Assessment and choice in long-term care
21 May 2007 | Clive Bowman, Medical Director, BUPA Care Services, Chair CCCDignity in later life very quickly becomes threatened when older citizens need ongoing care.
Currently, older people have to have their needs assessed separately by several health and care professionals:
- the first assessment is to establish eligibility for fully funded NHS long-term care
- if they are not eligible, then they need a second, separate assessment for the registered nursing care contribution
- that is followed by a further, third financial assessment for personal care.
At the end of this bewildering adventure, older people and their families are increasingly advised that effectively they’re on their own and responsible for funding their care. More often than not, it is the agency providing care or the care home that has to advise people and their relatives about the true cost of care.
Most people involved in this ‘industry of assessment’ know it has become a bureaucracy of madness using overlapping, largely invalid and incomparable techniques more concerned with the management of ‘scarce resources’ than benevolent response to individual need.
It is clear that there should be one comprehensive assessment of need to provide the basis for all practical choices.
Some people will choose budget care, just as they choose ‘no frills’ air travel, while others want premium services. The gap between budget and premium should be a matter of personal choice, but the journey of care should have the same safeguards and assurances irrespective of price.
The reality for individuals eligible for local authority funding is that there is frequently a gap between what the council will pay and the true cost of care. That means top-up fees are needed to secure adequate care. Currently, individuals and families are often able to meet these charges. But as dependence on top-ups continues to grow – by stealth and without clear policy – it becomes increasingly important that there is a safety net for the destitute, the frail, and the ill-prepared.
A steady stream of reports, ranging from a Royal Commission in 1999 to last year’s King’s Fund Wanless report and those from the Joseph Rowntree Foundation and many others, all say that present systems are failing. The time is right for a new approach that encourages people to plan for, access and receive care in later life. It will need clear distinctions between health needs and care needs, and a well-defined safety net. A good starting point would be a unified assessment that provides proportionate funding, forms the basis of a personal care plan, and is responsive to people’s evolving needs.
May 21st, 2007 at 9:42 pm
Really refreshing to see the whole complex mess described so succinctly and clearly.
I take it that the common assessment framework does not apply to people needing residential care? I wonder if there is local authority and health service that have even began to make a start on consolidating the processes as much as they are able.
May 22nd, 2007 at 2:39 pm
Very helpful, brief and clear article showing how simple the issues really are. Trouble is the government is frightened to address those issues. In much the same way that it is running from the issue of Council Tax and local authority funding, the government is continually postponing any decisions on long-term care. However, the longer it is left to drift, the harder the decisions will be!
May 25th, 2007 at 10:36 am
I agree with the article when it says that the assessment process is in need of change and simplification. I take issue with the statment that some people choose budget care as we would choose a budget airline. I think this is untrue. Many elderly people are forced to choose so called budget care because they have no other option. Elderly care is the ultimate post code health care system.
June 2nd, 2007 at 1:01 pm
Of course, there should be a clear distinction between choice and selection. We choose to satisfy a want, we select to fulfil a need. An instrument for unified assessment partially exists in the National Framework’s decision support tool for Continuing Healthcare. It addresses eleven “domains” of care and each domain is given a heuristic set of rules from which the assessor must make a subjective judgement. The principle could be converted to be quantified and described in a way easily understood, so that the average person is made aware of the 1 in 5 risk of a score, increasing as age increases to a care-critical level. This may inspire acceptance that the sooner something is done the better. Whether an objective decision would then be to purchase private insurance, or to approve specifically dedicated collection of premiums through the tax or national insurance system, remains a matter for continuing debate.
August 21st, 2007 at 11:47 am
I work in a PCT where there is only one assessment of people’s needs in Nursing Homes – this covers the social work assessment, Eligibility for NHS Continuing Care and if necessary the Registered Nursing Care Contributions. 3 assessments aren’t necessary!