Should Gransnet weigh in on care costs?

It obviously makes sense to have a healthy population that can contribute to the society in which they live, but to see that as the only reason for taking care of people is, I think, quite chilling.

It used to be 7 years before, TriciaF. Not sure if it still is now. But there are other rules about if you hand it over, you have to pay rent, etc., so it's not simple.

They can get that information from the Land Registry online, Tricia. So can anyone.

Eleothan - I think the time the house is made over to family still needs to be well before admission to a care home. In our case when the time came we had to make Mum's bank statements available to the Social Services, so they could see what was coming in and going out. Don't know if they would have access to documents about transfer of house ownership.

Obviously not, whitewave. It's only those who have a £1 million pound house who should be able to leave it to their children, not those like my mother in law who has one worth £150,000 who has to sell it to pay for her costs.
Although the government has topped care costs at £72,000 it does not include board and lodging in that £72,000. You still have to pay for what they call housekeeping on top of that.
That's why it needs sorting properly.

Notice that DC when arguing for an increase in the level that inheritance tax hits, said that it is right and proper that people who have worked hard all their lives and struggled to buy a house should be able to leave it to their children. I hope he uses the same argument when considering the cost of care and the way that the state will leave a person penny -less if it deems it necessary.

sorry, costs the state.

I take your point Emily but find it hard to accept that the motivation of founders of the NHS was simply to provide the country with a healthy workforce.
Surely they were thinking in terms of ending or limiting individuals' suffering too.
In those days they could not foresee the enormous changes in medicine which have prolonged life, but at enormous financial cost. Equally they could not foresee the increased life expectancy that we now have, but which comes for many people with years of debilitating chronic illness which costs the stars both in terms of medication and support.

I think the intention and ethos of the NHS was to ease people's suffering and the distinction between health and social care is an artificial one.
If you look at eloethans link you will see that the among the countries studied, England stands out as making this distinction when other countries do not.
Initially it was hoped the NHS would be free at the point of delivery - it was soon discovered that this was unaffordable and charges for NHS dentistry were introduced within 2 years.
Eye care and prescriptions are not free either - we accept this, so I really think that the idea of co-payments at least for social care should be re-examined.

Health and social care are ‘social goods’ because when you need either of these services, if you are in serious need, you will be unable to work, to earn money to pay for your needs to be met. You cannot afford to insure against everything and our NHS gives us a universal insurance.

Maintaining citizens in good health benefits the whole community both in terms of a healthy workforce boosts economic production and provides fit soldiers to fight. In 1899 up to 40% of recruits in Britain were unfit for military service! This was a wake up call to government that took them 50 years to rectify.

One person's health may affect another’s for example smallpox, HIV/Aids etc.. That is why we have vaccinations etc. and talk about maintaining herd immunity.

In the UK we decided that everyone should have access to health and this came in 1948. There are now fewer deaths per 10,000 in child birth, breast cancer, etc.

I believe it is easier to standardise health care to meet each need than social care. NICE do their best.

So why then is social care not free?

If you are disabled from an early age it will be. However if you were fortunate to be fit enough to work you are expected if you earned over a certain amount to save and pay your way. There were tax allowances on your pension contributions. Since the 1st of April this year the government have capped your care payments to £72,000 (see LucyGransnet)

I do appreciate that some gransnetters will feel that when a person needs residential care that should be free like the NHS

However the reality is that the cost benefit analysis of health care for all scores better than social care for all. Health for all gives us a thriving workforce but care for all just removes productive people (i.e. making things rather than offering services) from the workforce to become carers. Staying independent and not needing care is cost effective for the country so that is the way things go.

Have not got more time to think about this for longer.

My understanding is, and I may be wrong, that signing over a house just before an elderly person goes into care can be challenged as a deliberate depreciation of assets, or something to that effect.

I don't know if it is still the case, but in order for property and assets not to be used to finance care costs or to attract inheritance tax, I believe they needed to have been placed in trust several years before care is actually needed. Wealthier people are usually aware that there are devices that allow the avoidance of inheritance tax and care costs and engage one of the many legal firms that specialise in this sort of work to make the necessary arrangements. I know someone who did this - at that time, there had to be a gap of seven years before the property and assets were disregarded.

