case may be.
13 Approved
care homes
(1) In this Article
“registered home” means a home that is part of a care home service
within the meaning of paragraph 4 of Schedule 1 to the Regulation of Care (Jersey)
Law 2014.[5]
(2) A person carrying on a
registered home may apply to the Minister for the home to be an approved care
home.
(3) An application under
paragraph (2) must be made to the Minister on a form approved by the
Minister, or in such other manner as the Minister may accept as sufficient in
the circumstances of the case, and accompanied by such information, documents
and evidence as the Minister requires for the purpose of enabling the
application to be assessed.
(4) On receiving an
application under paragraph (2) the Minister may –
(a) grant
the application;
(b) grant
the application on a provisional basis; or
(c) refuse
the application.
(5) The Minister shall
notify the applicant in writing of any decision under paragraph (4) (a) or
(b) with reasons and, if the application is granted –
(a) under
paragraph (4)(a), that the home is an approved care home (such a home
being referred to in this Article as a “fully approved care home”);
or
(b) under
paragraph (4)(b), that the home is an approved care home only to the
extent that it provides long term care to individuals who were resident in the
home immediately before the application was granted (such a home being referred
to in this Article as a “provisionally approved care home”).
(6) The Minister shall not
grant an application under –
(a) paragraph (4)(a),
unless he or she is satisfied that –
(i) the home meets
the description in paragraph (1), and
(ii) there
is an agreement in place between the home, or a person representing the home,
and the Minister with respect to the administration services provided by the
home, such services being ancillary to the long-term care that the home
provides; or
(b) paragraph (4)(b),
unless he or she is satisfied that –
(i) the home meets
the description in paragraph (1), and
(ii) although
there is no agreement such as is described in paragraph (6)(a)(ii),
arrangements have been agreed between the home, or a person representing the
home, and the Minister, with a view to an agreement such as described in
paragraph (6)(a)(ii) being made in the future.
(7) A fully approved care
home or provisionally approved care home which ceases to be a registered home
is no longer an approved care home for the purposes of the Law from the date
that its cessation as a registered home takes effect.
(8) If the Minister is
satisfied that a fully approved care home or a provisionally approved care
home –
(a) is in
breach of a condition of registration under the Nursing Homes (Jersey)
Law 1994 or the Regulation of Care (Jersey)
Law 2014 (in circumstances where paragraph (7) does not apply); or
(b) is in
breach of the agreement referred to in paragraph (6)(a)(ii) or the arrangements
referred to in paragraph (6)(b)(ii), as the case may be,
the Minister may take the steps referred to in paragraph (9).[6]
(9) Those steps are
that –
(a) in
the case of a fully approved care home –
(i) the Minister may
make a determination by imposing a restriction on the care home to the effect
that it is an approved care home for the purposes of the Law only in respect of
persons resident in the home immediately before the date that the restriction
is imposed, and
(ii) if,
after imposing such a restriction, the Minister is not satisfied that the
breach of the condition or agreement referred to in paragraph (8) is
likely to be remedied in a satisfactory manner, the Minister may determine that
the home ceases to be an approved care home for the purposes of the Law from
the date of the Minister’s determination; or
(b) in
the case of a provisionally approved care home, if the Minister is not
satisfied that the breach of the condition or arrangements referred to in
paragraph (8) is likely to be remedied in a satisfactory manner, the
Minister may determine that the home ceases to be an approved care home for the
purposes of the Law from the date of the Minister’s determination.
(10) A notification of a decision
to refuse an application under paragraph (4)(c) or of a determination
under paragraph (9) shall be by notice in writing with reasons to the
person carrying on the care home and only after consideration of any objections
or representations in accordance with paragraph (11).
(11) Before giving a notification
under paragraph (4)(c) or (9) the Minister must serve notice on the
person carrying on the care home –
(a) giving
the Minister’s reasons for the Minister’s proposed refusal or
determination; and
(b) stating
that within such period as may be specified in the notice (not being less than
21 days beginning with the date of service of the notice) the person on
whom it is served may make objections or representations in writing to the
Minister concerning the proposal.
