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Forget the cap, here's the truly frightening cost of long-term care

The debate over where the government will set a contribution cap has confused people about the true costs of moving an elderly parent or relative into a care home.

 

by Michelle McGagh on Jan 08, 2013 at 14:20

Forget the cap, here's the truly frightening cost of long-term care

Rumours of a £75,000 cap on long-term care fees remain unconfirmed by the government, but whatever limit it puts in place the cost of caring for the elderly and infirm will amount to far more in practice.

A cap on long-term care fees was first recommended by the Dilnot Commission. Although Andrew Dilnot's report suggested a cap of between £25,000 and £50,000, there have since been calls for an increase to £60,000 by former minister of care Paul Burstow and predictions that a cash-strapped Treasury could push the ceiling as high as £75,000.

The introduction of a cap would clearly help people plan for long-term care and cover the costs.

However, Steve Lowe of Just Retirement, a retirement income provider, warns that the debate so far about where the cap should be set risks misleading people about the true costs of long-term care for the elderly.

He says there are two factors that are often overlooked.

How much will your local authority pay?

Currently anyone with savings of £23,250 has to contribute to their care costs while in a residential home. This excludes the value of their home if it remains occupied by a partner or spouse. People with less than this limit have their care paid for by the local authority. However, if the elderly person is single, the value of the house is taken into account, which is why so many people end up having to sell their homes when going into care.

Under the original Dilnot proposals a means test would be set at £100,000. Those with £100,000 or more of assets, excluding their home if it remains occupied by their partner or spouse, would pay for their own care up to the contribution cap (which, to repeat, he suggested should be between £25,000 and £50,000). Those with between £14,250 and £100,000 in savings would make contributions on a sliding scale up to the cap. Those with less than £14,250 in assets would contribute nothing.

As things stand, the government has neither decided on the cap or the means test. It's possible that if the government sets a higher cap than Dilnot suggested, it will lower the means test to even things out.

Whatever happens, Lowe says it is essential to understand that help from the local authority will not necessarily kick in as soon as you have spent the money up to the contribution cap.

This is because the local authority will base its contribution on how much it pays for people staying in care homes it runs, which may be far less than what the individual is actually paying in privately-run homes.

For example, if a local authority pays out £300 a week maximum for care, then it will calculate the costs incurred by a person in care as costing £300 a week, even if that person is living in the ‘Ritz of care homes’, costing £1,000 a week.

This means the individual would be responsible for paying the remaining £700 a week.

So although a care bill may reach the cap quickly because of the high cost of a home, the local authority will calculate the costs against its own care costs and deem that a person has not yet reached the cap.

This means that even although costs may be capped they could run into thousands of pounds more if the elderly person lives in a more expensive care home.

Don't forget 'hotel' costs

Once a person does reach the care cap, whatever that may be, the burden of long-term care costs is not over. 

Lowe says the state only pays for the actual care given, not the full cost of food or staying in the care home.

Lowe says the costs the local authority pays for are ‘related to staffing, medication, and the care received, but the person still has to pay "hotel" costs and that is around £10,000 a year’.

Although media attention has focused on the initial cap on care costs, Dilnot also recommended a second cap on how much people paid for 'hotel' costs of between £7,000 and £10,000 a year. 

As a result, Lowe says, the costs of long-term care are far larger than most people anticipate.

‘If the person stays in [a residential home] for five years, that is £50,000, plus the £60,000 cap, and you are looking at a minimum of £110,000, with some estimates over £200,000,’ he said.

35 comments so far. Why not have your say?

The Wills Man

Jan 08, 2013 at 14:56

Smoke and mirrors..............

Better for retired and retiring folk to ring-fence their assets via Trusts - at least that gives them the security of knowing something will be left for their children and grandchildren

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Anonymous 1 needed this 'off the record'

Jan 08, 2013 at 14:59

So - The cared-for will have to pay the extra over the level the council pays for care of the prople for whom it is fully responsible.

So - should those with power of attorney be using any 'savings' to fund action to require the councils to provide a good, and socially acceptable level of care.

That level being, perhaps comparative with EU considered rights to rights to be cared for, and treated in an apppropriate manner.

There is after all a legal responsibility for those with such powers to take appropriate action on behalf of those they act for.

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The Red Baron

Jan 08, 2013 at 15:30

'The Wills Man'

Agree Trusts have their place.

