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?

If you own an asset, the asset should be sold to pay for your care. When you move house, you don't keep your previous property, you sell it to pay for the next one. A care home is no different.

I like the idea of an insurance based model that everyone pays into but it feels too idealistic. It relies on us all having a basic standard of living when working. I can't afford to pay my extortionate rent at the moment even though I work full time in a professional job. I'm going to have to stop paying into my work pension to be able to keep a roof over my head so there's no way I could afford to pay even £10 per month into an insurance scheme.

I don’t think there are easy answers. Ideally people should pay themselves and I think that gives you the freedom of choice. I was chatting to a friend about her Aunt. Her partner left (with her agreement at the time) his house/ thier home to an arts charity they both worked at. No kids. The thing is she is now 90 with a life interest in a home that’s really unsuitable and in desperate need of repair. Pretty much confined to one room she goes in a triangle between bed, commode and chair. Expensive bills, Aga in the kitchen country cottage type place.

She’d quite like to move to a care home she is lonely and struggling. Gets 4* 15 minutes care a day. Which is barely any time atall as everything takes ages. In an ideal world she’d spend a few years getting pampered somewhere nice. In reality she has no assets so no choices. The council will fund the cheapest option.

Ive worked hard for my home (grew up in a council house So feel like a step up perhaps) and would be gutted to spend my dosh on a care home when I could pass it to my children so hopefully they in turn can be homeowners so I understand the resentment in paying huge care bills especially when others get the same care for free.

I think I’m inclined to sign a living will to say that I don’t consent to medical treatment beyond pain relief in the event of xyz. Then hopefully I’ll succumb to something relatively quick. I’m more about quality of life than quantity tbh.

I think the answer to this is proper investment into social housing. If rental costs are reasonable it fixes so many issues.

Imagine if your rent was 25% of your take home pay and you had security of tenure. I think people working full time jobs should be able to afford to live at a reasonable standard.

I think it's fair to expect someone with property to sell it to fund full time care, if it's obvious they will never live there again. Just as I think it's fair that someone with loads of savings shouldn't get, say, housing benefits.

I don't think it's the state's job to provide these things for people who can afford them. Sure, they may prefer to give their house to their children but no one has a right to inherit anything. Until the person is dead it's all their money to provide for themselves.

Getting insurance payments back if they aren't used for care can't work as the whole point of insurance is costs and risk are socialised amongst all insurance payers. The larger the base the lower the cost of insurance (in theory!).

I would say provide state care homes. These would be free, basic but good. No individual rooms, but well-regulated and safe.

If you want own room, nice furnishings etc, pay private costs.

Both mil and fil had dementia. They went through all their savings and house, with fil dying about a week before he officially ran out (23k). They were in the same home (only one which would take mil) as most who were paying zero.

My friend’s df has been in a home for four years. After making an official request she found out of 40 residents he was one of only 3 paying.

Half of social care spend is on working age adults. We need to stop thinking about it as an elderly only issue.

The elderly issue is a crucial discussion to sort out with regards to hospital bed blocking, but the financial burden is actually increasing in younger ages.

Yes, old folk should sell their houses if going into care homes, but care in their own house would still need to be funded. Perhaps a charge can be put against the estate. DM and her husband used all their savings, and ultimately their house when they went into care. It was the right thing to do.

75 a “grand old age”? Hardly. “Fought in a war”? Do the maths. Jeez.

This is an excellent discussion. I've been thinking about it for a while now.

My fil has dementia and it's getting harder for my mil to care for him.
She's fit and very healthy for an 80 year old, but she's still 80 years old!

My fil has his state pension and his fire brigade pension, as well; whereas my mil only has her state pension.

She worked for the NHS for about 25 years and didn't apply for a pension while she was there.
Which i was baffled by, but I have since learned that my fil said (when MIL started working for the NHS): we don't need another pension. We'll have our state pensions and my fb pension.

And a few years ago, they undertook an equity release scheme, and now don't have a penny to bless themselves with.

Everyone's wise after the event. No one ever thinks they'll be unwell and need care.

Many elderly individuals have significantly benefited from the sharp rise in house prices, creating wealth they did not actively earn. Yet, many argue that they worked hard throughout their lives to accumulate this wealth and therefore have the right to retain it and pass it down to their families.

Meanwhile, younger generations face the harsh reality of being priced out of the housing market, likely condemned to a lifetime of renting. On top of this, the retirement age continues to rise, meaning those same young people will be expected to work far longer than previous generations.