(12) If a person is aggrieved
by –
(a) a decision
of the Minister under paragraph (4); or
(b) a
determination under paragraph (9),
the person may appeal to the Royal Court no later than 28 days
after the date of receipt of the notification of the decision or determination,
as the case may be, on the ground that the decision or determination of the
Minister was unreasonable having regard to all the circumstances of the case.
(13) Unless the Royal Court so
orders, the lodging of an appeal shall not operate to stay the effect of a
decision under paragraph (4) or a determination under paragraph (9)
pending determination of the appeal.
(14) On hearing the appeal, the
Court may confirm, reverse or vary the Minister’s decision or
determination.
13A Approved providers
of home care service[7]
(1) A provider of a home
care service may apply to the Minister for approval under this Article.
(2) An application under
paragraph (1) must be made to the Minister on a form approved by the
Minister, or in such other manner as the Minister may accept as sufficient in
the circumstances of the case, and accompanied by such information, documents
and evidence as the Minister requires for the purpose of enabling the
application to be assessed.
(3) On receiving an
application under paragraph (1) the Minister may –
(a) grant
the application;
(b) grant
the application on a provisional basis; or
(c) refuse
the application.
(4) The Minister shall
notify the applicant in writing of any decision under paragraph (3)(a) or
(b) with reasons and –
(a) if
the application is granted under paragraph (3)(a), that the provider of
the home care service is fully approved; or
(b) if
the application is granted under paragraph (3)(b), that the provider of
the home care service is approved only to the extent of providing long term
care to individuals to whom they already provided it immediately before the
application was granted (a “provisionally approved” provider of a
home care service).
(5) The Minister shall not
grant an application under paragraph (3)(a) unless he or she is satisfied
that –
(a) the
provider of the home care service is registered under Article 7 of the Regulation of Care (Jersey)
Law 2014; and
(b) there
is an agreement in place between the provider of the home care service and the
Minister with respect to the administration services provided, such services
being ancillary to the long-term care provided.
(6) The Minister shall not
grant an application under paragraph (3)(b) unless he or she is satisfied
that –
(a) the
provider of the home care service is registered under Article 7 of the Regulation of Care (Jersey)
Law 2014; and
(b) although
there is no agreement as described in paragraph (5)(b), arrangements have
been agreed between the provider of the home care service and the Minister with
a view to such an agreement being made in the future.
(7) An approval under this
Article ceases to have effect when the registration under the Regulation of Care (Jersey)
Law 2014 ceases to have effect.
(8) If the Minister is
satisfied that an approved provider of a home care service is in breach of a
condition of registration under the Regulation of Care (Jersey)
Law 2014 (in circumstances where registration under that Law continues to
have effect) the Minister may take the steps referred to in paragraph (9).
(9) Those steps are
that –
(a) where
the provider of the home care service is fully approved –
(i) the Minister may
make a determination that imposes a restriction that the provider is approved
only to the extent of providing long term care to individuals to whom they
already provided it immediately before the date that the restriction is
imposed, and
(ii) if,
after imposing such a restriction, the Minister is not satisfied that the
breach of the agreement as described in paragraph (5)(b) or condition
referred to in paragraph (8) is likely to be remedied in a satisfactory
manner, the Minister may determine that the approval shall cease from the date
of the Minister’s determination; or
(b) where
the case of a provider of a home care service that is provisionally approved,
if the Minister is not satisfied that the breach of the arrangements referred
to in paragraph (6)(b) or condition referred to in paragraph (8) is
likely to be remedied in a satisfactory manner, the Minister may determine that
the approval shall cease from the date of the Minister’s determination.
(10) A notification of a decision
to refuse an application under paragraph (3)(c) or of a determination
under paragraph (9) shall be by notice in writing with reasons to the
provider of the home care service and may be given only after the Minister has
considered any objections or representations made in accordance with paragraph (11).
