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?

The cost of private care for someone with dementia can easily be £500k. If someone has worked hard and saved diligently to pass this on to their kids, it seems unfair to be hit with such a big bill due to bad luck with your health. I think it would be fairer if there was some form of government insurance to cover the cost. Alternatively a much higher cap on care costs, say £200k.

I agree with you that fundamental services are often best run by the state. Passing them to private partnership is almost always just pushing cost and responsibility into future never-never land - whichever government does it. Effectively paying for state services on credit.

I disagree with you and the current government that the way forward is to pay for state services through increasing taxes only on higher earners ('broad shoulders' - bullshit). And I'm very strongly opposed to excluding higher earners from state benefits when they are the ones who fund them.

So to be specific to this discussion, I'm against state funded social care for people without assets whilst requiring people with assets to pay for their own (identical) care.

State services should be paid for by everyone and benefit everyone.

It's how the Nordic model actually works, which people are so keen on here. I'm not sure they're all aware though that low and middle earners pay much more tax in the Nordic countries than UK equivalent earners here, but higher earners in the Nordic countries pay much less tax than the equivalent high earners here. Because everyone is paying in - and the system is structured so that people are incentivised to work and contribute - there's enough tax to run high quality services which are available to everyone. It works.

My DM, my FiL and an aunt (all with dementia) were all self funded in their care homes, and TBH since they had sufficient assets to pay, I really couldn’t object. TBH I looked on it as something of a ‘luxury’ to be able to choose the time and place, rather than being at the tender mercies of invariably cash-strapped social services, who will (understandably) typically wait until relatives doing their best to care are absolutely on their knees with exhaustion. I was certainly on my knees (both physical and mental exhaustion) after having FiL to live with us.

What I do feel strongly about is that too many people, especially where dementia is involved, are deliberately kept alive when letting Nature take its course would so often be kinder. In and out of hospital, on drips, stuffed with tablets to keep them ‘healthy’ - for what?? Dementia is only ever going to get worse, and anyone with late stage dementia is a truly pitiful sight, and I’m quite sure many of their former selves would never have wanted to end up like that.

What we can all do is to ensure that their health and welfare Power of Attorney states very clearly in which circs. they do not want life-saving or life-prolonging intervention.

@GETTINGLIKEMYMOTHER my SIL is a district nurse, does the home visits for ulcers and stuff.
She is also of the opinion that keeping old people alive for the sake of keeping them alive is one of the biggest drains on the NHS.

@strawberrybubblegum ’I disagree with you and the current government that the way forward is to pay for state services through increasing taxes only on higher earners’
I think you’ll find I never said or inferred that. I’m a HE myself!
I also agree that low and middle earners should pay enough tax, but the tax burden today is the highest it’s ever been ( so they say). Whether or not the country will end up fairer is now doubtful, we seem to be following the American model rather than European. As for the Nordic model, that ship has sailed.

USER149…….
“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.”

i like the idea that 75+ is a grand old age! My DH is 75 and plays a fast racquet sport 5 times a week. I myself play tennis 3 times a week at 72. We do all our own gardening, DIY, and a lot of walking. I think we might consider ourselves a ‘grand old age’ if we get to 85+.

However, we are prepared to fund whatever care we should need, and have made provisions for this, hopefully staying in our own home. If our home has to be sold then so be it. Why should the state pay for our care? Our DCs don’t expect inheritance and are making their own way in life. As it should be.

To be entirely fair, from what I’ve heard it’s often the relatives who insist on Mum or Dad being kept going, regardless of quality of life. So medics are wary of outrage if they suggest that palliative care might be kinder. Presumably they dread Daily Mail headlines on the lines of ‘Callous docs wanted Mum to die!’

I’ve also heard too often of people who fail to understand that food and water may be inappropriate when someone is dying (because their organs have started to shut down) and even try to insist on e.g. tube feeding, when someone has started to refuse food and drink. (As an aunt of mine did.)

As a doctor once put it. ‘They are not dying because they are not eating and drinking. They are not eating and drinking because they are dying.’

Lots of people wouldn't even have £200k to pass on.
I think an individuals savings could be spent down to about the last £10k

Maybe it should be a lot higher people can keep their savings to £200k or whatever the inheritance tax figure is. Anything above that should be spent on care costs.

I don’t agree, nor does the government. What use is 200k to the person once they are dead? Why should tax payers cough up that 200k in care costs?
Anyway, the point is mute as the government cannot afford to cover care costs for everyone.
If they tried to increase taxes or introduce compulsory insurance there will be the usual outcry.
In this country, you either need to be poor poor, and the state provides a meager support, but you are free and safe in the knowledge you will be provided for, or earn a considerable amount. The people working up to maybe 80k are just being milked.

I think a system similar to the one used in Guernsey would be more appropriate and fare.
A Health Benefit scheme is paid into on gross earnings
@7.2% for employees
6.9% for employers
11.9% for self employed
and non employed under pension age @ 11.3% ( ie earning money through other means )

The scheme pays out for pensions, social security, health care and elderly care

Its basically a compulsory insurance scheme introduced 20 or so years ago so that everyone paid in and wasn’t reliant on individuals making the choice themselves and then being stuck with nothing.

Properties and assets if you need long term care are not touched.
Having had a relative that had dementia and was in a care home for 12years she had brilliant care, the home was amazing and no family member or her assets were touched to look after her.
Another relative went into assisted living and had the same.

Well why even bother with a you can pass on £200k or whatever without paying inheritance tax.

It's all has to be part of the same argument dementia tax or inheritance tax.