Most elderly residential care now is run for profit - and as big a profit as possible. That means hiking up fees and cutting costs. That can result in inadequate staffing levels and poorly paid, under trained and demoralised staff. When I taught literacy to adult learners, one of my students worked in a care home for the elderly and was dismayed at the sort of cost-cutting that went on, which she felt threatened safe standards of hygiene. When she tried to challenge what was happening, the company made life very difficult for her and she eventually left.

It's a total minefield, so many variations on care and costs.
I shall be forever greatful to Age Concern who suggested the Trust Fund which I mentioned earlier. It meant that my auntie could stay where she was happy, even if I had issues over the years with slipping standards.
She died three years ago not owing anyone a penny, we were able to administer her will so that her great nephews and nieces benefited which was her wish. We could have done no more.

I wouldn't like to have to sort it all out fairly. I can't even begin to imagine where the starting point should be.

Re my post of yesterday (Saturday 11 April 13.57.54)

I was basing it on personal experience of people I knew whose attitude had been to live for the present and not worry about the future. Unlike others I knew who had led frugal lives, denied themselves what they considered to be luxuries (a washing machine!! a decent TV etc)

Flicketyb I was not implying that all those without money had spent it. I didn't think I would need to differentiate between those who never had it in the first place! I was simply making the point that the system is unfair. I obviously didn't word it very well.

The health/social care issue surely also needs to be addressed - don't they merge into one at some stage?

Tricia that is what I mean about the whole system needing to be looked at.

How much of the (eg) £1, 000 per week goes on the elderly person's care and keep, running costs etc, and how much ends up as profit?

You ladies write so well! Yes, I think Gransnet should be involved in this issue.
My view is the same as FlicketyB's.
Other points - what do people think about the morality of an elderly person signing over their house to their children (before they go into care)?
And looking at it from the other side, why have fees got to be so high? My Mum paid £250 pw about £13,000 pa when she was in a home, until she died in 2002.

jen co-payments have always been a political no-no in the NHS - the thinking seems to have been that it is unfair for better-off people to be able to 'buy' a better level of service or a better drug, or a better new hip, than others can afford.

Perhaps it's time to turn around the way we think of co-payments - perhaps if they were viewed as a contribution to the State system, rather than an individual making a purchase, the idea would be more acceptable.

I agree, jane. My mother in law was self-funding until they realised she could not look after herself at all. She falls over if she stands up, and has dementia now. At least the last time I visited her I did not get called by anybody else's name, just introduced as her cousin.
I think the rules need to be really sorted out if co-payments come in.
Thinking about when my husband was on the LCP, one week we were told he need not worry, it would all be paid by the NHS; the next week we had to fill in a form about what he could and could not do to find out if the NHS would pay or whether he would have to; the third week he stopped eating and drinking and died. That really should not happen.
In Denmark they complain about paying high taxes, but get better benefits on retirement.

The whole system of care for the elderly, the costs involved and how the money paid is spent needs to be looked at in detail.

Many homes are wonderful places, a home from home and place of security and safety for people unable to care for themselves or be cared for in their own homes.

However, some are inadequate, poorly run and run on a shoestring despite the cost of living in them being high.
Whilst the residents suffer inadequate care and nutrition, the multi-millionare owners of some of these homes are living the life of Riley.

Thanks for the link eloethan, interesting to see how other countries approach this.
I think that system of co-payments, with people paying towards the cost of their social/residential care, with perhaps varying contributions according to assets and income, would be fairer than the all or nothing system that seems to apply in England at present.

This question is on BBC1 at the moment.

I notice that the Tories are now wanting to increase the inheritance tax limit to £1million.
Danny Alexander now thinks that once again the Tories are looking at the wrong people, but he will not say if the Libdems will block it. Sitting on the fence will not save his seat. He's asking disaffected Tories to vote for him. I wonder how many of his constituents have property worth over £1million?

