AIBU to think a 10% inheritance levy for social care is fairer?

Actually, my dad’s care costs more like £1900 per week, but a portion of that is paid directly to the home out of the NHS pot, as he was assessed, within two weeks of being admitted into the care home, as requiring nursing care. The local authority assessment panel only assessed him as needing residential care, which further restricted the homes they were willing to consider. Before I engaged with this system, I thought social services and social workers were advocates for the person needing the service. I feel that was very naive!

ending my life on my terms is also a feature in my planning @Papyrophile! But I think we ought to have a fair crack at improving the system as well!

I shall be in touch with the Casey Commission. And while I shall lose out if income or inheritance taxes increase to fund the costs, actually I think it is important that our senior citizens are looked after kindly, fed well and kept clean. I am, I think, 15 or 20 years from needing to be cared for by strangers, and I'd rather take my own life than be passed around from pillar to post.

Personal finance - your pensions, savings, investments - is one aspect, and hugely important. I didn't mean to minimise the opportunities my generation (I'm 60) had with more DB and DC pension schemes, more childcare options (none of them cheap, however!) during working lives have had to build up a better-resourced retirement than my mother's generation. The state pension has improved, auto-enrolment has brought more people into pension saving, attendance allowance, pension credit, support on heating bills, free prescriptions and travel - there have been a lot of initiatives to improve the lot of pensioners and although I'd have to check the IFS numbers, I believe the rate of pensioner poverty now runs well below the rate of working age poverty.

But the other aspect of planning is a willingness to engage realistically and try to get ahead of the aging trajectory, rather than being ambushed by perfectly predictable evolutions of your physical needs. I'm probably pretty raw about this, having watched my parents (89 and 95, dad now in a nursing home) bring a toxic blend of passivity and stubbornness to the issue, and essentially engineering a circumstance where my brother and I became responsible for ensuring that he had somewhere safe, welcoming and decent to lay his head. His need for care, and their need for a serious readjustment in how they lived, and proper engagement with social services, had been signalled for years by his numerous falls. His increasingly dangerous driving! But because by some stroke of dumb luck he didn't break anything or sustain any worse injuries than bruises and cuts, (or kill anyone on the road) my parents refused to take heed. Until the day came that he could no longer get himself back up again, and was doubly incontinent, and struggled with daily living tasks so that my mum had to dress him, wash him, bring every bite of food to him and look on helplessly when he fell over, yet again, unable to help him up. I don't suppose any amount of policy reform, no matter how good, can change people's behaviour on such sensitive matters as aging, dependency, the viability of a long marriage in the face of physical frailty and money.

It is also true that the system is difficult to navigate, that at least some local authorities will try to push home care packages on people that have outlived such solutions being suitable for them, in order to ration access to residential care, and that my parents would have needed our help not to be pushed into a sub-standard home (and I mean literally, a home that had been deemed 'unsatisfactory' by the CQC, closed down, and reopened under new management less than 12 months later, but with no CQC inspection or rating. But at £1050 per week, was the cheapest option available, and the council social services team wanted to push my dad into it. We dug our heels in, insisted on finding a better home that would accept a third-party top up payment agreement, and he is very well-looked after in a home that costs around £1650 a week, plus extras for things like haircuts, chiropody and some, not all, outings.)

I really hope that everyone contributing to threads like this also contacts the Casey Commission, and their MP. And that when proposals for a bit more income tax across the board, or a bit extra on all estates, not just a sub-category of bigger estates and higher earners, are laid out in order to better resource the system so that those needing services get better ones, and those that need full-blown residential care can have their costs capped, so not every bloody penny gets wiped out, and an insurance market can come into being, the sodding opposition parties and their respective newspapers won't scream 'death taxes', 'fleecing the rich to pay for the feckless' and that a government actually gets a chance to do something sensible to meet the problems of the next 50 years!

Likewise @Badbadbunny ! I did have an employer pension fund when I worked in London and NY, but one I cashed in to put a deposit on my one bed flat and the other company went into receivership and the people who wound it up bought an insurance based pension for the fund members, which now pays me £300 per month. It wouldn't be enough to live on but it's a welcome top up.

