Abolish continuing care and make all social care means tested

[Figmentofmyimagination]

My mother - who is in a nursing home costing £950 a week with severe dementia and other serious medical conditions - has been assessed as meeting the eligibility criteria for continuing NHS care. This means that even though she has a house worth £250k+ and a pension income of £18,000 p.a., including her state pension, the whole of her care is now taxpayer funded.

She no longer has a practical need for any regular income. Instead, apart from the odd birthday present bought for grandchildren on her behalf, occasional new clothes, haircuts and the odd visit to the chiropodist, her whole pension income, including state pension, will simply build up in her bank account until she dies.

If there are to be £30 billion of "welfare cuts" then non-means tested continuing care must surely be abolished.

But doesn't that rather go against the principle of a health service free at point of delivery based on clinical need. The very reason CHC is not means tested it that it is not social care but care deemed a medical necessity.

Elderly care is going to become very contentious. If your mother had no pension or assets, would she still have high needs which required medical attention? Should a 45 year old who's employed and receiving cancer treatment be required to pay for their care?

The trouble with elderly care is distinguishing what is medically required, what is precautionary (elderly people who can't live alone for fear of serious falls/dementia) and what is social needs. I'm not really sure who is responsible for funding what area, but ultimately the money needs to come from somewhere. With an ageing population, and elderly people's children expected to work well into their 60s, it's more difficult for families to take care of their own.

I think that as soon as someone is in the setting of a long-term nursing home for continuing care, as opposed to a hospital setting, then the presumption should be that their care is means tested. Where someone young has dependents, then the means testing criteria should take this into account.

I take your point that in principle NHS care should be free, and where care is provided in a hospital setting, it must remain free.

These are substantial sums. The taxpayer is paying £750 each week (the local authority rate) via the local authority directly to a private care home (a really excellent one, I should add) to fund all my mum's needs. While this is clearly great news for me (!), there must be something wrong here.

CC is re-assessed annually, but even one year translates into £40,000 - for just one elderly person.

I do agree with you, that it needs to be reviewed. Even within an nhs context, there are elderly people more than happy staying on a medical ward that provides them with all their meals, warmth and social interaction. Those criteria aren't medical needs, so I do support people funding the social element of their care.

Have you offered to contribute ? You could move her to a private hospital and pay for her care ease your concience a wee bit. The NHS is from cradle to grave your mother obviously needs this medical care and treatment social care is means tested i dont know why you think it isnt

If someone is eligible for it then it's deemed they are medically unwell surely. Medically unwell people get treated by the NHS. Their social care needs should be funded by themselves if they can afford it of course.

I agree with you and I'm over 60.
I know someone whose DM is has severe dementia, is in a care home, but they had to sell house to fund the fees.
They actually tried to sue the LOcal health authority over it, which I found quite shocking.

I would be quite relieved that that my DM was being well looked after.

Yanbu a friend of my sister is in a similar situation, but they had to sell the house and they fought and fought to try to stop this. Greedy IMO.

Tbh it is a waste of money anyway, I'd rather go off to dignatas than have such a life and loose all dignity.

Another moral problem is that private companies make massive profits from these care homes.
The carers get paid minimum wage and are probably on HB and universal credit, the care may be funded by the tax payer, but then there are massive profits made.

isn't this all motivated by wanting to assure people that their estates will be intact to pass down? and rewarding those who have 'done the right thing'
ie why should the feckless non property owning poor get fully funded care while those who worked hard all their lives in order to pass something down to their children suffer by having to pay for it?

Same old everything should be means tested , until you become a pensioner

Just wanted to say that I'm sorry to hear your mum is so poorly.

The eligibility criteria for continuing care is very strict (in Scotland, not sure about rest of uk), so the majority of older people in care homes without very complex needs are having to fund their care in some way or another. Through investments, savings or properties. In my experience, nhs cc payments are rare, so probably not the biggest financial burden of the health and social care system.

I'm torn on this - on the one hand, your mother is in a position to make a contribution. On the other hand, why bother to save for your old age, aspire to owning your own home etc if it will just be used to pay for end of life care...when you could piss it up on flash cars and holidays, and then the government will have to pay up anyway?

I'd like to see a flat rate set level of contribution - maybe 25-50% of assets.

Having said that, we had to sell dgms house to pay for her care and, although we bemoaned the fact that her and gramps had worked hard all their lives to pay for the house and it was sad to sell it, it did mean we could choose the home she went to.

I don't think she should pay. Why does being old mean that NHS care isn't free. that's discrimination against the old. I agree that a flat rate of contribution means tested is a way forward. But people are already making sure their assets can't be taken by putting them in trusts and so on.

Just to echo the previous poster that obtaining continuing care funding is indeed very difficult and a very strict set of criteria has to be met. Dementia will not be sufficient on its own the person must have complex needs that can only be met in certain care situations. The funding is kept under review and if for example the persons condition worsens to the point where for example they are no longer agitated but confined to bed then the funding can be discontinued and the person will have to meet the care needs themselves if they have income or property.

Vivienne: most care homes for the elderly are privately owned profit making homes, run by businesses not run by the NHS.

There's an obvious distinction to be made between medical care and elderly continuing care. For starters, the latter obviates most living expenses. Of course it has to be means-tested.

I'm torn on this - on the one hand, your mother is in a position to make a contribution. On the other hand, why bother to save for your old age, aspire to owning your own home etc if it will just be used to pay for end of life care...when you could piss it up on flash cars and holidays, and then the government will have to pay up anyway?

As always. But surely having 250K in assets means that you land in a far better quality of home, right?

I am very surprised, OP, that the LA is going to pay for it all. I thought that it was all means tested

Does it vary from LA to LA?

OP, was your DM in hospital and moved to a Nursing Home as she has no one to care for her at home? Or was she being cared for at home and you found a Nursing Home and moved her? Does any of this make a difference to how funding is decided?

Tilly the LA are not paying for it. It's health needs that this lady has, therefore the NHS are funding it.

People who think NHS CHC should be abolished have clearly not worked in a profession where they fight for it. It is very hard to meet the criteria. Many people die while the NHS twiddle their thumbs and delay paperwork.

Goodbye this is true. Most people making this point don't realise that there is a bit of a "care home apartheid" growing up in the care system. When you start looking around, a lot of homes refuse local authority residents (because the rate is lower and because you can't sell them extra services).

When I was looking at residential (as opposed to nursing homes) I was really glad my DM owned a home, and so was privately funding, as the local authority options were frankly grimsville (with, oddly, loads more men than women?!? - don't know why that should be).

The continuing care part of her care fees is a very small fraction - I think it is just over £100 per week. It doesn't make much of a dent in the £950 per week fees - 1 third of which is subsidising the cost of the non paying residents for whom the Local authority pays roughly £500 per week.

I have never coma across anyone with any savings or assetts above approx £20K getting their fees paid. (sorry, I don't have the actual figures to hand, but have experience of 6 elderly relatives self funding and needing fairly extensive nursing care).

IME it is extremely difficult to even get a care needs assessment without full financial disclosure first.

IME it is extremely difficult to even get a care needs assessment without full financial disclosure first.

So, a tiny fraction of the elderly population is winding up in continuing care is what you're saying?

If so, that slightly changes the complexion of the issue - but the demographic breakdown of the country makes it unlikely that it will remain so.