Long-Term Care
(General Provisions) (Jersey) Order 2014
Made 26th June 2014
Coming into force 1st
July 2014
THE MINISTER FOR SOCIAL SECURITY, in pursuance of Articles 5, 6, 7, 8
and 16 of the Long-Term Care (Jersey) Law 2012[1], orders as follows –
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[2];
“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[3];
“Law” means the
Long-Term Care (Jersey) Law 2012[4];
“Medical Practitioners Law 1960”
means the Medical Practitioners (Registration) (Jersey) Law 1960[5];
“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, body or organization who –
(i) is
responsible for providing any long-term care as part of the approved care package,
and
(ii) receives
remuneration for providing such services,
is a party to an
agreement with the Minister for Health and Social Services making provision
with regard to such approval or, if there is no such agreement, arrangements
have been agreed between the person, body or organization and the Minister with
a view to such an agreement being made in the future.
(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].
(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 14 of the Mental Health (Jersey)
Law 1969[7];
(b) has a curator appointed under Article 43 of that Law to
manage and administer his or her property and affairs; or
(c) has a tuteur.
(4) An
appointment under paragraph (2) shall terminate –
(a) if the claimant is received into guardianship, or has a
curator or tuteur appointed;
(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.
(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[8] 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 which is –
(a) registered under the Nursing and Residential Homes (Jersey)
Law 1994[9]; or
(b) would be required to be registered under that Law were it
not for Article 3(2)(a) or (c) of that Law.
(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
and Residential Homes (Jersey) Law 1994 (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).
(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.
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[10];
“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[11] (“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[12];
(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[13] 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
and commencement
This Order may be cited as the
Long-Term Care (General Provisions) (Jersey) Order 2014 and shall come
into force on the same date that Parts 3 and 4 of the Long-Term Care
(Jersey) Law 2012 come into force.
senator f. du h. le gresley
Minister for Social Security