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.

Fairy - that was v much our experience. As I said, my mother, aged 94, was obviously dying. As anyone would, of any age, if they refused food and drink. There was no question of medical intervention to feed/hydrate her artificially. We fully supported the hospital's decision.

The problem arose over where she should die. The hospital could do no more for her and needed her bed so routinely put the discharge procedure in motion. This triggered the financial battle between the CC assessor and the LA. My concern was that she should not be moved in her final days/hours - and it could have been 'hours'. I asked an administrator how late in the process they would still move a dying patient and was told, with some embarrassment, 'Cheyne-Stokes breathing'.

I think this is appalling. Even primitive societies let their members die in peace. My mother could well have breathed her last in an ambulance somewhere on the M25. (To complicate things further, the hospital was in a different LA from the one responsible for her care.)

I doubt v much that we would have got CC (3 days after she died) if everyone concerned had not been aware of the fact that they were never going to have to pay it. But they had to go through the motions of an appeal against a contested decision. The whole thing was a charade brought about by the stringent rules of CC.

Back to the OP, in the past, patients in your mother's condition would have been in long-stay geriatric wards, obviously fully-funded. It would be interesting to know if CC paid to a private provider, i.e. a nursing home, is more or less expensive for the NHS.

(Thankyou for the flowers, 3 littlefrogs. Much appreciated.)

My father by the end was paying £130,000 a year (I kid you not) for day and night dementia care at home. He died just as he spent the last of his life savings on it.

I thought for most care homes people's savings went towards the hotel element (accommodation and food ) and the other part - medical care was the part which the state would pay up to a certain amount. The bottom line of the rules is that for most older people in a care home they tend to have to use their savings.

I do know of a situation where an extremely sick patient died just as he was being transferred from the ambulance into the hospice. His wife had endured 12 days of arguments and squabbles in the hospital as to where he would be going and when. I don't even think money was an issue in that case - just bureaucratic incompetence.

OP - if you feel so strongly about this, donate the money to your local hospice so that they have more beds and staff to care for dying people.

Luckily you don't live in Germany. If you need to go to a residential / nursing home you have to pay for it out of your pension and savings. You are allowed to keep a small percentage for your own use. If that still doesn't cover the nursing home fees, your children will have to pay. The children can keep 1600 Euros / month of their salary, with some room for additional money due to credits, mortgage etc, the rest goes towards the care home.

Now that sucks!

That is why some elderly German's have ended up in Homes in Eastern Europe I guess then Schnuller. Read an article whilst considering a move back to Germany for my Mothewho has Dememtia. Didn't realise the family have to pay. And explains why my Aunt was suggesting we get a live in Eastern European Carer for her.

Needless to say we haven't and she is self funding after the sale of her house.

Both of my parents were in nursing homes at different times (mum first - dementia and terminal cancer) in the final year of their lives. Their places were funded and savings not affected as they were below the limit.
However, they had to hand over all of their income from small private pensions and the state pension. In return they were given an allowance or 'pocket money'. At the time this was £18 per week although I think it is around £25 nowadays.
Their house was in my mother's name and I was told that we would have to sell it if my dad died first (as he was living in it at the time).
When I checked, the legal position was that the family could not be forced to sell but the local authority could make a claim for the fees against the value of the house.

Continuing health care is for people with severe medical needs-not for social care.
I think one of the difficulties is that different health authorities apply the criteria more or less stringently.
Historically Social care has gradually evolved from the Poor Law and is in the hands of local authorities-so is means tested, whereas health care is free at the point of access.
The present day situation where many older people's health and social care needs are indistinguishable makes a nonsense of this division. There needs to be a total reform.
At present there is a lot of unfairness with some people with severe needs paying and others in the same circumstances in receipt of CHC.
Also agree with the poster who said that owners of Nursing homes are lining their pockets whilst the staff are on low wages and the NHS is paying some fees.
Its a mess and is going to become a bigger mess without radical changes.

I see what you are saying. But our poor old and young. I think we should be caring for them more as a society. There is very little state funding for their care really (social not medical). We expect to pay carers and nursery staff barely the minimum wage. And place little social value/status on family members who care for free.

Sometimes I think we have a mindset that it is 'normal' to be working, healthy and independent and that there is something shameful or inconvenient about depending on others. However we all have times in our lives when we need help from others to survive - childhood, old age, illness, unemployment and surely it is what makes us human that we try to give all members of society as full a life as possible?

That is a bit of a rant aside from your point op. If you accept the premise that we 'must make cuts' then your view does make logical sense and I guess from a practical point of view we should all be prepared that our life savings may go on care. Which is definitely a good use of them. Or alternatively we could plan to splash them out on champagne and cruises in our 60s so we come under the means tested threshold.

Thymeout, thanks for your story. If it makes any difference at all, the medical team would not discharge a dying patient because they 'need a bed'. It would be because a lot of patients and their families would prefer to die at home or somewhere homely and familiar. Also, unless there was a prior wish from the patient or family, a doctor would never advocate discharge when a patient is cheyne-stoking as, you're right, they will most likely not make it home. Sometimes us docs do have the power to veto the administrators by simply saying no.

