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?

I tried to work out how much an insurance policy for social care in my old age might cost. Even assuming only 1/4 need it, for 5 years, it’s a startling amount of additional tax!

Things such as dementia are medical conditions and it is purely good/bad luck for those impacted.

I think that all care should be provided by the state. I'd pay for that with an inheritance tax that 'comes off the top' of all estates.

For example:

£50k charge on an estate worth £50k would leave zero inheritance for beneficiaries.
£50k charge on an estate of £250k would leave £200k.
£50k charge on an estate worth £2 million would leave £1.95 million, which would then be taxed again as it sits above the normal inheritance tax threshold.

Stop paying for children
Stop paying the disabled
Stop free medicine to those with certain conditions
Stop any welfare or support
Become America

Just wait until old age hits
Many will be getting a fuck off reality check

Yes @sickandtiredofitallnow - a couple of weeks ago I heard a parent call into to radio and say they had fought for their SEN child's place and was costing the council £100,000k a year. This is simply not sustainable, there needs to be a cap.

I strongly believe it should lie with the individual, not the state, where possible.

Currently local authorities bear the vst majority of the burden and the current Financial Assessment rules are very fair to the individual. However, there is a perception that any means tested contribution is individuals 'paying for their care'

It cannot be passed on to working people any further. We have no guarantee of universal state pension or NHS when we reach retirement age. That's already pushed into later years for us. We have already had less generous treatment from the state in the form of tuition fees, house prices to wages, fewer health and public services...

I find this subject interesting. Nobody would suggest a 40 year old sell their home for healthcare so I’m not sure at what age suddenly this becomes an expectation. Selling my granny’s home was heartbreaking. She was receiving care at home but had to go into a care home because the house had to be sold to fund the care. She’d much rather have stayed home.

Some people don't ever work or pay tax though.

I think we need to get away from this idea that our house is our childrens' inheritance.
For the many, this is a relatively short lived concept on the back of spiralling house values of the last 30 years. It is not earned income/assets and should be spent on care if necessary.

But in the future, house prices will not increase by the same amounts that they have in the last 3 decades. Many more people will be renting into retirement so won't have an asset to sell to pay for their care.
I think some type of insurance policy for those who can/want to make provision - and, therefore, have a choice and say in their care is the way forward. Those who can't afford to make provision should then be funded by the State, just as we fund the poor and vulnerable members of our society now - through the benefits system paid for by taxes and NI.

I have told my DS that he is not to live his life expecting and inheritance. He is very welcome to have anything that is left after our care is paid for. But as we're not planning on popping off for at least another 25/30 years, he needs to make his own way in the world.

Also most people over 75 have not "fought in wars". You need to be at least 97 to have been a young adult at the every end of WW2.

One thing that we could do to improve the situation is to carry out Advance Planning with everyone who has capacity to make their own medical decisions.

We aren't having those conversations enough right now.

If you permanently lose capacity to make decisions about your own care, do you want to continue being kept alive at all costs? Artificial feeding if you can't feed yourself? Antibiotics for every infection? Blood thinners, statins and blood pressure medication to prevent strokes? Ventilators if you can't breathe on your own?

Right now, the default is to continue life prolonging treatment, even if a person has no idea who or where they are. Lots of people who end up in care would never have chosen to be, but never had the conversation. If you don't want that for yourself, make an advance decision to refuse treatment so your decision is legally binding.

I think whatever society does there will always be people who require the welfare state. We have no option but to provide for them. I think what is unfair is that people who fund their own care have the same provision as those who get their care from the LA/ Government.

I'm not sure what the solution is. I don't think insurance is the way forward as some people just wouldn't take it out and if taken automatically out of benefits and earnings I doubt it would be ringfenced for future use rather than used as part of the budget. (Edit: unless privately held and insured or ensured by the Government especially if linked to the stock market).

I think the view that the elderly have paid for their care via tax and NI isn't quite right, tax and NI that is paid now is paid to support the NHS and services at the that time. The money isn't put aside in a pot for the future. The cost is rising and I wonder if I will have the same welfare safety net if I need it when I'm older.

Even conversations couldn't achieve that right now, could they? If you decide at 55 yrs that from 80 yrs, that you don't want any health interventions, would that still be valid if you weren't able to reissue that consent?

