To get annoyed when people try to avoid care costs

[paramedicswift]

People deserve good care in old care, potentially in their own home or in a care home.

While it is completely rational thing to do, people try avoid this cost by spending as much money as they can before they need this care or they give it away to family.

On one side, it is completely rational. I understand that people have paid taxes, national insurance and worked for their entire life. They have a desire to see this work to be passed onto their children for them to benefit from their hard work.

One the other side, it is incredibly entitled. To me, your care in old age is just another cost of life. It is like cost of food, cost of shelter. I wish I did not have to spend money on rent, food and travel to work. But I have to. This is just life.

It makes me even more angry when family inheritances come into it. It is just so greedy and horrible. I do not know why it is unacceptable to some people to apply for benefits and never work but completely acceptable to avoid paying for social care.

It is a bit of tragedy of commons because if everyone did it, then taxes would be wasted on caring for old people that COULD HAVE afforded the care themselves rather than important things such as education for children, public infrastructure projects and healthcare that benefit everyone.

To everyone according to their need. If someone cannot genuinely afford old age care and they did not deliberately avoid the costs, then I have no problems with state subsidised care.

Am I being unreasonable?

If you have the money, and are residing in a residential or nursing home, all residential aspects of your care, including your food, should be paid for by you.

There should be means testing to protect the assets of those terminally ill patients who have genuine financial dependents living in their home.

This is a deeply political issue which is toxic for both main parties - especially because it is driven, fundamentally, by people's' desire to hang on to wealth gained through house price inflation. But we need to separate the issue of care quality (which should always be excellent) from the question of who pays for it.

The bottom line is that we all die, and in most cases, we are never going to see that house or spend that pension again.

I agree that the distinction between social and clinical care and the way it applies to dementia makes no medical sense. It's a political fudge because as a society with competing priorities, we cannot afford the costs of paying to look after people with a terminal illness that has the potential to just go on and on. Eight years from diagnosis to death is the average for vascular dementia - that's around £35k to £40k a year of direct outlay per resident to fund the "basic level of residential care" people on this thread seem to think should be provided irrespective of means.

The only reason why my mum was fast tracked for continuing care is because she was diagnosed with a separate terminal illness in addition to the dementia, meaning that from the local authority's perspective, I guess they could see an end in sight, in terms of months rather than years. But the nature and range of the care she is receiving (which is excellent) has not changed as a result - or at least, if she is getting more clinical care, she still has the same residential needs that she always had. All that has changed is that she is no longer paying for it.

As I've said I think there's a massive blurring over ageing which requires social care on the whole and diseases such as dementia and alzheimers which are clinical mental health issues which require full time clinical care once the illness is advanced. Care homes are not staffed by specialist health care professionals to deal with these diseases; they are staffed by people who can deal with the social impacts of genuine old age. There is a significant difference between the two.

We are moving soon so that I am 40 minutes closer to my mother and will be able to visit once a week and drive there and back in a day. That will go on for as long as it has to, then I shall probably have to reduce my hours at work and visit more often, eventually she will move to live nearer to us, probably in sheltered accommodation. When she can't do that any more she may to move to a private care home. If her alzheimers progresses to the point my grandmother's did then I will not be able to look after her at home or elsewhere, she will require round the clock nursing care in a specialist unit. I don't think they exist anymore for the elderly. My mother is extremely lucky that if her own funds run out, we will be able to pay on her behalf. I really really hope that she doesn't deteriorate to the point my grandmother did. I hate to say this but it would be much much better if my mother developed a life limiting disease before the alzheimers really takes hold. I hope and pray that she does because I wouldn't wish my grandmother's last couple of years on my worst enemy and she had the best possible care that was available.

Yes, we cannot/do not want to look after the pil. In the case of mil, it would be impossible. She is doubly incontinent, needs a hoist, has no concept of night or day and before she became - I'm sorry to be blunt - a vegetable, she was aggressive and unreasonable. Fil is extremely doddery and is confused and also a bit of a pain. Frankly we could look after him, but we would rather he was looked after with three meals a day and a lot of care and attention. The pil are self-funding. To me, that is fair. Dh nor his brothers want/are able to step up to the plate = pil pay. If we had the pil at home, then obviously all the money (7K/month) would be saved.