However,

i) hope your 'solution' does not fall foul of deliberate deprivation rules?

ii) hope your clients are happy to forego choice as to where care is delivered?

iii)hope your clients are equally pleased to lose control of their assets?

Just some thoughts.

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The Wills Man

Jan 08, 2013 at 15:48

The Red Baron

i) Deliberate deprivation rules avoided - different reason for the Trust

ii) Clients retain full control and therefore have full choice of where care is delivered

iii) Clients retain full control via MoW even after loss of capacity.

All points covered - thank you for your care.

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Keith Cobby

Jan 08, 2013 at 16:04

The problem is, as I posted on this topic yesterday, the proposed figures are not confirmed. When they are the devil will still be in the detail and all of this will be subject to continual amendment. For guidance on this topic look at Government action on pensions.

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White Stick follower

Jan 08, 2013 at 16:08

The Ritz of Care Homes at £1K per week. Not in London & the Home Counties, where an average of around £950 for a mid level is more realistic. Go to top of the range and £1600-£2K is nearer the mark, plus an Initial Payment of several thousands for 'amenities', plus extras such as giving medicines and applying dressings. It is unfortunate that government and some commentators do not recognise the vast tariff differences around the country.

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Nick

Jan 08, 2013 at 16:12

My aunt went into a nursing home with only months to live.... £360,000 spent so far and she's still defying the doctors!

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Anonymous 2 needed this 'off the record'

Jan 08, 2013 at 16:27

At the first sign of dementia or incapacity then its three bottles of the best vodka and a large pack of paracetamols for me.

Not scared of joining the choir eternal but being old and infirm in the UK scares the hell out of me.

Forced to pay National Insurance premiums to a gangster government who tell you to get stuffed when you submit a claim on your policy.

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X Wall

Jan 08, 2013 at 16:37

Best to stay in your own home (no hotel costs) and pay for a local nurse to look in/phone once a day before one hits the 'incapable' barrier. Then pay more for more. It's got to be cheaper in the long run. stay with someone you get to know early on. No pressure, just keep it casual, cheery and frequent. NHS nurses need the extra too.

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The Red Baron

Jan 08, 2013 at 16:45

The Wills Man

Thanks for your replies.

i) presume timing is crucial?

ii) suggests this may be viewed as a gift with reservation?

iii) can only find MoW as being an abbreviation of Meals on Wheels! Please explain how an individual who has lost capacity can 'retain full control'.

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steven fieldfare

Jan 08, 2013 at 16:56

Re-inforce the points made by White Stick follower: Care Home costs are invariably much higher than the 26K average oft touted in comment on Dilnot. Increases in Care Home charges also run at much higher levels than general inflation because the care business is vulnerable to elements at the higher end of the inflation assessment mix (24 hour energy and manning costs).

Two additional points: differences between personal care and nursing care are frequently blurred in discussion; and that some Councils have been closing their own Care Homes in favour of fixed price contracts in the private sector.

While the NHS have usually faced up to their responsibilities over paying for care of terminally ill patients, that has not generally been so for dementia cases where they take an attitude that the patient is not in need of "continuing medical care" (ie in hospital) and put many obstacles in the way of claiming a nursing element of cost.

When Councils use Tesco style purchasing muscle in capping contracts with private care providers, Care Homes invariably react by charging "self funders" a higher rate. "Home sellers" therefore find themselves not only funding non payers through their Council Tax before entering full time care but also subsidising non payers when in Care Homes.

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White Stick follower

Jan 08, 2013 at 17:23

Further to my previous posts and the follow ups which are always helpful, my experience arises from the situation with which my 90-year old maiden lady Aunt faced. Having been admitted to the local 'main' hospital a number of times following falls- she lived alone in her own home, the hospital administrators decreed that she could not go home as she would only keep coming back, because of medically related conditions. On that basis the hospital ruled that she must go into a Care Home with 24/7 Medical back up on site, i.e. a Nursing Care Home. By way of contradiction the hospital/PCT/County Council determined that her needs were more social than medical and thus the local authority would not pay. As an option I carried out a costing exercise which showed that if she went home and employed Care Staff, 3 visits per day plus on site night care those costs would amount to some £1980 per month (plus £40 extra per night if the Night Carer had to get out of bed more than twice to attend my Aunt) plus her normal running costs of maintaining her home which were about another £1K +,so from a budget perspective it wasn't an option or as my Aunt said 'I can't afford that'.But she is in a decent home, well cared for and far healthier than she was in the hospital.So medical care needs are medical care needs only when the patient is paying.

