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?

@strawberrybubblegum sounds good however it’s a barrier to people moving house, like stamp duty. Better would be a monthly payment related to the value of your house, so moving immediately lowers that cost (if downsizing). Better than the spectre of coughing up @ 100k in tax to downsize.
As for inheritance, as long as someone pays for their care, they can leave whatever is left to whoever they want. If you are dead, you are not paying anything.

Eh? Older people have not fought in wars. The last war ended 80 years ago, so that would only include a few men aged 98 and up. And the large majority of women didn't work or pay taxes, are you saying they should or shouldn't have free social care? Your post doesn't make sense.

I think the insurance route might be a good way to go for private care, with state subsidised care for those who can't afford it.

A person only starts paying their fair share of the cost of running the country when they earn > £40k.

Lower earners are in no way subsidising the middle classes, even if they don't live to state pension age.

But you won't have paid enough tax to fund all the services you have used throughout your life (school, roads, doctors, public amenities) plus your social care in old age, so where does the money come from?

I would like to see inheritance tax on all assets (i.e. no tax free cap). It is an asset, and should be taxed via capital gains tax.

Yes agree with all of this

I think it should be paid by themselves too.
Unfortunately the argument of 'they've paid tax their entire life!' is not enough. The average person on average salary pays around 220k of tax. When you account for everything you get back that's not enough to say you have covered for 'free care' until you die.
I really think we as a country need to get out of the mindset of I've paid my tax, I deserve xyz. Yes, I hear elderly family members say it on repeat.
I agree an insurance would be the best idea, but no idea how it could be implemented if it was not optional. Ie people who are not working/low income.

I think as a country we need to decide on whether we're 'big state' or 'small state'.

If we're big state, then fine for tax to be based on income, but the same benefits: free childcare, free healthcare, free elder care need to be available to everyone. Not means tested. And a system so that people can top up with their own money - but not lose the entire state funding if they contribute anything. That means that what the state gives each person will be smaller - because it needs to cover everyone. But there's always an incentive to earn, because you'll always get the basics and then what you earn makes your life better.

If we're big stare, then taxes go down and the incredibly expensive state provision goes right down, and we fund our own needs, using eg an insurance system like the US.

What isn't sustainable is the direction we're going now. Increasingly expensive and substantial state provision for lower earners paid for by taking enormous amounts of tax from a smaller and smaller proportion of the higher earners... who aren't entitled to the provision they've funded. That simply doesn't work.

Oh, and throw in populist, rabble-rousing politicians saying that it's all the fault of the high earners... who are actually funding it all.

So you get to fund services you're not entitled to use yourself... and still be despised by the people you're funding. No thanks.

Only 5% of younger non pensioners pay for their care with the Govn paying for 95%
Why then should the elderly have to pay
Currently 51% of elderly pay for their care whilst 49% dont ( except for their pension )

Why is there
a) a different in terms of age
b) a difference in terms of all pensioners

If we want true equality it’s time to treat everyone the same.
Thats what all the moaning about IHT on farmers is about, treating everyone as equal.

Good point!

True, but I have read that care in one's own home costs as much, if not more, than care/ nursing home fees, and there a lot of people being cared for that way. The percentage of elderly actually in care homes is just the tip of the iceberg, and is a bit misleading if taken on its own in the context of funding.

I have an aunt on that position, with carers going in four times a day, for an hour each time.

She is almost certainly self-funding at the moment, out of her 'savings' (which is money she actually inherited herself about 50 years ago when her mother died!), but unless she dies before those funds run out, the rest of her care costs will be recouped when her modest home is eventually sold.

Personally, I think that is as it should be. The costs are eye-watering, and I think it is fair that a person's assets should fund some or all of that once they are dead. I say this even though I am one of those people who will probably miss out on an inheritance for this very reason when my mum dies, and my aunt too. Her house is an asset, and once she can no longer live in that house, of course it should fund her care rather than expecting taxpayers, many of them much poorer than she is, to pay for her.

This alone is a drop in the ocean though. Funding desperately needs to be found elsewhere. I agree with a poster above who said that inheritance tax should be set at a lower threshold, to make it applicable to far more estates. A dead person doesn't need that money any longer, and taking a bigger chunk of that would be easier on the working population than making them pay even more tax or similar via care insurance schemes.

@strawberrybubblegum

I agree with this.

I think that there's a lot of weight being put on a social contract model that has never been affordable. Even beveridge rowed back on prescriptions and eye care very quickly after the NHS, recognising that it was unaffordable to provide "optimum" care for people rather than a basic safety net in the British state model. Well, now the safety net is well and truly creaking.

Lots of people who are pushing insurance on this thread don't realise that the European model is really based on contribution. In many comparable EU countries, unemployment benefit is calculated based on what you earned before you became unemployed, wealthy families receive more child benefits etc - it is kind of like a tax rebate.

And people pay a lot of money to fund healthcare, including often paying upfront and then being reimbursed.

