Paying for Social Care

Casdon

If people need 24 hour access to medical care they are in hospital, if they need 24 hour access to nursing care but not medical care they are in a nursing home, or at home with a CHC package. If they don’t need either medical or nursing care 24 hours they are either at home or in a residential home. So no, a nursing home isn’t actually a medical setting - and therein is the nub of the problem, because there isn’t enough money in the system as a whole to pay for the care needs of people who have immediate nursing but not medical needs.

It would be wonderful if there was enough money available, it would solve the delayed transfers of care people who are in hospital which would free up the NHS to do what it was set up to do, and generally patients and their families would get their care needs more appropriately met.

I don't agree, I think a nursing home is a medical setting, a care home isn't but a nursing home is. A qualified nurse is providing medical care.

Well said theworriedwell and Doodledog.

My mother lives in a nursing home because she requires nursing and social care. Like your relative theworriedwell she pays £1300 a week for her care, which includes care of bed sores, dressing of her legs made very swollen by her heart failure as they leak water and she regularly gets cellulitis from this condition. She cannot walk anywhere without support or wheelchair. She feels nauseous every day, presumably due to the cocktail of drugs administered to her by the nurse and therefore frequently is simply in bed all day. Is she well enough to live at home, with carer visits and family visits? No, she is not. Does she require nursing? Yes, she does, along with social care ie help with toileting and other things.

I don’t understand why all the care she receives is thought by some to not be medical. Her needs have been created by the fact she has heart failure. Is that not a medical condition?

Incidentally I always understood that all elderly people in care pay for their food/accommodation via their pensions if they have no other assets. Perhaps that’s how all residents in care should pay? They should pay with their pensions for the food they eat and accommodation just as they would if they were living at home. Charging £1300 a week is immoral in my opinion, especially when those costs subsidise other residents who are paid for by the state.

growstuff

*As to what you spent when your mother was in hospital, people with relatives in care/nursing homes do the same.*

I doubt if many do what we did in my mother's last few weeks (long story), but I agree with you that the whole system is not easy.

I agree that £1,300 sounds excessive and I wonder how it's justified. I'd be interested in a breakdown.

PS. I just Googled the average cost of care homes:

The monthly average cost of residential care is £2816 and receiving nursing care in a care home costs on average £3552.

www.carehome.co.uk/advice/care-home-fees-and-costs-how-much-do-you-pay#:~:text=How%20much%20are%20care%20home,costs%20on%20average%20%C2%A33552.

Those figures are slightly more than those quoted by Age UK, so does anybody have accurate figures?

Sorry cross post. I explain some of the costs in my previous post.

Costs vary alot across the country, some areas are much more expensive than others, property costs and wages will be higher in London than in Lincolnshire for example.

It will also vary by type of home, if someone is likely to be in a home longterm would they prefer a small home with a more homely feel or a big purpose built place. With my relative I chose somewhere that would cater for her as her condition progressed, initially I could have chosen a home that was half the price but she would have had to move by now so I chose the more expensive option where she could stay till the end. She won't even go into hospital at the end, she will be in familiar surroundings with carers she knows.

When she had to move to a different wing of the home as her needs increased her named carer went with her, staff rotate anyway so she still had other carers she was familiar with on that wing.

Sometimes money makes the choice for you, the local authority wouldn't pay for the home she is in, sometimes it is where you feel comfortable. For me one thing was how did it smell, if I viewed a home and the smell of urine and boiled cabbage hit me I wouldn't leave her there, it wasn't somewhere I wanted to live so why would she?

Ah, Casdon has answered while I was typing. Thanks ?

I wonder if I am confusing nursing homes with care homes? To me they are the same thing, but maybe not, and if so would that make a difference? I just can’t see the logic of saying emphatically that one group of people who won’t live in their home again should get free care, and another should not. It makes no sense to me, and is entirely separate from my thoughts on taxation or any of the ‘fairness’ issues being discussed on this thread.

Re my friend’s son - no he has no house of any value, but he has inherited savings which are managed by an accountant so that he remains in receipt of the benefits that pay for his care. He would get the same care without that money though - his mum uses it to buy him ‘treats’ but mostly it is a cushion against future changes in the rules that might see him treated differently in future when his mum is no longer around to protect him.