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Primex

Jan 08, 2013 at 17:26

A generation, who came through the depravation of WW 2, loosing family and friends, one might think, have paid their dues in Britain's ledger.

And yet, with all the shamefaced greed of succeeding generations, we have stabbed them in the back, taking their hard owned homes and more, to pay for their nursing home care. No honour amongst thieves.

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Clive B

Jan 08, 2013 at 18:07

@ Primex

"with all the shamefaced greed of succeeding generations, we have stabbed them in the back, taking their hard owned homes and more, to pay for their nursing home care"

a) they never paid anything remotely close to enough to fund such care

b) are you suggesting they should be able to say "yes, I could pay for myself by selling my house, but I'd rather the taxpayer paid for it so I can leave my house to my kids" ? Perhaps they might like that. I'd like the taxpayer to buy me a new car, but that's not likely either.

Getting old isn't a medical condition, so I see no reason the person shouldn't pay for themselves. If anybody is treating them badly, it's their kids ("no, mum/dad, you certainly can't come live with us, we'd rather you go into a home, but don't forget to leave us your money after the taxpayer funds your care)

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White Stick follower

Jan 08, 2013 at 18:54

Four points. Point One medical care needs are covered by NI, but not if a patient can go elsewhere and pay for themselves it seems. Point two the local authority care rate would only meet about half of the current fees.Point Three, whilst a great many men, and women served in,mainly, WW2, of itself that does not justify state care.( My Aunt served in RAF as support & and after the War became a Welfare Officer connected to RAF, with MOD) .Point Four as for "greed" well it seems that if you spend ever penny you receive during your working life and make no provision for later years the State, i.e. the taxpayer will pick up the tab.

Far more relevant is how one defines "greed". To my mind spend today and to hell with tomorrow is greed, and expecting other citizens as taxpayers to keep one in the later years is the ultimate greed.

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Primex

Jan 08, 2013 at 19:09

Clive

The point that I was making is, that the post war generation should have made the necessary contingency funding over 60 years to afford the wartime pensioners free nursing home care.

They earned that right to free care, for the many personal sacrifices they made on behalf of our country.

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Roger T.

Jan 08, 2013 at 19:22

The cost of N.H.S. services is approaching 10% of G.D.P. to run - over £100 billion per year. The U.K. government is still borrowing heavily to fund all aspects of British life.

Living longer is not a change in the weather it is climate change.

To fund long term care for the elderly do we:

Borrow more/ increase taxes/ cut defence spending - - - - - - -

I have a 90 year old mother whose savings are being use to fund her care, its not good news.

All reading this column have an income to run their lives on, the U.K. is the same.

Comments on the situation of long term care funding would be more rounded if they included ideas, we all know what the problem is.

I think the U.K. should abolish universal benefits for a start.

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Clive B

Jan 08, 2013 at 20:10

Primex

Maybe the post war generation should have done that, but unfortunately they didn't. As we are today, we simply can't afford to keep saying "the state (i.e. us taxpayers) will pay for that"

Roger T

I saw an article in The Sunday Times last weekend showing how the welfare system has grown from some 4% of GDP in the 1950s to around 12% now, and the line is still going upwards.

Think the time is fast approaching where the state is going to have to say "if you can pay for itself, you'll have to, if the state pays (at all) it'll be at a minimum level to keep you from starving/being destitute)"

Unfortunately, politicians of all parties seem keen to help anybody and everybody but without counting the cost to us taxpayers.

I can see how the TEA (Taxed Enough Already) movement started in the US.

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Roger T.

Jan 08, 2013 at 20:55

Are there two Roger Ts out there?

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Roger T.

Jan 08, 2013 at 21:33

Apologies Clive B - misunderstood your reply to me.

5 year terms of government are short, opposition parties like to promise goodies that we all like.

Only affordability has any lifespan.

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steven fieldfare

Jan 08, 2013 at 21:41

Clive B and Roger T

While you make relevant arguments about overall affordability, I think the points that you miss are over fairness and balance. I also think Clive that you overlook downstream consequences of loss of inheritance.