People receiving CHC have high level medical needs and have a long term need for hospital level care.
At what age OP do you suggest that this care should start to be means tested?
To avoid age discrimination how would you feel if everyone of any age, except under 18s received medical care free but was means tested for food and accommodation whilst in hospital?
No?
You are talking about very ill people and I could sense ageism in your OP but couldn't pin it down initially.
I still feel that the criteria are applied inequitably by different health authorities though.

My brother was seriously ill (long term disability) and in and out of hospital for over a year having operations.

His DLA was stopped every single time he went into hospital.

His mortgage and bills didn't stop though.

Everyone's DLA or attendance allowance stops if they are admitted to hospital and after 6 weeks most of state pension stops.
Its particularly shit for younger people with a mortgage.
I don't think its a good idea for younger people to be means tested but also don't see why older people should pay for the health element of care.
Cradle to the grave.

I do see the bigger picture - surely that's the point. People are conflating at least three issues - no wonder, with a topic so emotive.

• The care quality should be excellent - that goes without saying - and it is extremely upsetting to see a loved one so ill - I know this, having seen it now for 6 years.

• the system is broken - local authorities are paying huge sums to private providers - but 86% of care workers are on zero hour contracts, and nearly all are paid just the minimum wage for the hours they work.

• although it is incredibly sad, there is no escaping that my mum will die in due course in this home. I'm not some kind of vile person for pointing out that it is irrational to take funding from the taxpayer when she has an income larger than the average uk income.

And taking funding from the taxpayer in these circumstances turns the NHS into a cash cow for private nursing homes and lifts the incentive to keep fees low.

• obviously as people have pointed out, I can salve my conscience in due course by making a hospice donation once my mum has died. I was just surprised by the wider issues it throws up that I wasn't expecting to find.

To whoever said otherwise, I wasn't conflating nursing and social care in the title to my post. My mum's needs have worsened and she now has serious medical needs - but she has the same social needs - eg for food and accommodation - as she had before. These should be paid for - although where you draw the line is obviously not v clear!

I know people fight for CC funding and that it is quite rare - but just one person with the resources to pay in each nursing home is quite a lot of money. I know people have desperately difficult experiences dealing with care - and hideous experiences navigating the funding system. I've been through all this, with my mum marooned in hospital in the past for weeks on end.

The issue of age discrimination is complex. It's a very handy slur to throw around. But there is a reason why age discrimination is the only equality strand capable of objective justification with evidence - because unlike most other discrimination strands, we all get old - and there has to be a balance somehow between young and old, when scarce resources are allocated. Recognising that is not age discriminatory.

I hear the whole "cradle to the grave" argument, but does anybody think aneirin bevan believed the purpose of the NHS was to enable people to leave legacies to their children?

I'm not coming back to this thread btw. I've never been offered a "lethal injection" on mumsnet before! Enough.

In our case it took 5 weeks to get DLA reinstated every single time, by which time he was back in hospital again. He didn't receive it for most of that year. The stress of not being able to pay the bills didn't help his very serious illness.

OP I am so sorry you are going through all this with your DM. It is so sad that those of us who are going through the last days and hours of a dearly loved relative's life are also dealing with so much paperwork and bureaucracy.

It makes it all so much harder.

I do sympathise OP-it is very difficult and hard to know where to draw the lines.

Using the OP's logic, we should start charging people for food in hospital too. After all, we all need food to eat and to survive and would have to pay for it if we weren't ill enough to need inpatient medical treatment.

Just one point-when Continuing health care starts the state pension should be greatly reduced-just as it is when you are in hospital for longer than 6 weeks (unless I'm out of date).

Tenerife I was talking about elder care in a nursing setting.

I know I said I wouldn't come back but there is one last point worth thinking about. Aneirin bevan had five giant evils in his sights. Health was one - but housing was another.

His big dream was actually that everyone would be in a council house - out of choice - that there would be no difference in quality or aspiration between home ownership and being a council tenant.

The point is that when he articulated his "cradle to the grave" NHS philosophy, he didn't have in mind that the housing he was building would become an investment, and that private home ownership as an investment would take on such a central role in the British economy.

So you can't really see one "giant" in isolation from another.

Some people's medical needs are such that they cannot be cared for in a nursing home and will spend the rest of their limited days in a hospital. It'd be a cold day in hell before I'd agree they should be charged for their food.

The other thing to consider is that it's not just the elderly who receive chc?

My son gets night carers for an extremely unstable life threatening condition because of continuing health care. Were it to be means tested on us, as parents - we wouldn't be able to afford it.

Apologies got any typos - I'm on my phone!

State pension doesn't stop after 6 weeks(or at all).
Chc is extremely hard to obtain and means someone's need is primarily health based (ie would ordinarily be met in a hospital) so yabu op.
For those discussing care fees etc the 2nd part of the care act comes into effect next April www.gov.uk/government/publications/care-act-2014-part-1-factsheets/care-act-factsheets--2