(11) Before giving a notification
under paragraph (3)(c) or (9) the Minister must serve notice on the
provider of the home care service –
(a) giving
the Minister’s reasons for the Minister’s proposed refusal or
determination; and
(b) stating
that within such period as may be specified in the notice (not being less than
21 days beginning with the date of service of the notice) the person on
whom it is served may make objections or representations in writing to the
Minister concerning the proposal.
(12) If a person is aggrieved
by –
(a) a
decision of the Minister under paragraph (3); or
(b) a
determination under paragraph (9),
the person may appeal to the Royal Court no later than 28 days
after the date of receipt of the notification of the decision or determination,
as the case may be, on the ground that the decision or determination of the
Minister was unreasonable having regard to all the circumstances of the case.
(13) Unless the Royal Court so
orders, the lodging of an appeal shall not operate to stay the effect of a
decision under paragraph (3) or a determination under paragraph (9)
pending determination of the appeal.
(14) On hearing the appeal, the
Court may confirm, reverse or vary the Minister’s decision or
determination.
part 4
transitional provisions
14 Interpretation
(1) In this
Part –
“HSS Charges Law” means the Long-Term Care (Health and
Social Services Charges) (Jersey) Law 2014;
“long-term care services” has the same meaning as in the
HSS Charges Law.
(2) References in this Part
to a person’s long-term care needs before the date this Order comes into
force shall be construed as a reference to the person’s long-term care
needs as described in Article 5(1) of the Law as if that Article were in
force before that date.
15 Deemed
registered persons
(1) A person
who –
(a) on
the date that this Order comes into force is a registered person who is a nurse
or social worker; and
(b) immediately
before that date had an arrangement with the Minister for Social Security for
the purpose of that person –
(i) making
assessments of the long-term care needs of individuals equivalent to the
assessments described in Article 5(1) of the Law, or
(ii) approving
arrangements for providing care for a person with such needs equivalent to the
arrangements described in Article 7(1) of the Law,
shall be deemed to be an approved registered person for the purposes
of Article 5 of the Law where clause (i) applies or for the purposes
of Article 7 of the Law where clause (ii) applies.
(2) A person to
whom –
(a) paragraph (1)(b)(i)
applies, is referred to in this Part as a “deemed Article 5 approved
registered person”;
(b) paragraph (1)(b)(ii)
applies, is referred to in this Part as a “deemed Article 7 approved
registered person”.
16 Deemed
approved care homes
A home which meets the description in Article 13(1) on the date
that this Order comes into force shall, on that date, be deemed to
be –
(a) a fully approved care
home if there is an agreement in place between the home, or a person
representing the home, and the Minister with respect to the administration
services provided by the home, such services being ancillary to the long- term
care that the home provides; or
(b) a provisionally
approved care home if there is no agreement in place such as described in
paragraph (a) but arrangements have been agreed between the home, or a
person representing the home, with a view to an agreement such as described in
paragraph (a) being made in the future.
17 Assessments
and approvals before the date this Order comes into force
(1) An assessment of an
individual as having long-term care needs of a level equivalent to any level
described in column 2 of the table in Article 8 of the Benefits Order
by a deemed Article 5 approved registered person before the date this
Order comes into force shall, subject to paragraph (2), have effect as an assessment
of that person as having that level of need on the date this Order comes into
force for the purposes of Article 5 of the Law, the Benefits Order and
this Order.
(2) An assessment shall
have the effect described in paragraph (1) subject to confirmation by a
determining officer that he or she is satisfied that the evidence justifies the
level of need that has been assessed.
(3) Where –
(a) an
individual has been assessed as having long-term care needs described in
paragraph (1);
(b) such
needs are met by arrangements for providing long-term care to the individual in
his or her home; and
(c) such
arrangements were approved by a deemed Article 7 approved registered
person before the date this Order comes into force or are equivalent to
arrangements that could be approved by such a person,
those arrangements shall be deemed on the date that this Order comes
into force to be an approved care package for the purposes of Article 7 of
the Law, the Benefits Order and this Order.
