Providing for Thatcher’s Adults

November 4, 2004 in Adults, Social care leaders

Kerry Stevens is a services manager at
Buckinghamshire Council’s adult services department. He has been
involved in providing, planning and managing services for older
people for a number of years. This article represents his personal
viewpoint and is not necessarily indicative of the council’s
policy.

Home ownership impacts on Britain’s economy. The vagaries of the
property market influence Bank of England interest rates, with
recent increases aimed at cooling a housing market seen as
overheated and out of control.

The sale of council housing in the 1980s contributed significantly
to a 40-year trend towards more home ownership and less renting. In
1966, less than half of all properties in England were privately
owned; now the figure is above 70 per cent.1

As a result, many more older people now own their homes and have
capital tied up in bricks and mortar. This in turn means they have
a different relationship with the state when it comes to social
services.

Against a backdrop of increasing demand generated by an ageing
population, the state restricts services to older people to ensure
there are enough resources to support those with the greatest need.
By means-testing those who access services, the state can
effectively ration resources to meet this demand. However, older
people who own their own homes can escape this rationing by selling
their homes and using the cash.

This situation is a natural progression of the Thatcherite
economics of the 1980s. Fewer people are now reliant on the state.
The resources locked up in people’s homes allow them to commission
services directly from providers without first forming a
relationship with the state.

You might imagine that the state gains from older people who own
their own homes selling up and moving to institutional care on the
proceeds. In these circumstances, the cost of care will be met by
the resident until their savings drop below £19,500. At this
point, the state will have to assess the person’s needs and
contribute to their care, assuming they fit eligibility
criteria.

This may seem an attractive option to the state -Êuntil it
realises that some older people do not warrant institutional care.
Or that they have directly commissioned a placement above the cost
ceiling that has been put in place to afford some management of the
local residential care market. In these situations the media
spotlight often falls on the local authority for moving a
“vulnerable” older person into a less plush institution or back
into the community.

It is also often the case that a relatively independent older
person directly commissions institutional care as a direct result
of a lack of support and advice from the state. Nominal ceilings on
the provision of community services and eligibility criteria may
divert the financially independent older person into an institution
because of a lack of such services. For the local authority, the
effect of this short-termist approach may be negative media
coverage and budget pressures. Yet in many cases an individual
could have been diverted from institutional care with additional
support or access to advice and information about community
services.

The state must begin to consider the impact of the “self-funder”,
because the new generation of older people – “Thatcher’s adults” –
are more likely to own their properties than their predecessors.
What may be a limited financial impact now is going to become
considerably greater.

Relationships with private providers and people will need to be
redrawn. The state should not always be seen as blameworthy in the
case of a privately-owned institution refusing to accept local
rates when an older citizen’s funds have dropped below the
£19,500 threshold. All owners of residential and nursing homes
who charge above the local rate should make the older person and
their families aware that, should they outlive their funds, the
state may not meet the cost.

The state also needs to consider the potential impact of older
people’s direct commissioning of institutional care. The state must
influence and control this commissioning to prevent the financial
backlash when funds are reduced. It will become a financial
necessity for staffing to be diverted to the resource-rich older
person to offer them support and advice on the direct commissioning
of services to meet their needs.

The range of services available also needs to be considered. The
natural choice of service for those unaware of the options
available to them will be institutional care. Often extra care
housing schemes in which the state is involved are not available to
those who possess considerable resources.

The opening up of these resources to the cash-rich, or the
partnership development of private schemes, will allow the state to
benefit from the freeing up of the person’s resources. These
placements may well be more suitable for the older person’s needs
and may be within the state’s cost envelope when the person’s funds
are reduced.

The empowerment of older people to directly commission services
gives a welcome boost to the quality and range of services. But as
long as services depend on the micro-influence of individual
decisions, they will only evolve slowly to meet the older person’s
expectations.

If macro-management of the process were supported by the state in
partnership with voluntary organisations operating in this area the
advantages would be less hit and miss, achieving quicker benefits
for more people.

The state cannot control this process. But it can influence it. The
power of the “grey pound” will have a growing impact on the market.
And social services departments must accept a new role: no longer
that of an agent of social control but as a guide to older people
so that they can successfully navigate a complex and often
mercenary market.

Abstract:

This article considers the impact of greater home ownership on
the ability of older people to directly commission services to meet
their needs. Managing the financial impact of this will require the
state to redraw its relationship with the citizen.

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