This system is similar to Guernseys where
everyone pays a flat rate of 20% on income with a tax free allowance, again the same for everyone, of £13,000.
everyone also pays the same % for health benefits with no tax free allowance.

People then don’t find themselves worse off when they go over a particular threshold which happens here.

This is so true. Completely natural to not eat when you're dying and yet people try and force them to eat. My sister was like this with my dad. In fact it's actually cruel to force anyone to eat in those circumstances. I think it was partly her hero complex and partly her denial of his and her own mortality.

My money doesn't belong to the government, even when I'm dead. It's mine. And I want my DD to have all of it. No one else: no matter how poor they are or how much they need it. That's my choice for my money which I've earned through my work.

Why should tax payers cough up that 200k in care costs?

Because I've payed into the tax system through my entire working life, on the understanding that when I need medical care or other support which the state gives to other citizens, then the state will pay for it.

Why should the taxpayers cough up 200k for someone else who has contributed less in taxes, but not for me???

Absolutely agree with @strawberrybubblegum the working tax payers of the country are getting fed up with being used as a spending pot for everyone, look at the thread the other day where the OP is on benefits but complaining she can 'only' have £16,000 of savings 😩 and how this should be increased!

Absolutely !!

Why some people seem to think when we die what we earned during our life time should be theirs or belong to the Government is a disgrace.
Its ours to do with as we wish and many countries do not have IHT and many have sensible fare and equal systems for long term care without money grabbing from someone’s savings.

Is this on top of income tax and National Insurance? I confess I don't know how the Guernsey tax system works but I don't think ordinary modest or middle income workers can afford another tax if it is?

Income tax is set at 20% for everyone irrespective of how much you earn.
Their is a tax free allowance of £13,000

This Health insurance is instead of what we call National Insurance.
Guernsey pre 2000 didn’t have free health care paid through NI it was all via personal health insurance like the USA. It didn’t work as how much people paid depended on how much they wanted to. Some employers ( like teachers ) paid money in, some employers didn’t.

the government cannot afford to cover care costs for everyone

I think governments have recently lost their way on what the purpose of government is.

They take money from each person in tax, to fund - on our behalf - the state services we benefit from.

Taxes allow for how our circumstances change over our lifetimes (eg we need education as children, but can only pay for it later when we become adults) and also a certain 'insurance' element against bad luck (health care and unemployment benefit) as well as simple shared costs (like policing, road maintenance etc). But they have absolutely no moral remit to take money from people if they don't broadly use it to benefit those same people.

The government is not a wealth redistribution mechanism, forcibly equalising wealth between everyone in the country (and beyond). Some redistribution is acceptable, as part of the 'insurance' part of their responsibility and to foster social belonging - but it absolutely shouldn't be their purpose or aim.

Inefficiency mostly, in terms of staff, procurement of goods and services, "brown envelopes" etc.

I was part of a small group who were trying to take over our tiny village library. As part of that, we got access to some of their "accounts", i.e. contracts for the security alarm maintenance, copier lease, window cleaning, internal cleaning, weeding the verge and cutting the grass, utilities, etc. It was absolutely ridiculous what the council were paying. Not even making any attempt to get cheaper deals. Same old story - they had a "budget" so as long as they kept spending within the pre-allocated budget, no one cared. The fact that the spending could have been a fraction of the budget with a bit of work to get better deals, use cheaper contractors/suppliers etc was an alien concept to them!

One example that I remember was the window cleaning contract. Remember this is a tiny village building - single story about the size of a double garage! They were paying a couple of hundred pounds per month. We got a quote from a long respected village window cleaner who'd do it for £25 per month!

If we go back to the original NI % contributions we could have another £9.4 billion in the coffers.
Why aren’t Labour doing that!

Agree with the inefficiency
We used a maintenance man for various things some time ago.
He also did maintenance for the local school

The Govn set allowances for this if the school don’t use the full allowance each year the Govn start reducing how much the school gets.
So for two years the maintenance man was asked to build, demolish and rebuild a play structure in the school playground just so that the school could get their yearly allowance and it wasn’t lost or reduced year on year. !
Madness

I agree.

The IHT rule changes have also highlighted similar issues and even people who aren't necessarily too badly affected by the pension, business and farmer changes are starting to sit up and take notice. In just the last two weeks, I've had more clients asking about IHT (who aren't farmers!) than I've had in the last five years! Literally, the phone and email is just one after another.

Part of the IHT discussion also strays onto care costs. A lot more people are suddenly looking forward and starting to think not only about any potential IHT liability, but also about care costs. Lots of clients are seriously looking at passing wealth down to the next generation(s) far sooner than they'd planned to just to get it transferred many years earlier to try to avoid the 7 year PET IHT charge and any council challenge for pre-care deprivation of assets. The sooner the better is the new mantra!

Well done, Rachel, her changes to IHT and the resultant increase in thinking/media coverage of care costs is going to end up reducing tax revenue and increasing care costs as more and more people arrange their affairs not only to reduce IHT but also reduce exposure to care costs by transferring wealth down through the generations much earlier than was the previous "norm".

If you are on benefits, you can't have £16k in savings. The amount you get tapers off from £6k.
If you have worked hard and managed to save an amount like that, then life throws you a curve ball, then you will find you will be entitled to nothing.
On that thread, it was the "working taxpayers" complaining that they can't keep their savings and would be made to live off of them. A horribly entitled attitude, and lots of misunderstanding about how the benefits system works.

So roughly €4000 a month? What are the options if her money was to run out? I agree with you that peace of mind is the most important factor!