FlicketyB Some people had mentioned about the unfairness of them having saved and gone without while others had spent all their money - my remark wasn't addressed to you.

I think janeainsworth is right. I think most elderly people are very reluctant to go into a care home and do so only as a last resort. They go into residential care because they are no longer able to manage on their own. As far as I know, people who are voluntary patients in psychiatric hospitals or units are not expected to pay for their care, whatever assets they might have.

In Sweden, the high taxes that people pay ensure good quality public services. The British taxation system is a good deal more generous to wealthy people and companies and yet still they make every effort to avoid paying. That is one of the principal issues that I think needs to be addressed. As long as those at the top are paying their fair share, I don't think the British public would object to paying higher taxes themselves to pay for decent services.

On top of that, I think there should also be an exploration of the fairest and most efficient way of funding what is likely to be a growing need for residential care for the elderly. We need to look at the systems of other countries and see which of them are the most fair and effective.

This is a piece of research that the King's Fund did:

www.kingsfund.org.uk/sites/files/kf/media/commission-background-paper-social-care-health-system-other-countries.pdf

Yes please Gransnet. Please get involved. If only to emphasise the difficulties - looking after an infirm spouse when you're infirm yourself; accessing funds and home help - which is a minefield of obstructions; finding suitable care when you have no one to help you; knowing what different accommodations are available, etc. Advisers based in the doctors surgeries perhaps? Simplification is desperately needed. For instance - £118,500 for goodness sake. When you're elderly numbers can often muddle easily. Why couldn't it have been £200,000? Just rounding numbers to easy amounts would make a difference.

I think many elderly infirm say they want to be in their own homes, despite being afraid of being alone and vulnerable, because they don't know all the options available and are afraid of losing all their money which they want to conserve to help their offspring.

I think one of the problems with this emotive issue is that we perhaps tend to view it from our own perspective, rather than taking an objective position.
I understand where you are coming from Flickety and up to a point I agree, but I do wonder about the divide we make between health care and social care.
I'm assuming that none of us would agree that someone who has high, ongoing healthcare costs and who has appreciable assets, should be forced to pay for their NHS treatment?
So why should they pay for social care costs?

I have never ever assumed that those without money have led indulgent lives. I was a domiciliary benefits advisor for Age Concern (as was) for many years and know only too well, living in a rural area, both how poor many people were throughout their lives and also how a disaster can wipe out a families financial resources.

The fact that the lottery of life means that one person's estate is eaten away by care fees, while their neighbour's is not, is not a good argument for saying those with resources should have help paying care fees. As we go through life, we may experience or know people who by luck or effort benefit from windfalls while other people are knocked back by all kinds of disasters. This is not a good argument for saying that if some asset you acquire increases your net worth you should pay a windfall tax depending on the value of your existing assets, nor that if business failure, catastrophe or illness besets you, you should receive a lump sum from the state to compensate you.

FlicketyB I understand where you're coming from, and to some extent I agree. There is no reason why less well off people with no capital should be expected to finance the protection of inheritances for beneficiaries. But it seems unfair that only a small proportion of elderly people go into residential care and because of their misfortune they lose a significant amount of their capital - while other, more fortunate, people's estates remain intact. Most people want to leave money to their children to make their lives easier (especially these days when both buying and renting a home costs a great deal of money), but it is just the "luck of the draw" as to who will end up paying away a large part of their estate.

I believe Gordon Brown suggested some sort of scheme whereby people entered into an agreement that a set figure was either paid upfront or deducted after death which would guarantee that they would be able to access care if it was needed. It would mean that most people would pay money for something from which they did not benefit but it would at least bring peace of mind.

I think it is wrong to assume that older people who have little capital have led indulgent lives of holidays, fast cars and expensive purchases. A lot of people are not very well paid and have found it hard enough just to pay their bills, let alone save. I don't understand why some people tend to see themselves as virtuous while assuming that everybody else is irresponsible and on the scrounge.

annsixty I'm fairly sure not all a person's capital from his/her home can be used to pay for care home fees. It used to be that £23,000 was protected but I think the figure has gone up.