Where should the cost burden for care of the elderly lie in society - with the state or individual

[mids2019]

I was watching an item on a politics show about the long standing problem of funding elderly care. There was some woman who was strongly critical of the funding middle as her mother had to swell her house to find care home fees. Could one argue that the parent had no need for her house with regrettably a very small chance of return so it is fair for that a set to be used in paying for free instead of the tax payer picking up the cost? It was an elephant in the room during the interview but the person losing the most in the scenario was the daughter who ultimately would inherit less but obviously this was not said.

I don't think there is a simple answer hence successive governments pushing this into touch but where should the cost burden lie, the state of the indiividual?

I think this subject is really co.implicated by the fact that we have universally free healthcare yet a private model for social care. There really is a sinking here. Hospitals will in future not be able to fill in for shortcomings of social care and there are many cases of the elderly taking up beds in hospitals as they can't be discharged without an adequate care package and I wonder if these cars packages are materialistic because of cost? We also get the situation where specialist nursing care is free yet caring in a care home is not so how do we square that circle?

not materialsing

I think an insurance based model is probably best. It could be an (expensive) add-on to the existing pension framework.

That way, care costs can be spread out over a lifetime and planned for. Meanwhile people can choose the level of cover they want. And the insurance element removes the risk of being made destitute by an especially expensive need.

Personally, I think those in prisons should be made to pay for their keep (or their families as it would be in the argument of care for the eldery) and that'd free some money up for care packages for the elderly.

In my opinion, after a grand old age - say 75, all old people should have free health care and affordable, government operated nursing homes should they need that care or in-home care in their own home for free.
They have earnt their rights, paid taxes, shouldered the running of commitees, fought in wars, given to charities etc etc.
Older people who want fancier, opulant nursing homes should still have some of the cost of private nursing homes paid for by government.

People's homes are often their main investment and rightly should be able to be left to whom ever they wish.
Other investments too (which pay a yearly income tax) should be left to pass on to the old person's family or charity of choice.
There is no reason to work hard, sacrifice and buy a house, buy shares or bank bonds if you can't leave a legacy to your family.

I think an insurance model may be the answer. However should you be compeled to pay ? Should those on benefits or low incomes have to pay?

As you say insurance would come with choice so would the wealthy set up packages that allowed a great deal of high quality care and the poor get a budget model?

I think the disconnect between free healthcare and individual funded social care will becoming more jarring in the future as the population ages. We spend a disproportionate amount of NHS money one the elderly and I wonder to what extent this is exacerbated by poor quality or non existent social care?
Could you argue that an insurance based model would be used to protect assets that others inherit?

Doesn't the argument above have a lot of overlap with the inheritance tax debate?

Ultimately someone has to pay but I am not certain the burden should lie entirely with the tax payer given the other demands on society and the fact in reality pensioners are often the most wealthy demogrpahic.

Very few people actually need to go into a care or nursing home. Of my four grandparents only one went into a care home and it was their choice rather than required by care needs.
There are 3 choices for paying for care 1 the state pays, 2 the individual pays and 3 the family provide it. In the area where I live families provide a lot of the care with some paid for care (or state if eligible). I can’t see how the state can pay for it all with huge tax rises. Currently council tax keeps going up to pay for care costs as it’s the biggest cost councils face. Not just for elderly care but children and adults with additional needs.
I don’t see how the working population can stand much more in tax rises. All the basics (water, energy, council tax, food, insurance, diesel) have risen so much that it’s taken so many people from comfortable to stretched. There comes a point when if you’re sitting on an asset you’re going to have to use it. Yes my grandparent sold a property to self fund the care I do understand that people are upset about it though

It should mainly be individuals with most people having pensions that cover their costs and if people need to sell their houses that they will no longer need to live in when they move to a care home ( and no spouse in house) then that's what they do. It should just be seen as yet another house move and you usually sell the house you are leaving. The state ie other tax payers shouldn't be expected to pay for this. People should aim to be financially independent

Is this just a funding issue, though? It's an industry that seems to be retracting and increasingly understaffed at a point when the inverted population pyramid is beginning to kick off.