Those who can afford to contribute to their care above the level of NI contributions certainly should - a principle well understood and accepted over taxation generally. But what has become anathmea over care charging is the skew between those who have to pay and those who do not.

This argument is brought sharply in focus over the WW2 survivors. Opportunity to get ahead and save for the future was restricted not only by the War itself but also by the difficult times for many years afterwards. Some gritted their teeth, scrimped and saved in their prime years to buy homes and provide for their future; laced also with natural desire to do well for their children. Others did not, lived for the present and relied on the State to provide for the future. Yet others had misfortune, ill health or poor circumstance that deserved the State safety net.

But in recent times, the welfare safety net has surely become elastic. When Clive B suggests that the State is unlikely to buy him a car, how very wrong can you be? Look at the numbers of cars provided by the motability scheme. View that against large increases in disability in post industrial Britain, when better working conditions might perhaps have been expected to decrease depression and bad backs.

And it does not take long to work out that those families who do not inherit are likely to fall ever behind in education and home provision for succeeding generations, piling up future demand for State funded care. As in taxation, if the bar is raised too high for care charges (and that is where we are at) then a culture of why bother or get rid of it early sets in. At Day Care, my Mother was once advised that she should have let the Captain of the Queen Mary look after her until she ran out of money and then checked in with Social Services, as it was the same deal - a story I've told before in previous comment - apologies.

I interpret Dilnot as recognising need for re-balancing welfare in a fairer way. Attempts also seem underway to tighten up on indulgences. Will it meet future welfare costs? Perhaps, given a large element of the welfare bill is occupied by State pensions which are part absorbed in full time care charges. Unlikely, if ideas persist that bonuses are payable for getting up to care in the night when the service is being charged for anyway. How about Voluntary Service at Home for the young unemployed and gap year crowd, in return for enhanced benefits and credits that give priority for higher education and/or cost reductions on fees?

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Anonymous 1 needed this 'off the record'

Jan 08, 2013 at 21:51

Re welfare increased from 4% to 12% of GDP -

Anyone got a similar comparism of the increase in cost to the country of MP's and then of ministers.

Remembering that at the moment GDP is very much down from 8 years ago!

Then consider the amount that would be in the 'pension fund' if what had been paid into the fund had been retained for paying the pensions of those who contributed, in proportion to their contributions.

(Sort of like if road fund tax had been used on the road system! )

Now, I do not believe that those without should be left without,

BUT it is definitely not fair that those who 'rely' on the state for their upkeep should not be worse off than those who make an effort to provide, even just in part, for themselves.

I, as a taxpayer have been taxed to maintain the health care, and social services care of the general populace, so why should I also be expected to pay directly for the provision of similar care for my relatives , just because I saved and provided for my family rather than taking holidays in exotic locations, and buying luxury goods manufactured abroad.

I know others who currently pay over £4000 pa after tax to travel into London to work 10 hour days, from a location where they can just afford a home to raise a family 2 to a bedroom, and others who are supported by the state in central London in a detached house with a separate bedroom for each of the children.

The children taking so much of their time that they cannot work, so are wholly supported from taxes.

Maybe if the government cut down on the provision for those who have needlessly got themselves into the state where they 'need' financial support,

And cut down on the waste in their service provision, and started managing finances in a similar manner to that which they expect the working public, and pensioners to manage, and did not pay bonuses, and give honors to civil servants for not doing their assigned tasks, then the country wouldn't be in such dire straights.

And - as a final winge - Stop taxing banks for paying bonuses, but tax the bonus recipients.

As Banks are substantially in the ownership of the government, and pension funds, taxing Bank profits is simply another way to deprive pensioners of the returns from their investment, and to swell the exchequers bonus paying funds.

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Rose G

Jan 09, 2013 at 13:04

The reason for care costs being so high in general is because we have a culture of unrealistic expectation combined with the increased use of costly technology & medication together with families who have been indoctrinated that they are taxpayers, so therefore should expect all care costs paid by the taxpayer.

The extended family, not just children but siblings plays a very important role in caring not just for the elderly but other vulnerable & sick people - however, Thatcher's children have all been brainwashed into thinking of numero uno, which is perfectly acceptable as a way of life for many, so therefore, more people end up in care homes rather than being looked after by their families. If you look at the ethnic population of those confined to care homes, you will find that those cultures where the elderly are respected, are not sent to care homes but care is shared by the family with the majority of women providing care.