Someone 75 was in their 30s when private pensions were rolled out in the mid 80s so had 30ish years of working life left during which they could have saved into their own pensions or joined their employers scheme. Neither myself nor sister were employed by a big firm so no employer pension scheme to join, but we both set up our own private pensions in the late 80s as there were adverts everywhere for them, lots of media coverage re their introduction etc. If I remember rightly, minimum was something small like £20 per month- we indexed it to increase yearly and then let compound growth do its thing and now both have decent pension pots now were in our 60s!

Thank you. As one of the over 75s I agree. Many of us did work with young children, but it was often just bits and pieces of jobs that could be fitted round our husband’s working hours. Childcare, unless one had willing family nearby, was almost non existent. Maternity leave? What was that! Women were still expected to leave some public sector jobs on marriage. The first good, permanent job i had after having children was part time. I couldn’t join the pension scheme unless I was full time.

We were of a generation where most of our mums were housewives, and unless we were middle class professionals, weren’t expected to have careers. Our lives really can’t be compared too closely to following generations.

Now we do, yes. Today's older pensioners did not work (a lot of women) and did not have the easy access to private pensions or compulsory workplace pensions.
Anyone in the workplace now has no excuse but you can't judge people aged 75+ by today's standards and opportunities.

fewer people have been in receipt of funded care, although more should be eligible... That shows care is being rationed already without expanding the definition of who qualifies and with what conditions.

Even Medical Care is already being hugely rationed in the NHS as well. Despite us spending a full 11.4% of our GDP on it: 21% of total taxation.

To the point that anyone who either has medical insurance through work or the means to self-fund does that instead.

We're in the worst of all worlds: where we pay huge amounts of the money we earn (through taxes) for a service we often can't use, because it's rationed through forcing people to wait years in pain. Or rationed by keeping seriously ill people in corridors with minimal care, or waiting hours for an ambulance, or moaning over their drip in A&E (our A&E was like a war zone the last time I was unfortunate enough to go. I waited 7 hours, but even the guy moaning in pain with his drip - and throwing up every so often - was sitting there more than an hour. He did at least get a hard plastic seat - lots of people were sitting on the floor).

But because it's supposed to care for everyone, there's no government-backed, universally available (non-underwritten) insurance, like other countries have. And no alternative at all for critical or emergency care.

It's a shit show. Why on earth would we support creating a Care Service in the same model?!?

We'll end up paying loads more tax... and still not have access to decent, universally available care in our old age. Still end up paying for it entirely ourselves out of pocket. Like we do - if we can - with healthcare now.

In the UK the ‘social pressure’ to save up to provide for the costs of cancer is met through compulsory taxation to cover the costs of NHS treatment. Other costs associated with cancer might be met by sick pay (so by your employer) or possibly by the individual through critical illness insurance. But as I said before, I don’t know why there is a boundary drawn for certain conditions (dementia in its various stripes, for example) which places them on the social care, rather than medical care, side. You would still get medication for such conditions funded in full, I think? There may be other elements of care which fall on the medical rather than social/personal care side and from all that I have heard, these judgments might vary from one authority to another, and over time, fewer people have been in receipt of funded care, although more should be eligible (working age adults living longer with serious disabilities, increased elderly population with more complex health problems, more single person households). That shows care is being rationed already without expanding the definition of who qualifies and with what conditions.

it’s a mess, I agree, and we’re already paying for it. Personally, I wouldn’t mind paying a percentage point more tax throughout my working life to try and smooth out and pool the risks. I don’t want my mother (or me! Or my husband) to be put to bed at 5pm in a nappy because that’s when the local authority service has capacity, and there’s no resource to fund extra visits on a 9pm round, and someone to help again early in the morning. At a certain and predictable time slot, not ‘between 7am and 9am, oh and it might be a different person each time.’ And this is not a free service, btw, but one to which the recipient makes a means tested contribution. Is it any wonder that people will live in any amount of squalor and peril rather than seek statutory help?