Absolutely agree, but for some especially from what I've seen on similar threads, working people are meant to be thrilled with the rising taxes and that it's constant take from our pay by the government to fund those unwilling to work and it's now multiple generational issues like this!

Inheritance do distort things like house prices and increase wealth inequality. Though it must be said that the good thing is that Inheritances can also be squandered

My parents have roughly £10 million in property and also in shares and told me not to expect an Inheritance . Dh also doesn't expect an Inheritance as he is 1 of 4 and his mum is leaving the house 100% to the youngest sister who will probably blow it on a sex change operation (there are no other assets).

at least my MIL wouldn't be here to see it cos I am guessing most parents wouldn't want to see that. We bought our own flat in London in our 20s and will rely on ourselves.

What these discussions highlight, more than anything else, is the growing number of people who know the price of everything and the value of nothing.

Who gets to put a price tag on life and why is it always those in need that are used to illustrate fake contribution-based morality and not those who get paid/extort a king's ransom for work done by those all too often being paid barely/not enough to live on?

What is it that continues to make people too stupid to question these things?

The way this is funded is between health, education and social care. Social care which has been assessed as required for children under 18 is funded by the LA so any residential place would be completely free. After 18 (education in theory can go upto 25 years old) the yp could be required to contribute from their benefits or in cases of residential have some of their benefits reduced or removed.

SEN places are often expensive because they are independent provisions rather than LA provision. Most parents would prefer their child to attend a local school but those locally can't meet their needs. Would these children then not be entitled to an education? - that's clearly not an answer but I do think investment into better LA SEN provision would be.

My parents were working class through and through. Manual/ factory work. They bought their council house in the 70s but because it was in London it grew enormously in value. Dad died, mum went into a care home at 92, still there at 96. The house was sold to pay for the care and all the money will eventually go. Fair enough - they weren’t canny enough to gift some in their lifetime.

But mum has sisters who were canny and gifted half their house to their children and has cousins who spent recklessly all their lives, made no provision for the future and get exactly the same benefits as she does. It’s the inequality and the worry that the system does not encourage anyone to be prudent.

I do think there should be a higher residue left than £23,000. £100,000 inheritance would have given my children a house deposit each - it’s not like the money won’t be recycled and spent. And it would have helped the following generations.

I think it 100% acceptable that anyone who needs a care home due to advanced age continues to pay for the ‘housing’ element, so sell one home to pay for a room and all overheads in another.

Aside from Attendance Allowance most care funding is means tested anyway, whether in a home or not.

Actual nursing, for conditions which are disease related (including dementia) should be paid for by the NHS, just as if the person were younger.

There needs to be a more honest conversation about what people have paid in and what they are currently claiming.

I have worked in Adult Social Care for several years. Many times, the (retired) child of a person receiving care has complained very angrily "but they've worked all their lives" when I can see that the person has been receiving state pension for 30 years! They say this totally genuinely. This also applies in situations where the person's care is being funded by the LA and they are being asked for a means tested contribution.

Health outcomes are not getting better, we are not going to have a generation that are able to work full time at 70 any more than previous generations. My own dad was showing signs of dementia before he retired at 64. His parents were 10 and 20 years older than that before they developed cognitive impairment. I'm worried for my own future.

I think we have a huge problem where people are expecting to hold on to wealth and pass on inheritance because we've built up a 'be poor in youth, save up for when you're older' type system where people have to accrue wealth and then hoard it when they're older.

Far better would be encouraging people to be prudent and manage better when they're younger then avoid wealth hoarding/inheritance from older generations. Eg, give young people very generous tax breaks for saving for deposit/paying mortgage, make taxes higher the older you are, bring back free higher education but link it to actual job skills, such as more apprenticeships etc than a degree for the sake of it. Make it easier to get settled at a younger age then people will be well placed to afford to live through their life and it'll be fair enough to take what they've accrued later for care fees etc, the younger generation won't need inheritance for a deposit etc so why should they get it, you can be far stingier then and increase inheritance tax, close loopholes etc.

Well quite. The question that needs to be asked is of you want more state funded care and to keep inheritances who do you want to more tax or what services do you want to be cut?

I've worked for a few agencies working in nursing homes as well as being regular or bank staff in them.
I've worked in homes with very wealthy folks and ones with previously homeless folk or people who've certainly experienced nothing nice in life. From basic food, to travel to guaranteed warmth.