I’m not trying to complicate things, though. I am trying to understand why you feel that some people are (universally) entitled to free care when they are ill (or infirm) and others aren’t.

If we want to be fair to all, surely either everyone should pay for their care if they have any money over a basic amount and we scrap the NHS and socialist-based provision, or we all pay in tax and get the care we need as and when (or if) we need it? I know which I would prefer.

I think that Johnson’s new ‘scheme’ is just as bad as the old, and it amazes me that people are arguing for it to remain in place.

If people need 24 hour access to medical care they are in hospital, if they need 24 hour access to nursing care but not medical care they are in a nursing home, or at home with a CHC package. If they don’t need either medical or nursing care 24 hours they are either at home or in a residential home. So no, a nursing home isn’t actually a medical setting - and therein is the nub of the problem, because there isn’t enough money in the system as a whole to pay for the care needs of people who have immediate nursing but not medical needs.

It would be wonderful if there was enough money available, it would solve the delayed transfers of care people who are in hospital which would free up the NHS to do what it was set up to do, and generally patients and their families would get their care needs more appropriately met.

Gwyneth

Why can’t Care Homes state exactly how much it costs for a patient. Obviously if the patient requires medical costs this will be more. As we know care workers are paid minimum wage. Older people don’t eat large meals. So how much is profit this needs to be made clear. Also I don’t think it’s fair that those paying their own costs should have to subsidise those who don’t. I agree with some posters who say that medical costs should be met by the State but patients should contribute to living costs from their pensions, even those on low incomes if the care home is now permanent, or sale of their homes, if they are not returning. The whole system of payment for care needs a complete review as does the NHS. Throwing money at it is only a temporary solution as costs will continue to increase year by year.

Care homes do state exactly how much it costs. I do voluntary work in a care home, do admin not care. When a council is paying for a placement the home has to do a complete breakdown of costs. It will include staffing costs which will be broken down into salaries recruitment, training, oncosts (NI Pension contributions holiday pay refresher training) plus how many hours are 1 to 1. Also food/laundry/management costs, their share of costs like electricity/water/gas, replacement costs of equipment, rent or mortgage interest on building. There are also insurance and registration costs and admin costs.

Believe me they will question everything and you'd be shocked at how it all adds up, there really isn't the fantastic profit that people think unless you are a big organisation with economies of scale.

As to what you spent when your mother was in hospital, people with relatives in care/nursing homes do the same.

I doubt if many do what we did in my mother's last few weeks (long story), but I agree with you that the whole system is not easy.

I agree that £1,300 sounds excessive and I wonder how it's justified. I'd be interested in a breakdown.

PS. I just Googled the average cost of care homes:

The monthly average cost of residential care is £2816 and receiving nursing care in a care home costs on average £3552.

www.carehome.co.uk/advice/care-home-fees-and-costs-how-much-do-you-pay#:~:text=How%20much%20are%20care%20home,costs%20on%20average%20%C2%A33552.

Those figures are slightly more than those quoted by Age UK, so does anybody have accurate figures?

Another point- several care-home Groups are run by large corporations - and a few smaller ones where the profits end up out of the country - funding extravagant lifestyles abroad.

Maybe the money should stay in this country?

Isn't a nursing home a medical setting?

Then you should expect to have it paid for.

Why is this so hard?

Alegrias1

Nope, no anomalies.

Hospital care should be free, including food, tv, parking, whatever. Irrespective of what is wrong with you.

If you are well enough to leave hospital and live in a non-medical setting, you can't expect anyone to support you in having two homes, no matter how old you are.

It's pretty clear to me.

Isn't a nursing home a medical setting?

Doodledog

Your point is clear, but I don’t agree that someone discharged to a care home is ‘well’. They would be sent home if that were the case, and I don’t think that it is logical at all.

Do you consider a young disabled person ‘well’? I have a friend with a disabled son who lives with a rota of carers in a house owned by the council ( or possibly the local healthcare trust). His (24/7) care is paid for, although his needs are mental rather than physical. His rent is free, and I think his food etc is paid from his benefits, as he will never be gainfully employed.