Of course everyone should save for the future, but again, why is this treated differently to other things that happen in old age? Why isn't there social pressure on everyone to save up to pay for treatment for the increasing risk of cancer as we age, but there is for care required for Parkinson's? Why does planning for dementia and Parkinson's come under personal responsibility, but not planning for cancer?

I do think there's something worth unpicking here about how we see 'care' that a person can't provide for themselves vs how we see medical treatment. I think there's an unacknowledged assumption that because you don't need medical qualifications to provide some types of 'care', then it shouldn't need any state support. But the whole problem is that this is still something the person can't provide for themselves - as in, physically can't do it, rather than being unqualified to. It's not optional outsourcing like paying for a gardener, a mobile hairdresser, a cleaner or ready meals, where the fallback option is just to ignore the garden, not get haircuts, accept a dirtier house and live off bread and jam. The care is both essential and specifically related to certain illnesses.

Anyway - I don't have a problem with old age naturally bringing increased costs that we have an obligation to prepare for and then to try to meet ourselves. I do have a problem with the inconsistency of how different disastrous illnesses are treated. I also strongly suspect that because so much unpaid caring is done by women the unspoken assumption is that that's how most of it should happen.

I think the point about things that are excluded is important to remember but it's also worth thinking that getting better versions of those (nicer food, a nicer environment etc.) is something people will feel very positive about saving for, especially if they know that if they end up not using it (or choose not to pay for the fancier versions) they will be able to leave what's left of their money after IHT to their children. It's much harder to feel positive about saving if you've ever witnessed how fast funds are swallowed up if someone is unlucky enough to get dementia or Parkinson's. It makes saving feel both grim and a bit pointless, as if you're a mug doing it at all, knowing that people in the rooms next door to you in the care home will be getting the same care for free, even subsidised by you.

Yes, plus how the transition would be managed, with the risk of people falling through the cracks.

My concern would be that if Britain went over to an insurance model it would be far more Americanised than systems that work well across Europe.

In France, health is by insurance - mandatory government insurance pays back most of your care, and most people take out a mutuelle insurance for the rest. Neither consider or exclude existing conditions.

https://www.fabfrenchinsurance.com/health/understanding-the-french-healthcare-system-101-a-guide-for-expats/

In Switzerland, basic insurance doesn't consider existing conditions but supplementary insurance does

https://expat-savvy.ch/blog/pre-existing-conditions-swiss-supplementary-insurance/

The Netherlands works like Switzerland.

These countries all have insurance-based healthcare, and all rank higher than the UK for overall health outcomes, patient access, and system performance in major international healthcare comparisons.

My personal experience shows how much better the access to healthcare is too.

Unfortunately, changing our NHS model to insurance-based would be hard and take time. I'm not convinced that our state institutions would manage it.

But I was talking about Burnham's proposed National Care Service.

When setting up a whole new national service, why on earth would he propose modelling it on the NHS - which works so badly, and is basically breaking down - instead of on the European insurance-based services other countries have shown work better?!?

Sheer Hubris, ideology and lack of vision is the unfortunate answer...

I don’t understand the distinction between Alzheimer’s/dementia care and other kinds of illnesses that are fully-funded, no. What happens for patients with other long term degenerative conditions, such as Parkinson’s or MND? Is their care funded when/if they reach a point where residential care is needed? Again, I am not sure if the proposal is that Alzheimer’s/other degenerative and terminal conditions be treated like end -stage cancer and all costs, including accommodation and food, be covered- as in the rarely available Continuing Health Care packages that it seems a vanishingly small number of patients secure.

I’ve looked inside more care homes than I ever wanted to in the last couple of years, helping sort my dad’s care. Some are as glitzy and beautiful as 5 star hotels. Some have been sorrowful shitholes. Some in the latter category that I have seen had Good ratings from the CQC. Didn’t stop them being miserable shitholes. Some in the former category don’t accept people with vascular dementia, because they can be physically robust, but frightened and aggressive. Possibly averse to being washed and their clothes changed. Patents with dementia exact more demands on staff time and skill and maybe need very different environments and care.

I have no clue what the solutions are, except that keeping things as they are rather than moving to some form of shared risk either levied on all estates, or through working lifetimes, or both, is essential. But even then, if I want to pay for the 5star accommodation option, I should have the option to do so.