18 Deemed
determinations
(1) Where, before the date
that this Order comes into force, an individual has been notified by a person
acting on behalf of the Minister of whether the individual is likely to be
entitled to a benefit under the Law and, if so, the amount of such benefit, such
notification will be deemed to be a determination by a determining officer made
on 1st July 2014 under Article 5(1)(a) that the individual is
entitled to such a benefit of that amount (“deemed determination”)
and to have been received by the individual on that date.
(2) Articles 5 and 6
shall apply to a deemed determination as they apply to a determination under
Article 5(1)(a).
19 Payment
towards standard care costs
(1) Any payment made by an
individual on or after 1st January 2013 and before the date this
Order comes into effect to meet the individual’s long-term care needs
shall be treated as having being paid towards the costs of the person’s
appropriate level of standard care for the purpose of meeting the condition in
Article 9(b) of the Benefits Order if –
(a) at
the time of the payment the individual was an adult;
(b) at
the time of the payment the individual met the conditions for residency
referred to in Article 3(2)(e) of the Law as if that Article were in force
at the time of the payment and references to the time of the person’s
claim for benefit were references to the time of that payment;
(c) the
care provided to the individual at the time of the payment was for meeting the
individual’s needs of a level that has been assessed and has effect as
described in Article 17(1);
(d) the
care provided to the individual at the time of the payment was –
(i) in a home that,
on the date this Order comes into effect, is deemed to be an approved care home
under Article 16, or
(ii) comprised
in arrangements deemed to be an approved care package under Article 17(3);
and
(e) the
individual has made a claim as described in Article 2 or has received a
deemed determination as described in Article 18(1).
(2) Article 10 of the Benefits
Order shall apply to any payment that is treated under paragraph (1) as
being paid for the purpose described in that paragraph.
20 Persons
receiving payments with respect to residential care under the Income Support
(Transitional Provisions) (Jersey) Order 2008
(1) This Article applies to
an adult who, immediately before the date that this Order comes into
force –
(a) was
eligible for a payment under Article 9 of the Income Support (Transitional
Provisions) (Jersey) Order 2008 (“Article 9”);
or
(b) was a
member of a household eligible for a payment under Article 4 of that Order
in circumstances where Article 6 does not apply by virtue of Article 7
(“Article 4”),
such a person being referred to in this Article as an
“eligible person”.
(2) On the date that this
Order comes into force, an eligible person is deemed to –
(a) meet
the conditions for residency referred to in Article 3(2)(e) of the Law;
and
(b) have
made a claim for benefit in accordance with Article 2 of this Order.
(3) If the amount of a
weekly payment to which an eligible person was entitled immediately prior to
the date that this Order comes into force under Article 9 or to which the
eligible person’s household was entitled under Article 4 exceeds the
amount of benefits for any week which are payable to the eligible person under
the Benefits Order, the aggregate amount of such benefits shall be increased by
such amount as the amount of payment –
(a) under
Article 9; or
(b) the
amount of payment under Article 4 to the extent that such payment was for
the costs of residential care for the eligible person,
exceeds the amount of the benefits payable for that week to the
eligible person under the Benefits Order.
(4) In paragraph (3)
the reference to benefits payable to an eligible person under the Benefits
Order refers to the aggregate of all the weekly benefits payable to the
eligible person under any of Articles 9, 11 and 12 of that Order.
(5) On and after the date
that this Order comes into force –
(a) an
eligible person is no longer entitled to a weekly payment under Article 9;
and
(b) a
household is no longer entitled to a payment under Article 4 to the extent
that such payment is for the costs of residential care for an eligible person.
21 Persons
paying in full charges under the HSS Charges Law
(1) This Article applies to
a person aged 65 years or over who, immediately before the date that this
Order comes into force –
(a) was receiving
long-term care services in a hospital as defined in the Long-Term Care (Health
and Social Services Charges) (Jersey) Order 2014;
(b) was
liable to pay the amount specified in that Order for those long-term care
services; and
(c) did
not receive any support from the Minister for Social Security in respect of the
amount payable under that Order,
such person being referred to in this Article as an “eligible
person”.
