What you said about the future of long-term funding

Congratulations to Paul Boyle, an OT at East Sussex Council who was selected by the magazine editor as giving the best response to how the UK should pay for the funding of long-term care.

We asked visitors to www.communitycare.co.uk and readers of Community Care magazine how the UK should pay for long term care in the future given current demographics trends.

Paul Boyle was judged by the magazine editor Mike Broad as making the best response to the question but many other valid points were raised. Here are some of them.

Winning entry

“The state should be able to pay for most if not all of the cost of caring for older people. This is affordable if public money were to be redirected from less desirable adventures to health and social care.

Older people should be at the centre of services and policy should build upon single assessment, direct payments, and individual budgets. Efficiency gains are possible in all these areas. Investment in technology should make assessment, care planning and commissioning, easier and more effective thereby reducing costs. The best placed professional, whether employed by social care or health, should be asking older people and their carers “what do you need to return home/stay at home?” At that point technology should allow for a service to be directly commissioned.

Adjunct to long-term care has to be speedier delivery of equipment, completion of adaptations, and telecare. Shorter stays in hospital and efficient assessments should improve the finances of local authorities and the NHS. A real incentive would be pooled budgets and integrated services.

Nonetheless a significant increase in funding has to be forthcoming. To accompany this local authorities need to transform their administration to release finances to fund the delivery of care rather than the management of information. A social and health economy that can deliver the services required, and can be afforded, is possible. In so doing greater co-operation and trust between health and social care is likely and we can all grow older confident that resources will be available to support us.”

Paul Boyle

“We are encouraged by the government to save more for our old age, but if we do and we then become ill, our efforts to maintain our standard of living are turned against us in the form of means-testing. People who have spent all they have earned get the same service without the need to pay for it. In my opinion, it is bad enough to develop ill health without the additional punishment of being financially penalised for something which may have been totally outside one’s control.

The funding of high standard, long term care should be a Government/NHS responsibilty, and it should be paid for through a reformed tax system.”

Graham Ross 

“I don’t think it is realistic to expect full funding regardless of a person’s capital and income because other services such as learning disabilities need more government funding, as mentioned in an earlier article in C Care, as do many other services.  If someone has a pension of £2,000 a month do we want to deprive someone else of a service to give them free care?  However, I do think that the levels that income and capital are allowed to fall to should be far more generous and particularly that the Personal Expenses Allowance should be much higher. I see many couples where one has gone into care and the other one is on pension credit guarantee credit (so don’t benefit from receiving half their spouses occupational pension) and is having to spend their own money on the person in care (often because the home are shrinking, losing garments etc) as well as run the home on far less money. There must be a middle road between totally free care and reasonable charging – but then maybe the costs of administering this would be more than the money they would collect.

Wendy Smart
Selby & York Carers Centre

“Having worked for some time in Older People’s Services, I wished to describe another angle on the well worn arguments going beyond “should older people have to sell their homes”. Working in an area with a wealthy retired population, as well as pockets of extreme poverty, I found many older people could fund their own care from the sale of property but also from stocks and shares, and private incomes. This drives up the cost of care locally – both in residential settings and domiciliary care agencies, who charge what the market will stand. Local Authority rates typically fall well below the rates of the better care homes, leading to an underclass of care homes (some are very good on a shoestring, but often “you get what you pay for”) who will take our less well off clients, although many of these are demanding a weekly “top up” of up to £50 or more a week. Moreover, Local Authority financial assessment processes levy cost recovery of care fees from clients based on income and savings, and will not therefore permit  clients to use savings (depleting their assets and thereby the fee recovery the LA can demand) to pay the top-up. Funding this extra therefore falls not to the older person, but the sons/daughters, who feel trapped between demands on their income from their own children/mortgage/own needs, and ensuring their parent is in a reasonable standard of care setting optimising quality of life. Something additional on which to reflect perhaps?”

Nicole Davies
Social Worker, Cheshire

“The funding of the long-term care of the elderly should be means tested as some can comfortably fund for their care whereas some find it extremely difficult. The state should be freed to support those who have hardships to fund for their care.”

Moses Zaranyika

“I think people should contribute towards the basic cost of long-term care in residential homes/long stay hospital beds.  I feel that people should pay for “hotel/bed and board” fees for the basics of the care they receive.  People’s saving could increase if they are not contributing to their care costs, whilst the state continue to pay for the placement.  I also feel that the same system should be applied within the UK, as it is unfair that charges differ in Scotland to England for example.  Fair Access to Care and Fairer Charging should apply to all.” 

Kathryn Allison

“I am a social worker with experience of working with elders and most recently in palliative care. If we had all the money in the world would we want to offer ‘free care’ to everyone? I feel we have to make the distinction between care (personal and health) and accomodation.We need a more mature method of assessing priority acute and long-term needs. We need to explore ways of shared budgets for PCT’s and SSD’s.

Above all we need to be imaginative about how to support elders where they want to be. This will involve putting money in quality and reliable services instead of the ‘bog standard’ home support vs care home ‘choice’.”

Stephen Holmes

“I am aged 56 and may need long-term care at the very time when the “money runs out”.  I have little savings and am not in a position to save, but I have always paid national insurance contributions which I understood guaranteed me “cradle to grave care”.
I don’t think we should reinvent the wheel.  Increase national insurance contributions for those who can afford to pay, and balance the books this way.  The state will always need to provide a safety net for those who cannot afford to pay and care should be of an equal standard for all. 
Why set up complex savings schemes when we have a system which can work well, IF it is administered properly.  As a social worker I can tell you categorically that too much money is being wasted on bureaucracy, assessment, computer entry and form filling.  Since 1993 the state has assumed too great a gate keeping role and the effect has been “money wasted” on perpetuating the system rather than helping older people.  Yes, support older people in remaining independent, but social workers should not be the rationers of services.  The national insurance system should draw in sufficient funds to pay for the care that older people want and need. 
In my ideal world I would let the older person decide what care he or she needs – not many people opt to enter long term care unless it is really needed.  We should revert to an “automatic right” to be admitted to residential care if it is desired.  In this situation, I do believe that the value of someone’s home should be counted as an asset and should be used to pay for the care.”

Angela Bond

“I’m a healthcare recruitment consultant and I have witnessed radical changes in the industry over the past few years. People are living longer and developing conditions that we’ve never known before, like Alzheimer’s for example. Disabled people now have, and rightly want, full and longer lives. And if you add to that rising public expectations in terms of what they expect from social care services, it’s absolutely right that the Treasury and the Government have acknowledged that social care is one of the great challenges facing our society.  Our country needs a new consensus for a new settlement that’s fair and sustainable. We need to redefine the relationship between the state, the family and the citizen. I feel care should be run the same way as the education system. Everybody should have compulsory care. if needed of course but those whom are willing to invest more should get an advanced level of care. Anyone with assets over £21,000, including property, has to pay for their own social care whether they live in a nursing home, this should stop also as it means people spend years paying off a mortgage only to swap all assets for care a few years down the line.”

John Tiniakos
Social Work

“I feel that funding long term care should be a partnership between the population and the government. Part of our national insurance contributions, should be set aside for long term care, and if you wish to choose where this care is given and by whom; you should be able to pay extra contributions.”

Norman C.A. O’Rourke

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