Regulation 86
1.—(1) Subject to sub-paragraph (2), the weekly applicable amount of a claimant to whom regulation 86 applies shall be the aggregate of—
(a)subject to paragraph 3, the weekly charge for the accommodation, including all meals and services, provided for him or, if he is a member of a family, for him and his family increased, where appropriate, in accordance with paragraph 2 but, except in a case to which paragraph 9 applies, subject to the maximum determined in accordance with paragraph 4;
(b)a weekly amount for personal expenses for him and, if he is a member of a family, for each member of his family determined in accordance with paragraph 10;
(c)where he is only temporarily in such accommodation any amount applicable under regulation 83(f) or 84(1)(g) (housing costs) in respect of the dwelling normally occupied as the home, and
(d)any amount applicable in accordance with regulation 87(3).
(2) No amount shall be included in respect of any child or young person who is a member of the claimant’s family if the capital of that child or young person calculated in accordance with Part VIII (income and capital) in like manner as for the claimant, except where otherwise provided, would exceed £3,000.
2.—(1) Where, in addition to the weekly charge for accommodation, a separate charge is made for the provision of heating, attention in connection with bodily functions, supervision, extra baths, laundry or a special diet needed for a medical reason, the weekly charge for the purpose of paragraph 1(1)(a) shall be increased by the amount of that charge.
(2) Where the weekly charge for the accommodation does not include the provision of all meals, it shall for the purpose of paragraph 1(1)(a), be increased in respect of the claimant or, if he is a member of a family, in respect of each member of his family by the following amount—
(a)if the meals can be purchased within the residential care home or nursing home, the amount equal to the actual cost of the meals, calculated on a weekly basis, or
(b)if the meals cannot be so purchased, the amount calculated on a weekly basis—
(i)for breakfast, at a daily rate of £1·10;
(ii)for a midday meal, at a daily rate of £1·55, and
(iii)for an evening meal, at a daily rate of £1·55,
except that, if some or all of the meals are normally provided free of charge or at a reduced rate, the amount shall be reduced to take account of the lower charge or reduction.
3. Where any part of the weekly charge for the accommodation is met by housing benefit, an amount equal to the part so met shall be deducted from the amount calculated in accordance with paragraph 1(1)(a).
4.—(1) Subject to paragraph 9, the maximum referred to in paragraph 1(1)(a) shall be—
(a)in the case of a single claimant, the appropriate amount in respect of that claimant specified in or determined in accordance with paragraphs 5 to 8;
(b)in the case of a claimant who is a member of a family the aggregate of the following amounts—
(i)in respect of the claimant, the appropriate amount in respect of him specified in or determined in accordance with paragraphs 5 to 8;
(ii)in respect of each member of his family who lives in the home aged under 11, 1½ times the amount specified in paragraph 2(a) of Schedule 1;
(iii)in respect of each member of his family aged not less than 11 who lives in the home, an amount which would be the appropriate amount specified in or determined in accordance with paragraphs 5 to 8 if the other member were the claimant.
(2) The maximum amount in respect of a member of the family aged under 11 calculated in the manner referred to in sub-paragraph (1)(b)(i) shall be rounded to the nearest multiple of 5p by treating an odd amount of 2·5p or more as 5p and by disregarding an odd amount of less than 2·5p.
5. Subject to paragraphs 7 and 8, where the accommodation provided for the claimant is a residential care home for persons in need of personal care by virtue of—
(a)past or present mental disorder but excluding mental handicap, the appropriate amount shall be £214·00 per week;
(b)past or present drug or alcohol dependence, the appropriate amount shall be £214·00 per week;
(c)mental handicap, the appropriate amount shall be £244·00 per week;
(d)physical disablement, the appropriate amount shall be £276·00 per week;
(e)any condition not falling within sub-paragraphs (a) to (d), the appropriate amount shall be £203·00 per week.
6. Subject to paragraphs 7 and 8, where the accommodation provided for the claimant is a nursing home for persons in need of personal care by virtue of—
(a)past or present mental disorder but excluding mental handicap, the appropriate amount shall be £304·00 per week;
(b)mental handicap, the appropriate amount shall be £310·00 per week;
(c)past or present drug or alcohol dependence, the appropriate amount shall be £304·00 per week;
(d)physical disablement, the appropriate amount shall be £341·00 per week;
(e)terminal illness, the appropriate amount shall be £303·00 per week;
(f)any condition not falling within sub-paragraphs (a) to (e), the appropriate amount shall be £303·00 per week.