I strongly believe that children, vulnerable adults and the elderly, basically anyone who needs an able-bodied or mentally capable person to care for them should regardless of their financial status be given that care.

The elderly are being failed massively. I think there should be a massive and I mean massive revamp in their care. They are worth the money. They really don't deserve the shit that hits them once they lose some or all of their capabilities.

I think homes should have en suite rooms as standard, I think toiletries should ALWAYS be provided, podiatrist monthly visits should be a standard. All homes should have a mini bus and at least 2 senior activies coordinators and 3 helpers. No more skeleton crews, no more 2 staff members to 70 residents. I'd have 10 staff minimum night and day.
I'd have 2 nurse minimum every shift.
Proper staff training and the carers to have training in dementia care, palliative care and taught how to not fuck their own backs up. I also believe training should be done yearly, communication and de escalation techniques and positive ways to physically intervene with incidents that do the least possible amount of damage to the elderly person.
I'd make sure each old person had things important to them available more often, so more visits from the relevant person in their religion to pray with etc
The food I believe should be done to a very high standard, more fancy hotel than hospital in the 90s and the food should have options that reflect the foods the individuals choices. If you've got older people who've grown up on traditional foods from whatever their background is, I believe a menu should reflect that. A curry option is as important as a traditional English dish and I've seen the elderly be given some utterly diabolical slop. I made amazing friends with a nursing home chef and her meals are so well thought out, even for the residents who can't eat food with texture, they're beautifully presented and that should be a standard.
I know people use phrases such as "wouldn't give my dog" about mediocre foods but I've seen things served to the elderly (and reported them repeatedly to discover nobody gives a shit) that I wouldn't leave outside for the foxes to play with. 20 years ago I went to a home and the older people were given burgers. (Shit looking ones, like carnival van stale burger) and the residents were so deflated. These were people who'd been raised by victorian parents, they'd lived through rationing, they wanted meat and 2 veg. Not cold fries and crap burgers. Because I've experienced that I'd have food menus designed by head chefs and I'd ensure that they were designed to cater for all the residents needs so vegetarian/kosher/halal but foods to be offered that they'd choose to eat, I think chefs could (as my friend did) include the residents in her menus and their seasonal changes. Being stuck in a nursing home, even nice ones, a good meal 3 times a day is important. Shit food = shit mood.

I'd happily pay more taxes to ensure at the end of the lives of the elderly they had regulated, government care in places that combated abuse, loneliness, poor quality care and no understanding regarding elderly physical health and mental health issues.

The homes would be designed with things to hugely benefit the residents physically wellness, some homes don't have a bath, old bones deserve a soak, even once a week a bath and a shower other days, a bath can really give a older person joy.

When I return to work in nursing homes when able to, my wages will be nmw and I'd genuinely pay a decent wedge of additional tax on that to cover this. I think those with money and property they'd rather leave to family and friends would likely also be happier to pay for their care over their lifespan, as opposed to selling up.

The thing that would make this possible is if it was only ran from government and nobody resourcing things so their friends could make a profit. Everything done from local council. Not outsourcing a single thing to prevent people profiting from this is the only way it could be sustainable.
It could create more jobs and could give nursing home staff skills and training they could take to consider careers as nurses should they wish.

As someone going through this. Like disability benefits the system is skewed. You get financial help through attendance allowance when it isn’t really needed but then can’t access high quality care when it is

I would have all care under state control or charities. No benefits but free access quickly when it is needed. The most needy cant get help whilst the system pays out billions to those who dont need it. I dont want more money- my parents have money- I do want high quality care provided when it is needed with no hassle.

I'd be prepared to pay into a mandatory insurance policy but only if the money gets passed onto my next of kin if I don't use it.

I wouldn't be happy to pay yet more taxes which are never guaranteed to be spent on the services it's meant to provide.

I'm watching a family member being royally fleeced by the nursing home she's in, just because she had her own home. That home has been sold and she's paying for her own care. She's spent over 100k in 18 months. She's wry upset that she'll have nothing to leave to her children who are struggling, like many, with the cost of living/ getting onto the housing ladder.

What's going to happen when the majority of people have no houses to sell to pay for their care?