Time to confront some hard choices about who pays for care
25 April 2007 | Julia Unwin, Director, Joseph Rowntree FoundationPeople are confused about what they can expect from the state in helping them pay for long-term care should they need it. We now need a system that has much clearer entitlements. In designing such a system, we need to make some basic choices clear to the public. The most important question is: do we want to provide a foundation of state-funded care for everyone, or should state help go only to the least well-off?
In recent years, other countries – including Germany and Japan – have overhauled their funding for care, creating entitlements for everyone and more consistent rules about how much private individuals should contribute. Within the UK, Scotland has taken a step in this direction by abolishing charges for personal care at home and introducing a flat-rate contribution to care home fees that is intended to cover the cost of personal care tasks.
There are some arguments for going down such a ‘universalist’ route in the UK as a whole. Helping someone carry out the basic functions of everyday living is not cheap and it is not a cost that a private individual can readily budget for. Private insurance on reasonable terms is not available. The problem is that insurers know too little about the longevity and health of older people several decades ahead to be able to offer products on reasonable terms.
That is why the Joseph Rowntree Foundation has argued in the past for a form of social insurance to which we all contribute when we are working and from which we all draw out when we need to. The case remains strong but this does not mean that the state should provide everything. We may want to opt for a foundation of support, where individuals are expected to make a contribution and where they are able to buy a higher level of care with their own resources if they wish to.
Of course the big question is: if we want wider support from the state, are we willing to pay for it through higher taxes or insurance contributions, or perhaps reprioritising of money spent on healthcare? We are keen over the next year to listen to the views of the public on this issue. The additional amount that is needed to pay for decent care is tiny compared, say, to growth in spending in the health service.
At the Foundation, we are also able to draw on the experience of residents of our own continuing care retirement community at Hartrigg Oaks in York. Here, residents are given peace of mind, having bought into a community where they can draw on the kind of care that best suits their current needs, with a minimum of disruption and without having to leave the area where they live. What we have learned from this project is how much people value stability at a stage of life when uncertainty is particularly unwelcome. We think that this principle needs to be applied more widely, and will be bringing our practical experience to debates about the future.
Julia Unwin CBE is Director of the Joseph Rowntree Foundation.
May 8th, 2007 at 10:08 am
OLDER PEOPLE PAY MOST FOR CARE
I note that your article states that over half of the cost of care is paid for by the state. This does not take account of the colossal amount of care provided by informal carers, which far excedes the amount of “paid for” care.
The government and the media continue portray older people as a “growing burden”, negating the contribution they have made and continue to make to our society. In fact a huge proportion of informal care is provided by older people themselves.
We must question our fundamental beliefs and values here. Is Social Care really so expensive? What are we comparing it with? Identity Cards, monitoring motorists, olympic games, let alone constant re-organisations and “the war on terror” seem to be costing far far more. Are our older people worth less than our other political and financial commitments? Is this what we want for our parents, grandparents, ourselves when we get there?
I have worked for the past 12 years, in community care for older and disabled people. It is embarassing, having to haggle for funds for fundamental needs, explaining that meagre savings and tiny pensions must be used to pay for care.
Congratulations to Scotland on having greater respect for its elders. Shame on us for colluding with this nonsense that it costs too much.
May 13th, 2007 at 12:01 pm
Mine is a selfish perspective, but here it is for what it’s worth: I come from a family where property was handed down the generations, and my father often said, and still does say, “this will be yours when I go”. I live in a housing association rented house, having lost my own house due to a business failure. But I assumed that one day my inheritance would give me the freedom to move wherever I wish. Now it seems there might not be any inheritance if my father who has Alzheimer’s has to go into a home, and I will be trapped where I am living. The alternative could be to give up my job and take on the full-time task, while in my sixties, of caring for him. I guess there must be a large number of other children who will feel obliged to turn their lives upside down to care for a parent in order to preserve their inheritance.
