Paying for Social Care

A couple of interesting facts:

Out of a total annual income of £15bn, an estimated £1.5bn (10%) leaks out of the care home industry annually in the form of rent, dividend payments, net interest payments out, directors’ fees, and profits before tax, money not going to front line care. This is equivalent to the £1.5bn of additional funding for social care promised by the government in the
September 2019 Spending Review.

Six of the largest 26 providers have owners based in a tax haven. This includes 4 out of the 5 largest private equity owned or backed providers and 2 of the 13 largest non-private equity for-profit care home providers.

chpi.org.uk/wp-content/uploads/2019/11/CHPI-PluggingTheLeaks-Nov19-FINAL.pdf

Doodledog

*I'm sure I have asked this before. Who and how will you determine those who could have but didn't?*

You can't. And it wouldn't be in my preferred way of doing things that you should have to.

If we all paid enough so that all who needed care got it, there would be no need. I couldn't give a rat's behind whether people have spent their money on good living or good works - to me it is theirs to spend how they like (after they have paid enough tax/NI to pay for an insurance scheme that protects us all) and that choice is what my posts on this thread are arguing to protect.

But we don't all pay enough - that's the problem!

Doodledog

No, but the thread is about what we think should be done to make things better, not how to cope within the system we've got.

Is it? I must have missed the agenda.

Maizie Please don't lecture me! I know about MMT!

BTW You might want to read a blog post by Richard Murphy yesterday(?) about the need for and role of taxation.

Over 80% of care home places are provided by for-profit organisations, many of whom are based overseas. Money paid to these providers often doesn't get returned to the Treasury because it gets squirreled abroad and certainly into the hands of a few. It is not the same as providing a public service provided by a state-run organisation. The latest changes mean that money paid in increased NICs by all workers, including some of the poorest, will end up with the family of wealthier individuals and foreign corporations. It's a transfer of money from the poor to the rich.

It is a fact that the need for social care for people in their 80s and 90s wasn't envisaged when the NHS was set up. I agree that there is no reason why it couldn't be provided now BUT it does need paying for one way or another. The issue is whether the cost should be borne collectively or by the individual and descendants.

Pre-war, the cost was met by descendants because the only people who went into homes were the relatively wealthy - and they did sell their homes to fund it. People who died in hospital from cancer or other terminal illnesses generally didn't last long and geriatric wards were pretty grim. Families provided much of the non-medical care, such as feeding, dressing, washing, laundry, etc.

Inheritance isn't another discussion because it's linked to how much people pay for end-of-life care and how much is left.

The NHS and social services were never designed to cope with the millions of people who now need care.

Even if it wasn't, there is no sound economic reason why it can't be done now. Taxation doesn't fund spending and governments with a sovereign currency can't run out of money. All the public money going into health and social care would be a stimulus to the economy through the multiplier effect. And in the end, so long as it isn't creamed off into tax havens by providers making huge profits, most of it will return to the Treasury by way of taxation.

We'd still have to grasp the inheritance tax nettle, though as inheritance tends to concentrate money into fewer hands and perpetrate inequality. But that's another discussion really..

I'm sure I have asked this before. Who and how will you determine those who could have but didn't?

You can't. And it wouldn't be in my preferred way of doing things that you should have to.

If we all paid enough so that all who needed care got it, there would be no need. I couldn't give a rat's behind whether people have spent their money on good living or good works - to me it is theirs to spend how they like (after they have paid enough tax/NI to pay for an insurance scheme that protects us all) and that choice is what my posts on this thread are arguing to protect.

No, but the thread is about what we think should be done to make things better, not how to cope within the system we've got.

Churchill coined the phrase "cradle to grave" in 1943, when the average life expectancy was about 65. Relatively few people lived beyond retirement age and it was quite rare to survive into one's 80s or 90s. Consequently, there weren't so many people living with dementia or who survived strokes and heart attacks, etc.

Historically, state support for old age has been almost non-existent. Those who could afford it ended up in nursing homes or at home with live-in care. Those who couldn't afford it and didn't have family as carers ended up in geriatric wards waiting to die and before that in work houses.

The NHS and social services were never designed to cope with the millions of people who now need care.

It’s my belief that everyone who requires nursing and care when they are old, or indeed if they are not old, then it should be provided and we, the tax payers, should pay. I paid all my life, except during the ten years that I cared for my young children. My husband paid all his life. The vast majority paid all their lives. The NHS is supposed to be cradle to grave. Not cradle till you get dementia, or are too disabled to go to the toilet alone, and then start paying yourself. The food and accommodation costs are covered by the person’s pension. Any further costs should be met by the state. The NHS is cradle to grave, including dementia or other disability caused by heart failure or other illnesses.

theworriedwell

*For me the problem comes when people want to give their children all their assets then have the state pay for their care. How is that different to the "feckless" people above who spent all their cash on drink and holidays? They both want to use their money in ways that are important to them, and expect me (and you) to financially support them afterwards.*

So if we want to keep going round in circles why should people who are terminally ill not pay for their care, they are dying so they won't need it.