I expect the cost-burden of elderly care in the future will land on the shoulders of the unpaid labour of women in the family, as per usual.

Hate to say this but the more elderly we save by improved medical treatments with no provision to care for them once we have kept them alive the worse it will get. Stop 'saving' those who are living a miserable, pain filled life - dying is natural and we are defying nature in most cases. The planning/budgeting for people living longer should have started about many years ago when medicine advanced.. We have left it far too late but National insurance has to increase, some contribution from the person, private insurance and as always women will run themselves into the ground when all this fails.

How many people are receiving sub optimal social care in the country and yet fantastic free care on the NHS? I think one thing in this debate is if you view care as an extension of health care or as a means of living generally? The extension of healthcare argument is a tricky one as healthcare is free but extending that prinicpal more widely is going to be expesnive. We also have the possible notion the most fervent advocates for free social care are those with the most to.pass down to their children.

I do see this as a bit of a macabre lottery where those who die a swift death while relatively mobile and independent pass on their estate untouched while those who degenerate more slowly are hit by great expense. I think it's the lottery of life that make this tricky from a policy point of view as well.

Problem is, more people rent so will not have houses to sell in the future. Also, you hear that the elderly have 'paid their way' but they simply haven't paid in enough to cover care fees at £1500 per week for 2-3 years, plus a hip op etc. We need a combination of insurance, private finance and more taxes during the working years.

Definitely a sex issue. Some countries in the middle East do not have care homes as it is women who give up careers and look after the elderly because of cultural expectation . The fact more and more children live remote from their parents in the UK is also a factor.

I think it is problematic thing to say that women should give up work because they have a societal obligation to look after the elderly but I have to say this is very much a cultural perspective.

Also remember that care staff are mainly women and are they getting screwed financially because people want as cheap a care as possible and that means low wages?

I do see this as a bit of a macabre lottery where those who die a swift death while relatively mobile and independent pass on their estate untouched while those who degenerate more slowly are hit by great expense. I think it's the lottery of life that make this tricky from a policy point of view as well

Yes, it's a lottery. That's just life isn't it? The state won't be able to make things fair for those waiting to inherit.

Another thing is that we have huge wealth inequality amongst the elderly and one couk d argue inequality in general increase with age due to house price increase, investment value increase, pension maturity etc. How do you encompass that reality with a fair care system that ensure s good health?

I think it is problematic thing to say that women should give up work because they have a societal obligation to look after the elderly but I have to say this is very much a cultural perspective

I hope you haven't mistaken my assessment of how things will most likely pan out for my preferred outcome?

A relatively small proportion of individuals need extensive care for a significant and expensive duration in their final years. Far more people have a relatively short final illness and death.

A relatively small proportion of people have significantly large enough assets that the amount they have to contribute to such care under current rules is noteworthy. When it does happen the sums involved can be eye-watering. And it's just the unpredictable turn of fate that decides who is affected.

In general when an eyewatering cost is going to be landed on a small number of individuals based on nothing but the unpredictable turn of fate, then spreading the cost of that burden among everyone is the sensible approach.

None of us know whether we are going to be affected. The question of whether it should be born by individuals or taxpayers is a sttange one because individuals ARE taxpayers and taxpayers ARE individuals.

The fairest model is that inheritance tax should be massively overhauled to bring a LOT more estates into paying it - currently only 4% of estates pay a penny. I would like reforms that more like 25%-50% of estates pay inheritance tax and all end-of-life care is totally free funded from the proceeds.

This won't be a vote winner though because the loudest voices are from those who just want to keep 100% of their money. Inheritance tax is unjustifiably hated by the selfish, so I expect the current inadequate arrangements will continue.

The problem is, what do you do if they don't/ can't? You can't just let people starve in the care of the state, no matter who they are.