(2) On the date that this
Order comes into force an eligible person is deemed to –
(a) meet
the conditions for residency referred to in Article 3(2)(e) of the Law;
and
(b) have
made a claim for benefit in accordance with Article 2 of this Order.
(3) An eligible person who
continues to receive long-term care services on and after the date this Order
comes into force, subject to meeting the conditions in paragraph (4),
shall receive a long-term care benefit in the form of a weekly grant instead of
the grant referred to in Article 9 of the Benefits Order as
follows –
(A + B + C) minus D,
where –
A is the standard care costs at the rate shown in the table in
Article 8 of the Benefits Order for the eligible person’s
appropriate level of standard care for the person in an approved care home;
B is the amount shown in Article 9(c) of the Benefits Order towards
the weekly costs of the eligible person living in an approved care home
(disregarding the amount for incidental expenses);
C is the weekly amount, if any, that was payable by the Minister for
Health and Social Services for the provision of long-term care services to the
eligible person in an establishment, other than one funded by the Minister,
immediately before the date that this Order comes into force to the extent that
amount is in excess of A + B;
D is £485.31.
(4) The
conditions referred to in paragraph (3) are –
(a) the
eligible person pays £485.31 a week for the provision of such long-term
care services on and after the date that this Order comes into force or, in the
case of any period of less than a week, £69.33 a day; and
(b) the
eligible person receives long-term care services in the same establishment in
which the person was receiving such services on the date immediately before the
date that this Order comes into force.
(5) Where paragraph (3)
applies to an eligible person, the conditions in Article 9 and the
provisions in Articles 11 and 12 of the Benefits Order shall be
disregarded.
(6) If an eligible person
does not meet the condition in paragraph (4), an amount of £182.82
for each week the eligible person received long-term care services for the
period ending 30th June 2014 and beginning not earlier than
1st January 2013 shall be treated as having been paid towards the
costs of the eligible person’s appropriate level of standard care for the
purpose of meeting the condition in Article 9(b) of the Benefits Order.
(7) If the condition in
paragraph (8) is satisfied, the weekly amount of any benefit payable under
the Benefits Order to an eligible person to whom paragraph (6) applies
shall be increased by the weekly amount, if any, that was payable by the
Minister for Health and Social Services for the provision of long-term care
services to the eligible person in an establishment, other than one funded by
the Minister, immediately before the date that this Order comes into force to
the extent that amount is in excess of A + B where –
A is the standard care costs at the rate shown in the table in
Article 8 of the Benefits Order for the eligible person’s
appropriate level of standard care for the eligible person in an approved care
home;
B is the amount shown in Article 9(c) of the Benefits Order towards
the weekly costs of the eligible person living in an approved care home
(disregarding the amount for incidental expenses).
(8) The condition referred
to in paragraph (7) is that the eligible person continues to receive
long-term care services in the same establishment in which the eligible person
was receiving long-term care services immediately before the date that this
Order comes into force.
22 Persons
under the age of 65 receiving long-term care services
(1) This Article applies to
a person who, immediately before the date this Order comes into force, was an
adult under the age of 65 years receiving long-term care services within
the meaning of the HSS Charges Law for which the person would have been liable
to pay a charge under the Long-Term Care (Health and Social Services Charges)
(Jersey) Order 2014 if the person had been aged 65 years or over,
such a person being referred to in this Article as an “eligible
person”.
(2) On the date that this
Order comes into force, an eligible person shall be deemed to –
(a) meet
the conditions for residency referred to in Article 3(2)(e) of the Law;
(b) have
made a claim for benefit in accordance with Article 2 of this Order; and
(c) have
no income or assets for the purposes of calculating the person’s
entitlement to benefits in accordance with the Benefits Order.
part 5
closing
23 Citation
This Order may be cited as
the Long-Term Care (General Provisions) (Jersey) Order 2014.