It is very hard to work out a fair system that seems fair to everyone. I think inheritance tax is fairer, you don't pay it till you are dead, everyone dies but not everyone needs care so it spreads the costs. Other people will have different ideas but I think one thing is for sure the system Johnson has come up with isn't going to solve the problems.

Well said theworriedwell.

You certainly have a lot on your plate, make sure to look after yourself too.

Doodledog

*How on earth can you say that? It's not fair that only some parents can leave money for their children.*

No, it's not. But unless you want to live on a collective farm or something, that's the way it is. It's not fair that some people are born talented and others aren't. It's not fair that some are born disabled and others aren't, and so on. Are you suggesting that we should reduce the advantages of being able bodied and intelligent, or good at something valued by society, too?

And I can say that because it is my opinion, just as you can state your own.

A very good post Doodledog. I agree with you.

To wish to redistribute finances totally as some apparently would like, and not wanting to allow anyone to inherit, would indicate that the writer supports communism, not socialism.

nadateturbe

This thread is going round in circles.
No one is suggesting those who are poor and haven't had the opportunity to accumulate any wealth shouldn't get care paid for when they are old.
But it's unfair that those who could have but didn't are able to take advantage of an unfair system.
It should be paid for by a tax system during working life which needs to be much more than the present level. Yes it's a difficult task but that's what the job of the government is.

I'm sure I have asked this before. Who and how will you determine those who could have but didn't? You seem to be judging this by gossip and hearsay. Therefore it seems likely you would approve of a Stasis-like regime.

When it comes to looking after people who need Care what difference does what happened in their past make; it's not as if it's possible to change it. They are where they are now. Putting them in the metaphorical stocks will not alter that. Your views seem to entail pillorying people to make yourself feel better. They are certainly add nothing to the discussion with your idea of how everyone but you behaves.

growstuff we are certainly not wealthy. We were both teachers and therefore drew teacher’s pay and now receive teacher pensions. My own pension is not very large as I took years out to care for my children. I think I’ll decide whether I’m wealthy or not, and I judge we are not wealthy, merely comfortable in our retirement. We had many very lean years when we were bringing up our children. I believe you were a teacher so you will be perfectly aware that teacher salaries are not in the wealthy class. Wealthy people own land, and much more. Wealthy people do not live in a normal house like ours and have investments etc. We are not wealthy whatever you may decide.

MissAdventure

Nobody is saying it outright, but that doesn't mean it's not being said.

Who do you think is saying it, and in which posts?

growstuff, that sounds like a good way to spend your final years (which obviously I hope are a long way off).

But that is your choice. Suppose someone else chose instead give their children money to fulfil their dreams? Why is it ok for you to make your choice, and them to be considered grasping for wanting to make theirs? Assuming that both you and they have paid into the system that supposedly insures us all against needing care, that is.

I think what we are all doing is looking at the NI system from different points of view. To me, it is an insurance scheme against illness and unemployment. If we are lucky, we won't use it, but it is still right that we pay in (a) just in case, and (b) to help those who do need it. There will be those who (for various reasons) don't pay in, and they should be covered too, but to me the point of it is that we can all claim on it if we need to. From cradle to grave. I have no problem with paying more than I am paying if the scheme is underfunded, but as I have said, I don't see it as the fault of contributors if we have not been asked to contribute enough - we don't manage the scheme.

Others seem to see it as a scheme paid for by those in work to cover only those who are unable to pay for care at point of need, although what constitutes 'unable' is up for discussion.

I don't think anyone is arguing for those who can't pay to be denied care, and I don't think anyone is saying that they want others to pay for them - rather that they have already paid their premiums and reserve the right to claim on them if the need arises.

MissAdventure

Nobody is saying it outright, but that doesn't mean it's not being said.

Exactly!

Otherwise, why has it been raised so often?

nadateturbe

This thread is going round in circles.
No one is suggesting those who are poor and haven't had the opportunity to accumulate any wealth shouldn't get care paid for when they are old.
But it's unfair that those who could have but didn't are able to take advantage of an unfair system.
It should be paid for by a tax system during working life which needs to be much more than the present level. Yes it's a difficult task but that's what the job of the government is.

Errr, maybe not, but it's certainly implied in some posts that they don't deserve as much - or, at least, that those who could afford to pay deserve just as much, which comes to the same thing because those who won't end up being able to leave anything behind will end up paying for those who can.