Would you charge him (or his mum) for that? The system gives him a chance of a happy and (relatively) normal life that he wouldn’t otherwise have unless his mother gave up any semblance of a life of her own. He is probably unlikely to live to old age, but who knows what advances in care will come along? If he does have a long life, at what point would you start to charge him and why? If you wouldn’t charge, on what basis is his case different from on old person with Dementia?

Well, that just shows what a postcode lottery the situation is. I mentioned before that I know somebody who has a very disabled son. He was born with various problems and is unable to walk or talk. He lives with his mother in bed or in a wheelchair. Although, his parents do receive some financial help, they still pay for 24/7 care, which they can fortunately afford.

growstuff

Doodledog How long do people in cancer spend in hospital? I don't know the answer, but I bet it's not that long. My Mum had terminal cancer, but was sent home until a couple of days before her death. It cost my sisters and me quite a lot of money with travel expenses, taking time off work and buying her special food and anything else we could think of to distract her. We didn't get any of that back.

Maybe there is a case for charging people in hospital for food (which has been discussed before on GN) but it would probably cost more to administer than the food itself because most people stay in hospital for a relatively short time.

No, I don't think people should spend years or months in a care home without contributing to their keep. They are effectively saving the money they would spend on themselves.

Some people are in hospitals for weeks or even months. Other than a deduction from their pension they pay nothing.

As to what you spent when your mother was in hospital, people with relatives in care/nursing homes do the same.

I gave the figure of £1,300 for the care my relative gets, do you spend £1,300 a week on yourself? I don't think many of us do. Contributing to normal costs is one thing but to pay that much does not equate to saving what you'd spend on yourself.

Alegrias1

My grandma went into a care honest the age of about 86. She didn't have a house that she owned, she had a council house. We knew she wouldn't go back into her little house again, so did she, so she gave it back to the council after 30 years of having lived there.

Now, if it had been her own house, we would have sold it. And she would have had a nice little lump sum. So by what possible metric is it acceptable for an 86 year old to have large sums of money in the bank and expect the state to pay her living expenses?

Not her medication, not her treatment, her living expenses.

You can twist it all you like to suggest I'm demanding money from the old and the sick, but I just find it immoral that anybody would expect to live in a care home and get the state to pay for their living expenses just so their children can inherit.

I think it is perfectly fair to pay living expenses, people in long term hospital care do as the money is deducted from their pension. However, for someone with a condition like advanced dementia they aren't just paying for living expenses. For my relative it involves catheters, medication, care of bedsores (not all the time but it happens) that isn't normal living expenses.

What if you go into hospital on a Tuesday but come out on a Thursday and your cousin's called Sandra?

When did I become responsible for giving details of the way that medical and social care should be funded in all hypothetical situations?

Sell your house if you're not going to live in it.

Doodledog

But as theworriedwell says, unfortunately many people die in hospital, and some of those have a terminal diagnosis when they get there. By your logic, they should also be asked to 'sell their homes and live off the proceeds', as they won't be living in them again.

Dementia is an illness, the same as the ones that kill people in other ways, so why should there be a difference in the way people with that particular illness are treated?

And what's with the 'normal human being' stuff? In both cases (people with Dementia and people with other terminal illnesses) we are talking about people at the end of their lives, who will be frightened and possibly in pain. We can at least be compassionate when talking about them.

Glad someone can see the unfairness in this.

Alegrias1

^So I ask again do you think someone should sell their home to pay for their treatment as they won't live in it again, they won't need it again.^

For the third time...

Nobody should have to sell their home to pay for medical treatment.

If you are going to spend the rest of your life in a care home, and you are the only person who lives in your house, and you think as a general principle people should take responsibility for their own living costs, sell your home and live off the proceeds, like any normal human being. Or don't sell your home, but use whatever resources are at your disposal to pay for your food, clothes, cleaning bills, whatever. Like a normal human being.

What about a nursing home? Why would a hospital be free and a nursing home not?

I agree foxie48.

Also, the care needs of people with severe and enduring mental health issues haven’t been considered sufficiently. There are hundreds of thousands of people whose mental health conditions mean that they are unable to lead independent lives, but they are often expected to do so. I wonder where the line is for what people would be prepared to pay to help support people. Expecting them to pay for their living expenses is fine as far as it goes, but many of them survive on benefits anyway, they don’t have any assets, so one public purse would be paying another. There’s certainly no easy answers.