Until this is recognised, and valued, carers will be paid minimum wage, & care quality is minimum too - having said that, the privatisation of care does not mean a better quality, it is hit & miss.

I am quite happy to sign on the dotted line to say no more care when I get to the stage where I cannot do the tasks necessary for daily living - I have no problems with ending my own life, although the means need to be explored to check out my options. I have not completed the Advanced Directive as yet as I am still working. I have discussed the options with my children in some detail about not wanting heroic resuscitation when I cease to function as fully as I am now. Just the thought of some strange person doing intimate tasks for me is just not on.

It is up to the individual to decide what is important to them and plan accordingly. I have no wish for either my children or some paid worker to clean up after me.

The medical profession should also take into account the lack of quality of life for people they are spending millions on, just so they can remain theoretically alive. Our political leaders should stop making promises no one can keep, let alone fund.

If we correlate the numbers of children confined to care homes, together with the numbers of old people in care homes, we can come to the conclusion that we are not a very caring society; we care little for our children, and hence our children care little for us, no need for a huge public funded inquiry to find this out.

Whicever way we look at it, there is no budget that can cope with the numbers of people who expect to be looked after from cradle to grave and anyone saying this is affordable is only lying.

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steven fieldfare

Jan 09, 2013 at 14:45

For Anonymous 1 and Rose G

I would not argue with your general sentiments over affordability of care and need for more family responsibility. Family care also responds to arguments over right to inherit and merit in accruing family wealth over generations. (I recognise, of course, risk that idiots in the line of succession may simply blow it all - but suspect that they would also be those who expect to inherit without effort).

But I do have difficulty with your belief that you would/should willingly end matters when intimate personal care is needed to carry on. While a good theory, it has not been my observed experience that this is what happens.

Among the elderly, disabilities creep up gradually. Failing mobility is common with associated falling. Need for a bit of help with the shopping and neigbours calling in to ensure security is not life threatening. Even an inability to get up from the floor or having that broken wrist repaired does not seem too much of a crisis, after all you can get those alarm things. Pain is livable with too, in the main, as in non life threatening conditions much is below the screaming level and can be effectively controlled and endured - especially with the Granddaughter's wedding to look forward to. Evidence for this view? Try and get a routine appointment anytime soon at your local hospital's Pain Clinic.

As the limbs stiffen, help with those fiddly buttons that they insist in putting on cardigans is not too much to ask for at bedtime and when getting up, while risk of falls while bathing and washing can be coped with by daughter or the lady who calls.

I don't know how the GP reckons that I am diabetic as I have never taken sugar in my tea. Anyway it seems under control with those pills and the clinic outings for regular tests are a bit of an opportunity to get out and talk with people. You can't expect your eyesight to be good at my age, but the big button telephone and magnifying glass seems to have sorted things out.

I just wish that these remote controls weren't so fiddly and complicated. I think there may be something wrong with the TV. Anyway, most of the programmes seem foreign as they all have those sub-title things. I know that the kitchen floor was flooded last week, but everybody is forgetful and there is nothing wrong up here unlike some of those others down at the Club.

The will to live and life's longing for itself is very powerful and reason and judgement depart without self recognition of anything other than forgetfulness - it's called Dementia. And,in this condition, to end it would require someone else to put you down. Cynics would say that is what some hospitals achieve with the Liverpool Care Pathway.

What seems rational from afar does not seem so simple when it is up close and personal.

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Anonymous 1 needed this 'off the record'

Jan 09, 2013 at 15:40

Steven,

I'm not sure what to say in reply to your post, although it does seem that a response would be appropriate.

A major part of my post was that the government has taken it upon itself to charge the general working public for providing care services, and now, having taken money from those members of the public that those members of the public would use for care for themselves and their families, now want to avoid paying for the care they have stopped the public making financial, or social (family) provision for.

You are, apparantly coping with the disabilities and annoyances associated with ageing.

However, I appreciate the point of view expressed by Rose, and believe that people should be allowed to decide if they want to live beyond the time when they can take care of themselves without help, or not, or if they want the body to be kept alive when the controlling intellect has ceased to function adequately, rather than just properly.

Now, considering your mentioning of the Hospital pain clinic, and diabetis

My recent experiences of the hospital and associated NHS service usage is that an enormous amount of money could be saved by having some people working in the hospital admin sacked for incompetance.