Nobody is saying it outright, but that doesn't mean it's not being said.

This thread is going round in circles.
No one is suggesting those who are poor and haven't had the opportunity to accumulate any wealth shouldn't get care paid for when they are old.
But it's unfair that those who could have but didn't are able to take advantage of an unfair system.
It should be paid for by a tax system during working life which needs to be much more than the present level. Yes it's a difficult task but that's what the job of the government is.

PS Doodledog If I were to find buried treasure, I would help all my family members (children and sisters) now. I wouldn't disinherit my children, but I wouldn't expect anybody else to pay for any of my needs. I'd probably choose to stay at home and pay for 24/7 live in care out of my treasure. First of all, I'd have to buy myself a property, which I'd future-proof to take needs into account. I certainly wouldn't fret about any inheritance and I don't think my children would either, which is just as well because I probably wouldn't have anything left.

Hope that answers your question.

theworriedwell

*For me the problem comes when people want to give their children all their assets then have the state pay for their care. How is that different to the "feckless" people above who spent all their cash on drink and holidays? They both want to use their money in ways that are important to them, and expect me (and you) to financially support them afterwards.*

So if we want to keep going round in circles why should people who are terminally ill not pay for their care, they are dying so they won't need it.

It is very hard to work out a fair system that seems fair to everyone. I think inheritance tax is fairer, you don't pay it till you are dead, everyone dies but not everyone needs care so it spreads the costs. Other people will have different ideas but I think one thing is for sure the system Johnson has come up with isn't going to solve the problems.

My parents did pay for their care when they were terminally ill. They didn't have any state support at the end. They were at home and relied on family (in one case, a neighbour as well) and paid for people to come in and do housework. No medical interventions would have helped. One of my sisters retired earlier than she had intended to look after my mother and was travelling nearly 200 miles every day for weeks, so couldn't accept any work. I wish people would disabuse themselves of the idea that people with cancer get "free" care at the end of their lives.

Great post MOnica.

I agree with you that the greatest gift a parent can give a child is teach him/her to fly high and make his/her own way in the world.

We need to go back to the basic principle that everyone is expected to earn their keep and pay their way in the world until they die.

Most countries now recognise that not everybody can do that, so governments help those who cannot support themselves whether through age, disability or other problem.

Now it seems, some of those fortunate enough to be able to pay their way through life are whining and complaining and saying it is not fair because the government doesn't help them as well. Well, why should they?

As for those arguing that they are the deserving rich who put their money into their house unlike the undeserving rich who squandered their all and are now poor. Well they had the choice - and the money that gave them the choice and the choice they made was their preferred choice. They also would have had a better standard of living for most of their adult life. They should be glad they have the assets to be able to choose the care they have in old age if they need it.

I cannot describe the buzz I got when I could look at the value of my house and knew that it was valuable enough for me to be able to pay for any care I might need in my last years for the length of time I was likely to need it.

We have given our children a good upbringing, helped them get the degrees and training they needed to make their way in the world. We have already given them the greatest gift parents can give their children - a good start in the world - if we can do the same for our DGC that will be a bonus. But, otherwise, I will proudly pay my own way to the end.

I would be ashamed to take subsidies from those poorer than me to enable me to give money to my children when I die.

Sorry - that was in reply to Alegrias.

Maybe it isn't different. But you have argued that 'the feckless', along with the hard-working unfortunate, the disadvantaged and anyone else who has no money by the time they get old should have their costs paid. Why single out those who have scraped together a few quid over the government's allowance for approbation?

And there has never been an answer to the question of why , if you think that it is so wrong to get accommodation paid by the state, this terminally ill from causes other than Dementia should get their costs paid - just that you think that all medical care should be free.

I'll ask you the same question as I asked growstuff.

I don't know your financial circumstances, but for the sake of argument, if you wrote a best-seller, or found buried treasure and became rich, would you disinherit your children, or leave the dosh to them?

If the latter, how does that square with your belief that inheritance is unfair?

I agree, theworriedwell

For me the problem comes when people want to give their children all their assets then have the state pay for their care. How is that different to the "feckless" people above who spent all their cash on drink and holidays? They both want to use their money in ways that are important to them, and expect me (and you) to financially support them afterwards.

So if we want to keep going round in circles why should people who are terminally ill not pay for their care, they are dying so they won't need it.

It is very hard to work out a fair system that seems fair to everyone. I think inheritance tax is fairer, you don't pay it till you are dead, everyone dies but not everyone needs care so it spreads the costs. Other people will have different ideas but I think one thing is for sure the system Johnson has come up with isn't going to solve the problems.