I cannot believe that some expect this generation to shoulder the burden of higher taxes just so asset-rich retirees can preserve their wealth. I don't have children yet I find this mentality incredibly selfish.

I speak as someone who bought a property as a single person, on a low income, and who could inherit from their parents. I have no expectations and appreciate I may not get a penny if they need to pay for care.

Echo what a couple of PPs have said - a residential care home is the person’s residence. Some of the fees should be seen as rent, rates, utility bills, TV license etc. Then cleaning and provisioning and cooking 3 meals a day, and providing the communal areas (dining room, sitting room) and maintaining any gardens. It would be inequitable for all of the above to be covered by the state of the person has other assets, because it is the cost of living for everyone in the country.

The person’s attendance allowance goes some way in the state covering the care costs of a residential home (eg help with bathing and eating).

Is the cost of care per week - provided by a home that is probably part of a larger business - to the individual (or LA) currently too high? Possibly. But it cannot and should not be zero just because a person “worked hard all their lives” (if they did… my mum, who doesn’t currently need care, was a SAHM and my dad, who did, worked 9-5 for the civil service, retired at 60 and had a pretty well balanced time of it)

I remember feeling really aggrieved when my gran went into a care home and we had to sell her house, then watch the lump sum melt like snow off a dyke. My gran would have been heartbroken if she had understood the financial implications but luckily she wasn't really able to grasp it by then.

I think I've accepted now that this is simply pragmatism and it's not realistic to think that valuable homes can sit empty so that adult kids can inherit while the homeowner is costing the taxpayer a grand and a half a week. It just doesn't work.

Most people won't go into residential care and once in, most care home residents are there for less than a year. My grans were both unlucky and spent years at the end of their lives in care homes, and both of their legacies were drained.

@Lovelysummerdays if my rent was 25% of my take home pay, I'd think I'd won the lottery! I agree, the housing crisis is a huge issue in our society and it has a knock on effect for other issues like social care.

If I owned my own home and wasn't living hand to mouth each month like I am now, I'd be happy to use my home to pay for my care in old age. I wouldn't see it as that big of a deal.

As it stands, all my money goes on rent so I can't even afford to pay into a workplace pension. If I ever need care, I'll have to rely on the state to pay for it. And I'll be the one claiming pension credit or whatever top up benefits are available when I retire. I'm an unnecessary burden on the state, it makes me angry that I should be able to provide for myself.

I think people begrudge using their assets to pay for care because they know their own children and grandchildren won't be able to afford to buy a home without inheritance.

I have never understood the thinking it is down to the state to fund nursing home care for the elderly who can afford to pay for it themselves.

The fact people can go into a care home and expect the state to pay for it if they have the means to fund it themselves, I find ludicrous. Why should the tax payer be expected to foot the bill?

I don't think people should stand to inherit a property worth hundreds of thousands on the basis the state pays for the owner of the properties care.

If, in the lottery of life, I have to go into residential care, I will sell my home to fund it, I can't see any argument for doing otherwise.

Interesting discussion. The state has only offered help for the care of the elderly very recently in historical terms, less than the last 100 years of human history - a bit like most of the other state assistance we have today.

Two significant things come into play for me when thinking about this issue in broad terms. First, is that societies should be responsible for those who cannot be responsible for themselves, secondly, being personally responsible. Most of us know that we will be born, live our 80 odd years and die. There is a fairly well established trajectory there and a reasonable understanding of what those years will most likely look like. We need to ensure children are educated in such a way that they can be responsible for their own lives, wherever possible. There is a discussion to be had about how well that is done these days.

Clearly, shit happens and there is a case to be made then about the society we live in supporting us. Some people will never be able to help themselves and they need the most help and from my own perspective the state has a role there.

However, if we want cradle to grave care that is free at the point of delivery, then we all need to commit to that as a country and pay the tax that is necessary to fund that kind of care. There are countries, such as Denmark, with remarkable social care systems but their population pay huge amounts of tax for that.

Here in the UK we sit, like a lot of countries, with a neither one thing nor the other kind of system. I wonder how long that will be sustainable. Our adversarial political system, mean that the Tories edge us towards a more capitalist, free market approach and Labour edge us towards a more social welfare, interventionist approach. We wander endlessly along the middle ground. Maybe that is a good thing or maybe it means we get the worst of both worlds.