7. The appropriate amount applicable to a claimant in a residential care home or nursing home shall, subject to paragraph 8, be determined—
(a)where the home is a residential care home registered under Part II of the Registered Homes Order, by reference to the particulars recorded in the register kept by the relevant Health and Social Services Board for the purposes of that Order, or
(b)where the home is a residential care home not so registered or a nursing home, by reference to the type of care which, taking into account the facilities and accommodation provided, the home is providing to the claimant.
8.—(1) Where more than one amount would otherwise be applicable, in accordance with paragraph 7, to a claimant in a residential care home or a nursing home, the appropriate amount in any case shall be determined in accordance with sub-paragraphs (2) to (4).
(2) Where the home is a residential care home registered under Part II of the Registered Homes Order and where the personal care that the claimant is receiving corresponds to the care received by a category of residents for whom the register indicates that the home provides accommodation, the appropriate amount shall be the amount, in paragraph 5, as is consistent with that personal care.
(3) Where the home is a residential care home which is so registered but where the personal care that the claimant is receiving does not correspond to the care received by a category of residents for whom the register indicates that the home provides accommodation, the appropriate amount shall be the lesser or least amount, in paragraph 5, as is consistent with those categories.
(4) In any case not falling within sub-paragraph (2) or (3), the appropriate amount shall be whichever amount of the amounts applicable in accordance with paragraph 5, 6 or 7 is, having regard to the types of personal care that the home provides, most consistent with the personal care being received by the claimant in that accommodation.
9.—(1) Where a claimant who satisfies the conditions in sub-paragraph (2) has been able to meet the charges referred to in paragraphs 1 and 2 without recourse to a jobseeker’s allowance, income support or supplementary benefit, the maximum determined in accordance with paragraph 4 shall not apply for the period of 13 weeks or, if alternative accommodation is found earlier, such lesser period following the date of claim except to the extent that the claimant is able to meet out of income disregarded for the purposes of Part VIII (income and capital) the balance of the actual charge over the maximum.
(2) The conditions for the purposes of sub-paragraph (1) are that—
(a)the claimant has lived in the same accommodation for more than 12 months;
(b)he was able to afford the charges in respect of that accommodation when he took up residence;
(c)having regard to the availability of suitable alternative accommodation and to the circumstances mentioned in paragraph 12(5)(b) of Schedule 2 (housing costs), it is reasonable that the maximum should not apply in order to allow him time to find alternative accommodation;
(d)he is not a person who is being accommodated—
(i)by the Northern Ireland Housing Executive under Part II of the Housing (Northern Ireland) Order 1988(1), or
(ii)by a Health and Social Services Board or an HSS trust under Article 21 of the Children (Northern Ireland) Order 1995(2) (provision of accommodation for children), and
(e)he is seeking alternative accommodation and intends to leave his present accommodation once alternative accommodation is found.
(3) Where—
(a)the claimant was a resident in a residential care home or nursing home immediately before 29th April 1985 and has continued after that date to be resident in the same accommodation, apart from any period of temporary absence;
(b)immediately before that date, the actual charge for the claimant’s accommodation was being met either wholly or partly out of the claimant’s resources, or, wholly or partly out of other resources which can no longer be made available for this purpose;
(c)since that date the Department has not at any time accepted responsibility for the making of arrangements for the provision of such accommodation for the claimant; and
(d)the adjudication officer is satisfied that, unless this provision applies in the claimant’s case, he will suffer exceptional hardship,
the maximum amount shall be the rate specified in sub-paragraph (4) if that rate exceeds the maximum which, but for this sub-paragraph, would be determined under paragraph 4.
(4) For the purposes of sub-paragraph (3) the rate is either—
(a)the actual weekly charge for the accommodation immediately before 29th April 1985 plus £10, or
(b)the aggregate of the following amounts—
(i)the amount estimated under regulation 9(6) of the Supplementary Benefit (Requirements) Regulations (Northern Ireland) 1983(3) as then in operation as the reasonable weekly charge for the area immediately before that date;
(ii)£26·15, and
(iii)if the claimant was entitled at that date to attendance allowance under section 35 of the Social Security (Northern Ireland) Act 1975(4) at the higher rate £28·60 or, as the case may be, at the lower rate, £19·10,
whichever is the lower amount.
10. The allowance for personal expenses for the claimant and each member of his family referred to in paragraph 1(1)(b) shall be—
(a)for the claimant £13·75, and if he has a partner, for his partner, £13·75;
(b)for a young person aged 18, £13·75;
(c)for a young person aged under 18 but over 16, £9·55;
(d)for a child aged under 16 but over 11, £8·25;
(e)for a child aged under 11, £5·65.
S.R. 1983 No. 61; relevant amending regulations are S.R. 1986 No. 240