Continuity of Care when a Person Moves

1. Continuity of Care Arrangements

Continuity of Care arrangements apply when a person with eligible Care and Support needs (who is receiving Care and Support arranged by the Local Authority in a setting other than a care home, shared lives or supported living placement) chooses to move from one Local Authority area to another Local Authority area, resulting in a change to their ordinary residence status.

Continuity of Care arrangements do not apply when the Local Authority is providing the person with Care and Support in a care home, shared lives or supported living placement because these types of accommodation are all specified accommodation under the Deeming Provisions (Section 39 of the Care Act 2014), meaning that the Local Authority placing them remains responsible for meeting their needs before, during and after the move.

Where Continuity of Care arrangements apply but the person lacks the mental capacity to make a decision about where they live, they cannot be said to have chosen to move to the new area. In those cases, careful consideration needs to be given to whether that person remains ordinarily resident in the original area or whether ordinary residence has changed to the new area. The key factors will be the strength of the connection to the new area and the reason for the move. If in doubt, always seek legal advice.

Continuity of Care arrangements involve the 2 local authorities working with the person to ensure that their Care and Support (and any carer's Support) is in place before, during and after their move so as to provide an undisrupted service and smooth transition from one area to another.

The key to good continuity of care arrangements is effective and timely co-operation between the local authorities. The following is an example of how 2 local authorities could co-operate and work together with the person through the process:

Stage in Process	Role of the Person	Role of 1st Local Authority	Role of 2nd Local Authority
The person is deciding whether to move	Contact the local authorities to gather information required to support the decision	Provide information about the Continuity of Care process to the person	Provide local information and advice to the person or carer, including about Care and Support provision and financial assessment
The person has decided to move	Notify one of the local authorities of the decision made	Notify the 2nd Local Authority (if the person chose to notify the 1st authority first) If the person employs a PA who may not be moving with them offer advice about contractual obligations/terminating contracts	Establish that the person's intention to move is genuine by speaking to them, the 1st Authority and any other relevant person able to confirm this Notify the 1st Authority when satisfied the intention to move is genuine
Preparing and planning	Let the local authorities know about any key dates that affect the move e.g. if a new job starts in the new area when this is	Provide information about the person and carer to the 2nd Authority, including any Care and Support Plan or previous assessment and details of any equipment or adaptations Agree a move date with the person and the 2nd Authority	Contact the person to arrange an assessment and discuss how to meet their eligible needs Provide an advocate Agree a Personal Budget and complete a Care and Support Plan
Moving	Arrange and fund the removal of furniture and other belongings to the new area	Ensure that the person has the Care and Support they need on the day of the move to support them to move	Ensure that the person's Care and Support services are in place from such time as they have moved into the area, including any Direct Payment to pay a PA and any adaptations

2. When Continuity of Care Arrangements do not go to Plan

On occasion the 2nd Local Authority may not have completed the required assessment or Care and Support Plan in order to ensure that Care and Support to meet eligible needs is in place from the day of the move. This does not affect their responsibility to arrange and fund the services required and in this situation the Care Act requires them to either:

Liaise with the current Care and Support provider and the person to ensure that the same provision remains in place and at the same level until the assessment has been completed; or
Arrange for a local Care and Support provider to provide Care and Support at the same level as the person had been receiving in the 1st Authority until the assessment has been completed.

The Care Act statutory guidance does not stipulate what to do should the 2nd Authority fail in their duty to do either of the above, potentially leaving the person without the Care and Support they need after the move. If the 1st Local Authority is aware of this then, where practicable, they should continue to provide the Care and Support that the person needs, and to liaise with the 2nd Authority to monitor progress and agree terms of reimbursement. Where there is a dispute about Ordinary Residence the procedures to resolve Disputes between 2 or more Local Authorities should be followed.

3. If the Person decides not to move as Planned

If the move is postponed due to circumstances beyond the person's control (for example if they become unwell) they will remain ordinarily resident in the 1st Local Authority until they move. The 2 authorities should maintain contact with the person and each other and make sure that Continuity of Care Arrangements are in place on any revised date. The Care Act suggests that each Local Authority should consider 'cutting their losses' in respect to any costs incurred in managing Continuity of Care delays.

If the move is cancelled altogether the Care Act does make provision for the 2nd Local Authority to recover costs incurred in arranging for Continuity of Care from the 1st Local Authority, although it should consider whether doing so would be reasonable based on the circumstances of each case (including whether or not the 1st Local Authority was aware that the person would not be moving).

4. Continuity of Care for People with additional Health Needs

Under the Care Act, the 2nd Local Authority should aim to complete their assessment jointly with the local Integrated Care Board (ICB), so that support for the person's health needs can also be in place from the day of the move. The ICB in the 2nd area and the ICB in the 1st area have a duty to co-operate with the local authorities and with each other in the same way as the local authorities do to ensure a smooth transition for the person.

Where the person has a piece of equipment on long-term loan from the NHS, the 2nd Local Authority should discuss with the relevant NHS body in its area. Both are jointly responsible under the Act for ensuring that adequate equipment is in place when the person moves (this can either be a continuation of the current equipment loan or a new loan for a new piece of equipment).

5. Equipment and Adaptations

Many people with Care and Support needs will also have equipment installed and adaptations made to their home.

Important to know

Where the 1st Authority has provided equipment, it should move with the person to the 2nd Authority, so long as the person wishes to take it and it is still the best and most cost-effective way of meeting the eligible need (this can be determined by either Local Authority so long as there is agreement). This applies whatever the original cost of the item.

When equipment is to move with the person the local authorities should discuss and agree in advance how the equipment will be maintained and arrangements for any future replacement. The Care Act statutory guidance offers no advice about how to agree this and what it expects the outcome of such arrangements to be, but the expectation that they are made and agreed by all prior to the move is clear.

Adaptations are often not as easy to move from one property to another as they are normally fitted to the specific measurements of the person's home or are permanent fixtures (e.g. an external ramp). In these situations the Care Act suggests it would be more practicable for the 2nd Authority to organise the installation of any adaptations required, undertaking any additional assessment required.

Managing Disputes about the Benefit of Equipment

If the 1st Local Authority does not feel that the equipment currently in situ will be needed after the move and the 2nd Authority does not agree then an assessment should be undertaken to confirm the eligible need. The Care Act does not specify but it would make sense that this should be undertaken by the 2nd Local Authority as they are disputing the need for the equipment and will be responsible for meeting the person's eligible needs when they have moved. If the assessment has not been undertaken by the time of the move it may be prudent for the 1st Authority to move the equipment with the person until such time as the assessment outcome is known.

If either Local Authority is of the view that additional equipment may be required following the move, an assessment should be carried out before the move to determine this so as to avoid any unnecessary risk of harm to the person or their carer. Again, the Care Act does not specify who would be responsible for such an assessment or the provision of subsequent equipment. However, if the equipment is required both before and after the move the 1st Local Authority will need to assess and provide the equipment as they are responsible for meeting the person's current needs. The equipment should then be taken with the person when they move. If the equipment is only going to be required after the move (for example rails to support a person to access a bath when their current home has a wet-room) it would be reasonable to suggest the 2nd Authority assumes responsibility for assessing and ensuring that the provision is in place from the day of the move. Alternatively through co-operation the 1st Local Authority could complete the assessment on behalf of the second Authority who could then provide the equipment.