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?

Britain did used to have varied benefits based on income in the 1970s but then they scrapped it. If out of work (primarily men because women were in the home mostly bringing up children and/or looking after their elderly relatives), the family got minimal benefits but these were topped by "Supplementary Benefit" based on the income the claimant had earned previously (ie, those who had paid in more in tax/NI got more out of the system). My relative, who was in the building trade, sometimes got laid off in bad Winter weather and our family used to get Supp Ben as it was known until he got re-employed when the weather improved

It's not just about elderly people.
Who actually wants to exist with the late stages of dementia, no clue who your family is, no clue about anything, unable to speak or eat?

While people have a quality of life it is absolutely 100% worth fighting for but late stages of dementia just isn't and the same with certain other brain injuries.

It's all well and good when people suggest you should have insurance. The UK government tried to make people stand on their own two feet with pensions - Opt out of the government scheme sort yourselves out - so much has gone wrong with that they have said it no longer matters if you opted out you'll get the same pensions as people who didn't.

It's great how some people are saying they don't want to burden the next generation with their care costs.

I'd bet they are also the same people who've given chunks of money to their kids for house deposits and helped them get on the housing ladder.

They aren't the people who paid council rent for 30 years before being able to buy their house. And who spent wisely lucky if they had one holiday a year so they'd have a small comfort cushion that they'd like to be able to pass to their DC.

@strawberrybubblegum

It is interesting isn't it?

I don't know how you would fund an insurance based model without making people who are older and close to retirement pay a big premium upfront though - the demographics are against starting now with lots of older people and fewer younger ones

(As an aside, the other thing I really don't understand is why the government went for the furlough model that it did - as you say, it has all the tax details. It should have gone with requiring employers to freeze employment terms (ie no accrual of redundancy payments, but can't make redundant, just put the employee on freeze) until after pandemic, universal credit, plus some kind of relief tax rebate for individuals and forcing banks to extend mortgage terms where needed. Would have been more consistent with our big state approach than to pay more to higher earners!)

These threads are always full of people loftily proclaiming that a person in this or that state ‘has no quality of life’ and ‘would probably rather be dead anyway’. But apart from end-stage dementia (which is a very different situation, obviously) NO ONE has the right to make assumptions about this. Only the individual knows how they feel about their life and the prospect of its continuation. My dad was in quite a bad way towards the end of his life, a lot of people would have assumed he was ready to go, but was still fiercely adamant about wanting to hang on as long as possible. And it's completely right and proper that the NHS and social services helped him to do so.

To reiterate, I accept it’s different with dementia, but even in that instance a person must be allowed to decide whatever’s best for them for as long as they have the capacity to do so. It just makes me see red when people presume to decide for others whether or not they ‘should’ want to continue living.

Then all the care workers need to quit and get better paid jobs so that they can afford to pay for their own care later on. Sound ok?

Yes, of course. They're free to find a better paying job, and pay into their own insurance. If there aren't enough carers, then market economics means that the pay would go up, and more people will be attracted back into the industry.

But my observation is that an market-driven insurance-based model penalises individuals for bad luck (in health or circumstances).

That's why a state-run, contribution-based system is more appealing to me. It keeps the link to personal responsibility, but doesn't put individuals out to dry.

@holdmecloseyoungtonydanza

To reiterate, I accept it’s different with dementia, but even in that instance a person must be allowed to decide whatever’s best for them for as long as they have the capacity to do so.

That's the problem, though. As dementia progresses, they may quickly lose such capacity.

When is the "right time"??

We're going through this with MIL - she fiercely resisted setting up a power of attorney as she always claimed she'd know when the "time was right", but that specific moment in time passed her by without her realising. Now we're struggling without a POA in place as she's no longer capable of understanding what it is so we can't set one up anymore. The time has passed!

Same with end of life. Some days she seems happy, engaged with the World, etc. Other days, she's miserable and suicidal, constantly talking about putting her head in the oven (it's electric!!) or throwing herself under a bus on the road outside (she's not on a bus route!!). If we gave her the choice of "end of life" options, some days she'd jump at the chance, other days she'd tell us to bugger off!

So, how do you determine whether she has capacity or not?

Because that worked so well when the Low Pay Unit was disbanded in the very early 90s. Apparently market forces would ensure employers paid a decent wage Yeah thats why by the mid 90s i was seeing jobs advertised in the Job Centre for £50 a WEEK (and NO it wasnt a training role for young people) and £1.50 an hour. This is why the minimum wage and tax credits had to be brought in including (finally) a working tax credit for those who hadnt reproduced

A doctor or Solicitor has to verify the person has capacity regardless of their age when applying to set up a POA. When my relative got one, I insisted on leaving the room so the Solicitor could have an open and honest conversation with him and assess his capacity independently without me being there. Lots of people fail to do Wills and POAs unfortunately. You could apply to the Court of Protection for Guardianship. It costs more than POA and is more tightly supervised than a POA by OPG, such as, eg, having to produce receipts and the amount that can be withdrawn restricted. The difference is POA is "freely given" by the donor and Guardianship isn't so requires more supervision. At least Guardianship allows access to the person's accounts to pay bills etc so it's better than nothing. I wish you well sorting your MIL situation

Everyone should pay in , unfortunately there are too many takers and not enough givers

We will be in a position where a million pound estate will be eaten up by care . We are £200k down already with plenty of time left

I will probably buy an annuity but with some may variables im unsure what to do until we get to the care home position

In many European countries, the way it works is that you pay home carers and nurses directly, then get part of the cost back from your medical insurance/the state.