That said, the sackings should also include, or perhaps, start with the management who are failing to properly manage the staff and facilities that they are paid to manage:

Appointment letters that take 3 days to get into the postal system, are sent 2nd class, and detail appointments on the day following their printing.

Managers complaining that people turning up at A&E should have gone to their doctors, or a small injuries facility, when the small injuries facility in the town centre has been closed, and there is space for one next to the A&E.

2, 4, or even 8 hour waits for triage, and basic xray/scanning of injuries and internals, while the patient suffers, and the injury becomes more costly and time consuming to deal with.

2 instances illustrating the above:

My father, having had a fall and scraped an area of skin from an arm was left until the damaged skin had dried, then taking several hours work to soften and replace the skin, with many home visits over the following month from the district nurse to check on the wound and redo the dressings, when similar wounds treated by the now defunct injuries centre had taken about 30 minutes attendance, and about 4 visits for dressings.

Then there was the time when the doctor sent him (via ambulance) to have his arm xrayed in case it was fractured:

5 hour wait for the xray 4 more hours wait before it was looked at, - so a good job it wasn't fractured!

Then, instead of being sent home in a taxi, he was kept in untill the following evening waiting for an ambulance could take him home

Couldn't afford the £5.00 taxi fare, could afford the ambulance usage, with 2 staff, and the 3 meals, and the day in the hospital bed!

So - back to your post.

As long as you are happy to live your life, then you should not only be allowed to do so, but also receive all the assistance needed for you to do so.

If you have adequate physical and mental problems that you are not happy living, and you decide that you no longer want to continue living, then that, again, should be your decision, and option.

Re the " Liverpool Care Pathway", that is a matter that should attract the substantial involvement of the police, with the senior management of the facility being held responsible for the effects of their actions, and of their inaction/acquiescence.

Then the government appointed supervisory and inspection services should be similarly examined with them, and the specific members of the government who were responsible, or charged with their appointment.

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steven fieldfare

Jan 09, 2013 at 18:17

Anon 1

It's a genuine debate and no need to bat lightly on my behalf. I am fit and well; and was paraphrasing from observation of an elderly Mother and others I have come into contact with over the past 10 years. I am just back from queuing for a Blue Badge parking slot at the supermarket.

I promote no magic solution to elderly needs but I am clear that if we are to avoid a train wreck, serious grip of the problem must be taken soon. I am also clear that this must be achieved through equitable and balanced contribution; and not by ripping off the investment and saving of the prudent to pay for those who have been less so. Unspoken in Dilnot is recognition of this problem.

Others have commented on possible solutions. I do not hold, however, with views thay go along the lines of ... perhaps some should have provided for themselves better than they have, but we are where we are; and therefore those better prepared contemporaries will have to pay for them until their own assets are stripped away and legacy gone. That means the unprepared and their successor family have got away with it.

Kicking the pay can down the road to successor generations is no solution either, just as it isn't for national debt overall. The care burden must be faced up to by this generation in a fair and balanced way - either in kind, through family and charity care, or by contribution. Taxes play a part - and not yet do the pips squeak, when higher rate taxes now are compared with those after WW2. There is austerity and austerity - and austerity then had no market for pizza deliveries and Costa Lot coffee. You made a point earlier that GDP is very much down from 8 years ago. Is it? There is an interesting Guardian article that suggests around 2% less (Google "UK GDP comparisons"). The overarching problem is that GDP is not growing and that, therefore, expectation and growing demand cannot be met. We argue instead over who gets bigger pieces of the current pie and, usually, most vocally by those who failed to keep in reserve pieces of previous pies..

And for those who would wish to hack at Defence, I would point out that we have already taken a "peace dividend" out of what was sustained at the turn of the century and have been back for seconds since. That, in itself, has shifted around 1.5% of GDP over to other uses.

One way, I suggested earlier, in which we could seek care solutions in kind is by employing the young. They have no money to contribute and It may have the effect of bringing the problem home to them; and perhaps encourage better preparation for the future. But above all, we need to bear down on high costs and efficiency of care; and I don't mean getting more poorly paid carers to run around faster and faster.

You suggested that, with falling GDP, Ministers perhaps need to curtail personal prolifigacy. You could equally well attach that to Council CEOs and Directors of Social and Health Services (and some Charities) who enjoy salaries and benefits that often surpass those of mere Ministers.