The fundamental root of this problem is unspeakable and can’t be addressed -There is logistical reality and then there is the moral component that has led us there. The reality is not solvable because morally it wouldn’t be right.

The problem is that too many people have been kept alive, and now the inverse triangle is struggling to support them. This will only get worse. The fact is there is limited resource. This wasn’t necessarily felt as much in the last few decades as this storm brewed, but we are reaching a crunch point where resources cannot provide for everyone. So it literally is taking from the young to keep the old alive, via huge nhs involvement and then subsidising care of required.

the vast majority of older generations will not be net contributors by the time they die. This will probably continue with the ‘boomer’ generation. So the “they’ve contributed all their life” maths doesn’t actually work. Most people aren’t net contributors. But in 50 years time, if my generation ever need the nhs or care services, it will not be provided as it is now. It’s not sustainable

im not saying we should kill off the elderly. I’m saying it’s unsolvable because fundamentally healthcare has kept too many people alive that can’t be supported. And I’m not just talking about end stage dementia. I mean for example someone having a stroke in their 70s would have previously passed away either from it or in the next few years. Now with preventative medicine they could be kept alive for another 10-15 years with other progressive illnesses that cost NHS money eg subsequent heart disease, maybe diabetes, maybe a joint replacement. It’s just not sustainable.

If you have worked and saved all your life, to potentially lose all your savings and your home and be unable to leave anything to your children seems very unfair especially if residents are subsidising other peoples’ care. There was talk of a cap of £86,000 being imposed and being ‘oven ready’ but this seems to have been quietly forgotten. Probably this was far too low a figure to be realistic.

I can’t see why a levy of a reasonable percentage of your house could not be implemented to adjust for property prices in different areas. At least some inheritance could be passed on, especially necessary as otherwise many children will never be able to purchase a home compounding the rental problem.

Adult social care currently costs local authorities around £20.5 billion a year.

The subsidised House of Commons bar costs £17m a year. The House of Lords costs £100m a year. Total revenue for magazines and newspapers this year was £4 billion - 20 percent of this will be less than £1bn. There is still a very substantial shortfall.

IMO the only way of dealing with this is through an insurance policy under which the insurer commits to paying the cost of care for life. It may (well) need to be subsidised or dealt with in a similar way to flooding or terrorism where the government acts as a backstop.

The state. Although I know this is unaffordable as things stand. There is no real difference between health and social care and so either both should be state provided or both should be fully chargeable. So I'll go with state provided.

Mmm-so what about people who will have no inheritance? Is it fair to tax them more so that well off kids can get their money?

We have free medical care at the point of need. That's part of our social contract.

Beyond that we have a social safety net that covers people who need help but have no money to pay.

if you have funds or an asset you should support yourself, whatever you need. I'd even say if one person goes into a home & leaves a partner in their home then a charge should be put on that home to be paid when the partner dies or the home is sold.

It's painful (I've been there) but I can't fathom why the state should fund care for someone with their own means just so people can inherit it.

Well it would be a start

Although I think having an insurance option people could choose to take out to cover care would also be a good idea.

I’d agree with a Pp that actually we’ve become really good at saving people. Which is an expensive business in terms of care so if you have lots of high needs expensive care plans to fund then it’s a lot. Not even just looking at the elderly. School placements that run into the six figures due to care needs. Then long term care for adults. Half the social care budget is for adults. Then care for the elderly often kept alive with a cocktail of medication.

I’m not saying we should start bumping people off but a conversation on how things could be funded better and more effectively. If often seems like there is poor planning and funding is forced through courts and tribunals and then it’s a knee jerk reaction into expensive providers who are the only ones with a space.

I often think that working with families providing care would be cheaper. Right now it seems like responsibility is completely shunted at the family and then when there is a crisis / carer burnout, there is a refusal to have them home from hospital, expensive bed blocking, assessments and guilt tripping till a place can be found. If care was properly planned for and stepped up as necessary you wouldn’t end up in this combative situation with social services where they end up having to take 100% of the care.

Cutting budgets for respite care makes no sense to me. If you pay for care 15% of the time (once a week ish) to help families keep going the other 85% then surely you can support multiple families. Or you could just push them to crisis point, take you a tribunal and lose. Then another massive chunk of budget is in pockets of external provider. Further cuts ensue so other families and carers reach crisis point.

I think there should be a system of obligatory state-funded non- profit insurance as exists in parts of the EU, because we don't know who is going to need thousands of pounds worth of care, or someone who costs nothing.