No other country works on the basis that ordinary working people (ie median earners) don't pay very much at all towards health costs out of wage packet, high taxes are levied on a diminishing number of people earning high income (but not necessarily the most wealthy), then everyone gets the same benefits and the same standard of care throughout life whatever they put in (which is expected to be high). I think this is because it just doesn't work from a social contract perspective. People would lose motivation to get on, which is being seen now with the cliff edge model of taxation and benefits we have.

Moving to a purely insurance model would be unfair on current working people who do not stand to inherit. You could phase in gradually, but you still need to make up a shortfall and provide for current elderly.

Big state solution:

I think that once you become frail or infirm and require intervention from social services, social care, bed blocking etc, the local council should be able to take on your care and take a charge of 20% of the value of your home to do it, unless relatives can pony up the cash to fund the care package by other means. If you go into a care home, council can rent out your home until you die and house is sold by executor (within say 1 year), with 80% of proceeds going to relatives.

Small state solution:

Everyone has to fund own care if they can afford it above bare minimum. If they choose not to pay for care, then tough. But you still have issues with bed blockers etc.

(The contribution basis in EU systems is incidentally why the didn't British came unstuck when trying to negotiate with Merkel etc re the impact of EU migration prior to Brexit - the EU rules say that you should treat all EU citizens the same, which works well for a new arrival to an EU country that bases benefits substantially on prior contributions as no one is entitled to anything on day 1 and low wage occupations don't accrue significant benefits.)

There are very few people with enough wealth to be affected by inheritance taxation, estimates are about 4% of the population.

Lots of people with wealth below the threshold of course, that could get eaten up astonishingly quickly by care home fees at c.£1500 a week.

Should everyone else have to suffer because they can't afford care?

What if their diagnosis isn't just the frailty of old age, and isn't one of the nearly one million people in this country with a dementia diagnosis?

Should you have to pay for care if you have MS, motor neurone disease, or similar?

Or is it just dementia patients who get told it's irreversible, pay for care ?

So everyone knows what it's for and can see they are paying for it. NI covers several things already. Those who don't work and contribute should have to pay it from their benefits too.

That's not how it works. If you self fund you also have to subsidise others who the council pays for. My sister used to work in a care home and the people who self fund pay hundreds more every single week to cover the lower amounts councils are charged. If no self finders in a home it would not be viable and would close. They need a certain number of self finders to make it viable. It's terribly wrong to make someone sell their home not just to fund themselves but to fund other random strangers too.

I would rather pay for my care than burden the very stretched younger generations even more.

No Government when looking at the figures will offer free care. If they did many woujd shove elders into a home to enjoy not having the responsibility and keeping the houses, within 2 years there would be no spaces for those in dire need. Like SEN spaces in schools.

Local authorities would be going bankrupt left right and centre.

There would be even less local services.

Offer something great free and it would be dog eat dog.

We have full intentions, if we get to that age, to downsize to a shelter housing flat, to stay independent as long as. All self funded.

That's really interesting. I didn't know about the disconnect between the European social contract and our own - and the consequences for our EU membership are so interesting!

I would personally be far more in favour of moving towards a contribution-based social model than an insurance-based model.

Given that the government has all historic tax records, this could be implemented at any point in time, based on historic records (not saying it would be easy!) It wouldn't be popular, but we need to move to something sustainable.

The Hippocratic oath is no longer fit for purpose. It was not meant to save people regardless. Just because you can preserve life does not mean it is right to do so. Why not stick us all in cryogenic chambers so we can live forever? Hang the cost, it’s liiiiife .

The pil spent £600k + their pensions - all of their money including house - on dementia care. You cannot reasonably expect the state to pick up the tab for generations to come living a decade or more in a care home.

What is needed, however, is a difficult conversation about fairness . Private homes taking self-funders and council-funded people with the same service/rooms is galling. Is there any other service in life where those paying top dollar get the same as someone paying nowt?

👏👏

Shouldn't we have solved this issue before assisted dying?

There is going to be so much a rutiny necessary to ensure the elderly aren't either being coerced or financially motivated to go through an assisted dying process. Grim thoughts but does it need discussing?

Couldn't agree more. It's just a matter of time imo. Especially if some of the intolerant attitudes showcased on MN recently are representative of society's general view of the elderly now, which I suspect they are.

Buying a house kind of is insurance. It gives you stability and security and then you hope that you don't have to sell it for care and you pass it on. My parents don't have great health, I expect at least one of them to need care. It would be lovely to get an inheritance but I'm not expecting one. I am fine with the house being sold to cover their care. You could argue that only being able to keep £20k is an issue and that could be raised while still selling.

It's not necessarily an ageist thing , but a realistic one when it comes to health and people want a choice not to live if they really don't want to. I do understand it's a controversial subject though and the bill for euthanasia probably won't go through anyway.
Not when there's money to be made out of anyone who has dementia ( and the problems around capacity and all that goes with that too)
It's a tricky subject.

But would he rather be dead if it was free?

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