In 1948 when the concept of cradle to grave care was initiated, men born in 1948 had a life expectancy of 66 and women 70. That's now moved to 73 and 79. It was never imagined that life expectancy would increase so rapidly nor that many of the cancers/illnesses that killed people prematurely would be cured and that people would continue to live with a range of serious illnesses into their 80s and 90's. The NHS is severely underfunded and so is social care but realistically we would need to increase what we pay into the system to give free medical and social care to everyone by a huge amount and reading through these posts, most people seem to think that they have already paid their share! We will never have a free service for all because basically voters won't pay for it and won't vote for a party that wants to make big increases. Just look at the backlash that has already begun to BJ's increases. The trouble is too many people want someone else to pay their share of the burden and are frightened that someone else less deserving than themselves will get an unfair advantage. Reading through some of these posts has made me feel rather depressed

I totally agree with your earlier post Alegrias that it is immoral for anyone to expect their social care to be paid for by the rest of society so their family can inherit the home they can no longer live in.

Thank you for that information doodledog

Doodledog

Your point is clear, but I don’t agree that someone discharged to a care home is ‘well’. They would be sent home if that were the case, and I don’t think that it is logical at all.

Do you consider a young disabled person ‘well’? I have a friend with a disabled son who lives with a rota of carers in a house owned by the council ( or possibly the local healthcare trust). His (24/7) care is paid for, although his needs are mental rather than physical. His rent is free, and I think his food etc is paid from his benefits, as he will never be gainfully employed.

Would you charge him (or his mum) for that? The system gives him a chance of a happy and (relatively) normal life that he wouldn’t otherwise have unless his mother gave up any semblance of a life of her own. He is probably unlikely to live to old age, but who knows what advances in care will come along? If he does have a long life, at what point would you start to charge him and why? If you wouldn’t charge, on what basis is his case different from on old person with Dementia?

I feel you are coming up with increasingly complex situations in an effort to show that what I'm saying is wrong Doodledog. Anyway.

Does the young man in your example own a house worth, say £200k, that nobody else lives in, that he will never live in again? If he does, then he should sell it and use the proceeds to help fund how he lives now. When the money runs out, he should expect the taxpayer to cover his needs. His mum shouldn't be responsible for any of it.

Its got nothing to do with what's wrong with a person, how old they are, or what their relatives own. And not everybody in a care home is "unwell". Many of them are just old.

So much for my last word on the matter....

Sorry, that was to Algerias.

Gwyneth, people in local authority homes already use their pensions to pay towards their care. They get pocket money for personal items like toothpaste, but their food and so on are covered by that.

Your point is clear, but I don’t agree that someone discharged to a care home is ‘well’. They would be sent home if that were the case, and I don’t think that it is logical at all.

Do you consider a young disabled person ‘well’? I have a friend with a disabled son who lives with a rota of carers in a house owned by the council ( or possibly the local healthcare trust). His (24/7) care is paid for, although his needs are mental rather than physical. His rent is free, and I think his food etc is paid from his benefits, as he will never be gainfully employed.

Would you charge him (or his mum) for that? The system gives him a chance of a happy and (relatively) normal life that he wouldn’t otherwise have unless his mother gave up any semblance of a life of her own. He is probably unlikely to live to old age, but who knows what advances in care will come along? If he does have a long life, at what point would you start to charge him and why? If you wouldn’t charge, on what basis is his case different from on old person with Dementia?

Why can’t Care Homes state exactly how much it costs for a patient. Obviously if the patient requires medical costs this will be more. As we know care workers are paid minimum wage. Older people don’t eat large meals. So how much is profit this needs to be made clear. Also I don’t think it’s fair that those paying their own costs should have to subsidise those who don’t. I agree with some posters who say that medical costs should be met by the State but patients should contribute to living costs from their pensions, even those on low incomes if the care home is now permanent, or sale of their homes, if they are not returning. The whole system of payment for care needs a complete review as does the NHS. Throwing money at it is only a temporary solution as costs will continue to increase year by year.