I don't have an issue with people having to sell their houses to pay for care in principle, and my parents have quite a nice house (and all the money from my gran's house has already gone on care home fees). But the current system seems complicated. Insurance bundled in with a pension as suggested upthread sounds like a good idea to me.

In general when an eyewatering cost is going to be landed on a small number of individuals based on nothing but the unpredictable turn of fate, then spreading the cost of that burden among everyone is the sensible approach.

When it's put like that it makes the argument for an insurance system clearer.

...National Insurance for the basic model, but let people choose to pay for more if they can and want to.

First of all, there are very few people still alive who ‘fought in the war’, so that argument is a moot point. How do you figure out how much money over 75s have given to charities? How much time have they put into running communities? Also, if they live in a house worth £1m, who gets to keep that house when they go into a care home?
If I need to be looked after and have the means to pay for it, then I should - rather than handing over all my assets to a child who has done absolutely nothing to earn them.

We have a problem in that companies are owning and making profit out of care homes and nurseries. I am not saying they need to be owned by the state but they should be not for profit with rigorous oversight.
My mum is the reason I would fight for universal application of any rules. She is 80. Started work at 15 and apart from maternity leave with me, worked all her life. Saved hard, has a good pension and a nice flat.
My dad died and left us with debt that we paid off
My grandad left everything to her brother as she had been always so good with saving whereas he had always spent everything. 2 years later he rang her to be a guarantor on a loan for a new car With my support she said no, his business failed 4 months later.he moved on but had she said yes she would have been left with years of loan payments.
He would get free care and she wouldn't yet they have worked the same but one has saved and one hasn't. I don't care about her money but I do care about her doing everything she can to be independent and she would be penalised for doing the right thing.
Insurance is another good idea. Again it would have to be run and governed properly so it's not a money grab by already wealthy insurance companies.

By merry koala

not at all. I am saying there are still some turnaround use this argument.

I'll speak about 2 couples I know , one couple worked , saved , didn't drink or smoke , didn't have holidays to get a mortgage , didn't claim benefits .
Other couple , worked sporadically cash in hand , often claiming benefits at the same time , took drugs , & smoked & drank .
Both couples , now retired . Mortgage couple , it's now paid off , get pension , but no other benefits . Don't holiday to save money .
If had to go into care , will be expected to self pay , house probably taken into consideration.

Other couple get rent paid , get council tax paid , get pension , get pension credit , they have played on aliments to get pip so don't pay for car tax either ( they admit they say worse than they are . Will get all cost of living support , get warm home allowence , go on lots of holidays & go abroad , drive a decent car . Give their daughter spare cash to bank ( still their money ) so they don't go over the limit
If they went into care will be free .

Same as when the elderly can't - they go without!

I am from Germany and we have an insurance system for funds towards care, it's mandatory, you are paying automatically with your employer paying half. So if you require in-home or residential care, you are assessed and depending on the care level you are allocated funds.

These do not by any means cover the costs.

My mum had to be moved into residential care when she fell so badly that she is now wheelchair bound. She has additional benefits due to my late dad's state employment, so her costs are fully covered with the insurance, benefits and her pension. It's calculated up the last penny she gets.

But - she still has to find funds for clothing, treats, toileteries, books, TV, telephone, hairdresser and medication not covered by her health insurance. So she is paying on average €100 per month out of her savings.

If she wouldn't have the state benefits, she would have to use all her savings less €10K and then apply for social care benefits which do include a "spending allowance" but it's really small.

I come from a decent size town with several residential homes and when we had to find one, it was difficult. My sister worked in one as a admin housekeeper and her employer was always fully booked as well, places go in a matter of days.

So the need is there, families aren't able to do in-home care anymore long-term, my mum cared for my gran for 6 months, the effect on our family life was profound and she always insisted she would never ask for this herself.

I think families need to realise that inheritance is a gift, not an expectation. Property and money may not be there when a person dies.