May 21st, 2007 at 8:10 pm
I HAVE WORKED IN COMMUNITY CARE FOR SEVERAL YEARS AS A CARER AND MORE RECENTLY AS A QUALIFIED CARE MANAGER PREDOMINANTLY WITH OLDER PEOPLE/PEOPLE WITH PHYSICAL AND/OR MENTAL HEALTH NEEDS. I TOO FIND IT INCREASINGLY FRUSTRATING HAVING TO HAGGLE FOR FUNDING FOR BASIC HUMAN NEEDS, HOWEVER I ALSO APPRECIATE THAT COUNCILS HAVE TO PRIOIRITISE RESOURCES.LIKE ME THE MAJORITY OF CARE MANAGERS I WORK WITH WOULD UNDOUBTEDLY LIKE TO SEE M0RE PREVENTATIVE SERVICES BEING PROVIDED AND A STRONGER RECOGNITION FROM THE GOVERNMENT AND SOCIETY MORE GENERALLY REGARDING THE INVALUABLE CONTRIBUTION THAT OLDER PEOPLE HAVE MADE AND CONTINUE TO MKAE TO OUR SOCIETY. HOWEVER NO MATTER HOW MUCH WE MAY VALUE OLDER PEOPLE THE REALITY IS SUCH THAT DEMOGRAPHIC CHANGES ARE UNLIKELY TO MEET THE INCREASING NEEDS OF OLDER PEOPLE IN 0UR SOCIETY WITHOUT A FUNDAMENTAL CHANGE IN OUR CURRENT SYSTEM. AS IS THE SITUATION NOW, THE CLAIM FOR RESOURCES WILL OUTWEIGH THE DEMAND. WHILST I AGREE THAT MORE MONEY NEEDS TO BE INVESTED IN COMMUNITY CARE SERVICES IN GENERAL, I FEEL THAT WE ALL HAVE A RESPONSIBILITY TO CONTRIBUTE TOWARDS THE COST OF OUR CARE, NO MATTER HOW SMALL THAT CONTRIBUTION MAY BE. NEVERTHELESS THE GOVERNMENT HAS A SIGNIFICANT ROLE TO PLAY. IT SHOULD BE VIEWED AS A PARTNERSHIP APPROACH. CERTAINLY MORE NEEDS TO BE DONE TO ADDRESS AND ACKNOWLEDGE THE HARSH REALITIES THAT MANY PEOPLE IN NEED OF SUPPORT AND THEIR CARERS FACE ON A DAY TO DAY BASIS BUT WE ALL HAVE TO ACKNOWLEDGE AND ACCEPT THAT WE ALL HAVE SOME RESPONSIBILITY IN RESPECT OF THIS.
August 15th, 2007 at 11:52 am
My experience is based on the demise of my mother, who died of dementia two weeks ago in hospital. To no avail we went through the nursing care/social care/care home merry-go-round, as in the end she was too ill to be discharged from hospital. Three days before she died, she was STILL assessed as needing only social care, despite being incontinent and unable to eat, walk, or talk. My point is that the boundary between social care and nursing care is meaningless. What dementia sufferers need is just THE CORRECT CARE. But the state has created this appalling boundary where nursing care costs nothing but social care is means tested at the equivalent of a 100% tax rate. Further, there is a conflict of interest. My mum’s hospital had a ‘care facilitator’. This person’s job is to arrange care for patients about to be discharged. They and the management have a vested interest in offloading patients into social care homes because the costs of care are then transferred from the NHS either onto the council or to the sufferer. The costs of social care are c. £20,000 per annum for those with even paltry life-savings whereas the costs of nursing care are zero and this massive difference is the result of an assessment which can be very finely judged. If charges are to be made in future, which is debateable for those who have spent their lives paying tax and NI contributions, then there should be a lot more use of sliding scales, a much higher limit for residuary life-savings (why not have alignment with inheritance tax?)and I agree with the correspondent who pointed out the immorality of the means-test fees being paid after tax deductions. The distinction between social and nursing care should not have such a punitive financial impact for sufferers and their families.