But savings here are more markers of intent and culture change than solutions because of scale. Culture change is essential to bring real efficiencies in organisation and practice.

One commentator mentioned the frequent Spanish practice in Care Homes and domiciliary care of surcharging for getting up in the night when on night shift. There are many others, usually tucked away behind "Health and Safety" . When will the NHS and Social Services employ joint care forces for post-medical care? Some areas have both NHS re-habilitation wards, where you await clearance assessments from mobility, social and discharge teams (but not at weekends), and also re-habilitation wings in Council care homes for domiciliary care assessment (both are State funded for statutory periods regardless of means). Why are private domiciliary care companies competing in the same geographical areas, extending travelling time and costs and reducing care periods? Why can't those "self funding" Care Home places buy leaseholds on their flatlets/rooms sold on later at market value and without cost? Why aren't specialised GP practioners for the elderly, pharmacists and Social Care/meals on wheels offices gathered together at Care Homes to provide on site services?

With alarm bells finally ringing, efforts are being made now to tackle the increase in welfare spending from 4-12% of GDP by preventative health care meaures among the willing, re-assessing all that depression and those bad backs; and by proposed restrictions on the nearly free motors. Vested interests are, of course, fighting back on behalf of the vulnerable.

Against this back drop, there is a long way to go in providing a balanced and fairer mix for elderly care.

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Rose G

Jan 10, 2013 at 12:18

Steven

I accept that my proposed actions are not the answer for anyone but myself. Having worked in care homes, I found that most of the workers were quite happy to sit all night with their knitting and only check on patients when asked to do so. This was more than 25 odd years ago and my thoughts on care in care homes have not changed. We pay carers minimum wage & expect miracles. We should not expect carers to undertake tasks if we ourselves are not prepared to do so for our loved ones. That is my criticism of those who wish to question the care provided to their loved ones.

The question of culture is definitely important - some cultures care for their elderly. The attitude within British culture is to expect others to do the caring, while the relatives do the criticising.

I also have a family history of early death - my dad was dead by 55; he was informed that his heart had been so damaged, there was no way to get the muscles back to any kind of condition to carry on. My elder sister was dead by age 45; my mother lasted till 60 - so I look forward to an early death rather than carrying on till I can not care for myself. I certainly still miss my parents & sister but would not wish them back for my own selfish reasons - they died while still corpus mentus & that is the kind of death I wish for myself.

The western attitude to death is just ridiculous - death is part of the life cycle and until we learn to deal with this we will continue to provide care for vegetative people in the belief that it is caring - I blame politicians, the media and the professionals for promoting this rather unrealistic expectation that we will all live to 100 and that others will not only fund that care but be happy to.

It is upto individuals to decide what is their options. In this day and age, we should not have to suffer the consequences of the increased use of modern technology to keep us alive with the expectation that others will pay for the care.

The mindset that we pay our taxes and therefore should have our care provided for is a bit bizarre for me because when we look at the figures, our lifetimes contribution in taxes are nothing compared to what care providers expect to be paid - if we multiply our contributions by 1000, we probably are closer to the actual cost to the taxpayer for social care. My hope is that people actual wake up and get real instead of living in lahlahland, where expectations exceed ability to care. The natural end of all human being is death, and accepting this will go a long way to bring down costs. Keeping people alive because we can is just an ego thing, so we can feel superior as a nation.

Part of my dissertation at university was on the subject of attitudes to death and I got really good feedback from my tutor . Although my attitude to death maybe different from the mindset I find in the UK, I still believe it is healthier to plan for your future with the expectation that you will die, rather than living on in the hope that death, disease happens to someone else, or that someone else picks up the tab for your care!

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steven fieldfare

Jan 10, 2013 at 16:30

Rose G

I agree with your conclusions that families need to step up to the plate more in re-paying care debts to their elderly kin; and that we have much to re-learn from other cultures. Perhaps a national campaign on this theme would not go amiss alongside State care reforms. Forgive me if this view did not come through clearly enough in previous comment.

I was, however, challenging your apparent view that elderly people somehow reach a "Digitas" point, where they recognise and find unacceptable a need for intimate personal care and the burden that imposes.

While this sort of personal choice may be rational in younger and quicker minds, that are faced with increasing pain and known terminal illness, I was suggesting that is not the case among majority numbers of the elderly. Many have dementia and mobility difficulties that creep up in stages and ultimately severely limit self help and personal independence; yet they have continuing awareness, interest and fulfillment in life.