People are employing nurses and carers directly, and are free to offer higher pay.

It seems to work well for the nurses and carers too, who are self-employed and able to choose how they work. They normally get together in pairs/groups to share the load and cover holiday.

That would certainly have cost the state (ie us) less and resulted in less fraud. It would have put the burden initially on people being furloughed though - and I don't think the government were certain they would get compliance.

Tax rebate would have offset it, but setting that up quickly would be hard. (Dealing with each individual rather than each company)

Maybe it could have worked in conjunction with forcing mortgage lenders to hold on penalties, since that's most people's main difference in income needs.

They would probably have had to introduce a loans/ grants scheme for individuals as they did for businesses until the tax rebates came through. Otherwise there would surely be some edge cases where the loss of income caused a catastrophe to someone.

I suspect it probably just felt harder...

I'm sorry you're going through this, it sounds really hard, and I totally accept that a situation like this is a different kettle of fish to someone who has capacity. I wish I knew what the answer was - my mum has Alzheimer's and although she's on a fairly even keel atm, I worry about what the future holds.

You can employ people directly in the UK but Councils don't tend to tell you about it. I found out when I broke down in tears in front of my dad's psychiatrist Consultant who asked to see me briefly on my own before bringing in dad. She gave me a photocopy of a leaflet called "Direct Payments" and she said the Council would try and deny it's a legal right to get them but it is a legal right. Carersuk.org may be able to advise. Direct payments are for people requiring care in their own homes

Yes, my sister will be paying for her own care from her inheritance and most likely the sale of her own home. What's your point?

Sorry this is wrong. No doctor or solicitor is needed to set up a POA. Any friend, neighbour or colleague for example who has known the donor for a while and agrees they are signing of their own volition can take this role

I suppose I was drawing on my own experience. My relative with MCI so it needed to be an independent person with authority such as a doctor/Solicitor to ensure his interests were served in my opinion. Also, having worked in financial services, I've seen the arguments that ensue when people don't engage someone like an independent doctor/Solicitor. You are however technically right that someone, not family though, who has known the donor well for at least 2 years can sign the Certificate so I don't disagree with you. I personally wouldn't risk doing that

The declaration of the "witness" has to make is something along the lines of confirming that the person making the POA understands what they're agreeing to. That can sometimes be hard to determine if the person is clearly confused or forgetful about things. You also need to know someone closely enough to even ask them to do it - you're not going to ask random strangers!

In my MIL's case, the only people we could ask who "know" her are her neighbours. They're going to struggle making the declaration as several times she's been knocking on their doors asking where she is, who she is, where's her husband (who's been dead 15 years!), not to mention knowing that she's been brought home by the police a few times after being found wandering around in the middle of the night!

She's also had formal diagnosis from her GP, so there's "evidence" on record that she's got pretty advanced stage dementia.

As I say, the moment has long passed for us to get a POA for her without going down the court route.

I really feel for you. My relative's MCI went to advanced dementia and it was incredibly stressful trying to keep him safe but at least I had POA. Your only option now if you need to access MIL accounts to pay her bills is Office of Public Guardian. Good luck.

I don't know about an obligatory insurance option as not everyone needs social care or can pay for it privately.

No-one in my family has ever needed social care - only nursing care for short periods of time at the end of their lives which was funded on the NHS.

But then we all use the NHS to a greater or lesser degree and pay tax for it and indeed any other public services. Should we all just pay for more tax and have social care funded? Depends on the cost I guess.

From a lot of the comments on this thread you would think only dementia patients had to pay for their care. MIL had a devastating stroke that left her paralysed, non verbal, and incontinent. She lived for nearly 9 years after that 3.5 in a care home and the rest at home cared for by FIL with 4 care visits a day. She had exactly the same funding rules as any other elderly person needing care. Ditto my dad who has osteoporosis and heart failure.
My mum has dementia but it's admin support she needs, very little of her current need 4 years after diagnosis is medical and what she does need she gets, but the NHS doesn't cover not recognising your debit card because the design has changed so you think you've lost it or throwing away your wifi router because you've forgotten what it is or throwing away your mobile phone because you think it's broken because you forget they need charging or mowing the lawn because you haven't noticed it's grown.

I was actually talking about the care workers who work in care HOMES. And not just them either Supermarket workers those who work in hospitality etc The Amazon workers who delivered ppl the stuff they wanted during lockdowns How would they pay for their care. or should they be living on the street when they get old if they develop Alzheimers.

@SharpOpalNewt not everyone needs childcare or schools or universities or local bus services etc - but as a society we all pay into it if we want a functioning society

Yes that was my point. Students do pay university fees with a loan and things like dental care is not funded on the NHS or only partly. It is a question of cost and whether it could or should be covered by general taxation or just by those who need it.