As things stand, this won't work for anyone with complex medical histories because a) insurance companies won't cover them and b) private hospitals will send them back to the NHS there are no A&E or intensive care facilities in private hospitals.

@BigSkies2022 Given the huge sums involved in dementia care, is it not spiteful to say that those who did make provision for their later years must spend everything they have - right down to £14k - to pay not only for their own care but also for the care of those who didn't make provision for their own old age? Even after a lifetime of paying through high taxes for those same people who didn't support themselves?

I think it is.

I think after a lifetime of paying and paying and paying for other people (pretty much anyone who has built up assets over their lifetime has also paid huge amounts of tax: on the income they earned to buy those assets), the state should actually fulfil their side of the deal and provide funded care for the person with Alzheimers.

If, for a section of society, the state only ever takes - and never provides - how can it be considered a society?

A society must be reciprocal. And ours no longer is.

And yes, I absolutely agree that it needs to be addressed. And I wish that the discourse would make clear what exactly it is that the new rules and funding, as and when they are introduced, will cover. I think people might get a shock to discover that accommodation, food, social activities, laundry services, haircuts, foot care, carers accompanying residents to medical appointments- all the things that make living in care pleasant and a good alternative for the person concerned and their family- will still have to be self-funded.

Well, I suppose we all have the chance (assuming no long standing or birth disability) during our lifetimes to plan for old age and the increasing probability of frailty, dependency, immobility and need for care. Whether that’s something relatively minor like no longer being able to drive or manage your own housework and home upkeep, or the full-blown need for physical assistance in every aspect of daily living, it’s possible to conceive it happening to you and to plan for it. It’s not spiteful to propose that everyone should be involved in making provision for their later years, surely?

Do you think more people would opt for a care home if it was essentially free? If the threshold to get the free care for middle classes has to be assessed by social care would there be big battles and tribunals over care awards like there is with SEN funding? What would the standard of the free care home be - would people have to share rooms like they do in an NHS hospital? Could you opt to pay a bit extra and get a few more facilities (private room, ensuite, better meals)?

I agree that it should be paid for as a collective risk for everyone and not just fall individually on the individual needing care. The NHS was meant to be a cradle to the grave service and people need care because of health problems regardless of their age. I also agree with percentages rather than a flat rate of the maximum an individual should pay for care, which would mean that someone with a modest income and average price house would lose everything to pay for care while very well off people would keep a high proportion of their assets and people without assets would get everything free.
My mother was in a nursing home for four years. The people paying and the people funded by the local authority got exactly the same service as did the patients on CHC. Paying did not secure a better standard of care.

Is it a 10% levy in addition to current IHT rules, or instead of?

Unpopularly, I think in addition to would be better, and it should be ringfenced for providing social care for all who have been assessed as needing it for free at the point of use. I also think that since pretty much all social care would be state funded, the state should work with the sector to find a cost effective way of delivering the standard offer.

I don't really have any skin in the game as both my parents have passed away. One had no social care needs and the other qualified for CHC for the last few months of life when care was needed.

They can't squeeze any more out of the living, so now they plan to tax the average dead person. Their next wheeze will be a property tax on all houses, even 200k ones. If you can't afford to pay, they will take a charge and apply interest. They will sell the charges to banks in order to raise yet more money to squander. The banks will start charging homeowners rent on the part they own.

Slippery slope, 10 per cent for dementia care. Then the left demand another 10 per cent to pay off student loans. Then another 10 per cent to build social housing etc. After all, the person being taxed is dead. Income tax started as a shilling in the pound to fund the Napoleonic wars. Eventually, the state will get the lot and by and large waste it.

This - one of the clearest arguments I have see against the iniquities of our current care system for those with dementia illnesses. It is so cruel as we do provide care (albeit woefully inadequate) for other mental illnesses. Quite why dementia is singled out for this unfairness is beyond me.

The problem is that those who have assets/house/ savings in old age pay, the lot if necessary but the ones who offloaded the money in a timely manner or saved nothing get it free - how can people keep saying the rich should pay - it’s a huge incentive to get it put in a trust