But above all, I was suggesting that decline is so slow for many elderly people that they fail to recognise any point where they could rationally express a wish not to carry on. And any outside or family help with forming that idea is a potential can of worms. Look at the controversy over the Liverpool Care Pathway, which is said to deal humanely with only the last few days of life.

I hope this better expresses my argument where it differs from yours.

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GrahamR

Jan 10, 2013 at 21:50

The Wills Man :-

What is MoW ?

Good point about settling assets into a trust but unless this is not a discretionary trust then it is likely to be a chargeable lifetime transfer with 20% upfront tax charge. A LoW (letter of wishes) would only partly retain some element of "requested" control of assets (therefore Red Baron may have a good point about there being a real legal loss of absolute assets control).

Is simply “giving away assets to children and hoping to survive seven years to avoid IHT” a transaction that would breach the deliberate deprivation rules ? [accept here the technical point that the 7 year clock won’t start running until the date of physical vacation of the residential dwelling as the ‘gifts with reservation rules’ apply still after the trust settlement date until vacation date).

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Rightcharlie1

Jan 14, 2013 at 04:41

It's time to return to our old ways of looking after gran!! I work abroad and the countries I visit all have parents and grand parents either living with or being looked after by siblings. This solves a lot of our expensive problems, elederly care and child care, and living costs, everything is shared.

In the UK we want out with no responsibility!! And because of this Care Homes are able to take the p*ss because they know if a person can't pay, the government (or local council) will. Another failure of our civil servants to obtain and maintain value for money, but that's why they are civil servants, a general lack of entepreneurial market force perception, and unfortunately the care home owners know this and fleece them and ultimately you and I (well not me, I don't pay UK tax - and this is one of the reasons why)!

Care Home, the clue is in the title, how do they have the bare faced cheek to charge extra for care?? it is a joke, but does following the American system that everything has a cost - this practice should be subject to a report with a minimum level of expected care included, I re-itterate, it is a Care Home!

The report should estimate fair value for care. My accomodation costs abroad - comaprible with sheltered housing - is £28,000 per annum and includes all food (in 5 restaurants), houskeeping 6 days a week, 24 hour security and laundry!!

Again our civil servants fail us in obtaining fair value. Sack them all and start again!!!!

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The Wills Man

Jan 14, 2013 at 09:07

GrahamR

A Mow (Memorandum of Wishes) is the legal term for a letter of wishes as you stated.

Yes, Trusts are complex to draft and they can easily be done incorrectly which results in either a loss of control or total/partial failure, which is why it is always advisable to see a specialist who knows how the various aspects of Law affect the intention of the settlor.

The 7 year PET is useful for mitigating IHT where the gift is not going to impact on the lifestyle of the giver, but is not relevant in regard to Care costs except where it may be deemed as "Deliberate deprivation"

The real problem many face is that general practitioners (solicitors and others) do not have sufficient knowledge of this area of Law and therefore cannot give relevant advice nor are they able to spend the time drafting Trusts etc. that will effectively meet the needs AND survive legal challenges from Local Authorities et al

"Failing to plan is planning to fail" is the watchword.; are your assets worth spending a few thousand pounds protecting from the possible costs of care provided by the State who are desperately short of money and will make you pay for care on their terms rather than yours?

That last comment is a reflection on the increasingly costly consequences of raising the standards of care

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Lesley Holmes

Jan 15, 2013 at 07:14

Rightcharlie1 has a wonderful solution - but where is it?

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Lesley Holmes

Jan 15, 2013 at 07:14

Rightcharlie1 has a wonderful solution - but where is it?

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Anonymous 2 needed this 'off the record'

Feb 28, 2013 at 16:56

The Govt pay more in benefits, which are premarily made up of payments to fit and healthy adults in work, than the govt receives in income tax.

Its simply down to what the Govt considers priority.

It currently choses to do the following with our taxes;

Pay billions to unelected quangoes;

Pay out billions on overseas wars;

Pay billions in benefits to fit and healthy in work adults;

Pay billions in public sector pension (all public sector employees should be immediately transferred to NEST)

Pay billions in foreign aid

Pay billions to the corrupt, undemorcratic and wasteful EU.

All the above take priority over our old and sick

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