What is not fair is elderly people with mahoosive assets fighting (or rather their dcs fighting) to get free care when the only consideration is their inheritance going up the swanee.

Im so sorry for those of you who have watched a much loved relative go through this.

I took my father out in his wheelchair today for the first time. He has dementia and moved into care this week. He doesnt know where he is and where his house is. So I pushed him round the village pointing out landmarks and his house to try and orientate him. He said "hello, do I know you?" to everyone we passed. He waved at all the cars. He kept asking "is that a cul de sac?" " is that a cul de sac? " and " where am I?". When I took him back to the care home he asked " why are all these people in my house?" and starting crying. Dementia is fucking horrible!!!! Formerly he was a maths teacher, a rugby referee and youth coach. He studied Theology and Latin, speaks Gaelic...or did. Now he wets himself and wonders where he is.

Re-marking thread because I'm getting upset about some of these posts, but am not able to answer them right now.

How the fucking fuck did my generation raise such a bunch of entitled, blaming twats?

This thread is so depressing -- I've not been able to get it off my mind. The worldview of the OP is one that just denies the reality of the way an economy works. Those who acquire capital are the ones who pay the taxes and create the products upon which the entire government and its "benefits" depend. They create wealth, which a government can't. Beyond a certain point, a massive government can only waste resources through unchecked mismanagement, corruption, nepotism, and simple incompetence.

dementedma )))(((.

Demented ma there is a book - you might have read it already - that I found useful - contented dementia by Oliver James. We are a bit passed it now, but what I found helpful was the explanation of the memory loss (my mum has no short term memory and her long term memory only seems to access very unpleasant memories).

He said we should imagine our minds like a stamp album and each event like a stamp that you stick in your album. People with dementia never stick the event in the album. They might stick in the emotion that links to the event - say a more contented feeling if someone close has been to visit - but the visit itself never goes into the album. It's not "forgetting". It's more like not remembering in the first place. This doesn't stop me going "do you remember when we...", or pointing out things she should remember!!

Sometimes she suddenly does remember or recognise things, in quite bizarre ways. An old school friend became a TV news reporter, and on one of my recent visits she suddenly pointed him out doing street interviews on the lounge TV!

If you need support, you should sign on to "talking point" if you haven't already - the altzheimers society forum. It's really helpful and supportive.

My father was happy to pay the £130k a year for day and night dementia care at home (eventually he did indeed need a hoist at home as someone mentioned above and then he needed two carers at all times too due to the lifting issues hence the massive cost) and use up his life savings and we would of course have had him to live with us if he'd preferred that to staying at home.

Whom do we think is best or worst:-

1. James never worked, went on the social, eventually drew his pension and went into fully funded local authority care until death. James could have worked and if he did work he could have also chosen not to spend spend spend on holidays, eating out and the like but he realised if he had no savings and no pension then the state would provide.

1. Jim worked very hard indeed, saved every penny, not even really often going on holidays because he was so worried about old age care (he is in effect my father) and used every last penny of his last savings on his dementia care at home without state help. He also paid a lot of tax in his life.

1. Andrew worked reasonably hard most of his life and has a house worth £400k. His children are quite keen to inherit as they have not yet been able to buy their own home or they just want the money. So he sells his house and moves into a rented flat when he turns 65. He gives his money to his children. Now he is 85 and needs dementia care - the state provides.

1. John knows he is going to be quite ill fairly soon, early stage dementia etc and wants his children to inherit his £400k assets (house). He sells the house and gives them the money and a year later needs to go into a care home which the state provides as he "has no money".

Under current law John is the only one breaking the last if he gave away his money in contemplation of fairly imminent dementia care. Whereas when I gave my daughters a small sum to help with a first property deposit now about 30 years before I need care that is not my trying to con the state.

1. James may feel that he has beaten the system by never having to work or pay for his care. However, his quality of life has not been as good as it would have been if he'd decided to work as he will have had less disposable income than the others and statistically speaking, he is likely to be the first of the four men to die, potentially saving the state money on care costs.

(Just because he's happy, doesn't mean his life was better than any of the others - most people want more than a life on benefits can buy)

1. The savings made by Jim over his life have enabled him to have a much higher standard of care in later years than if he had been dependent on state care. It is very expensive though, and would require a fairly high income in order to save adequately for that level of care. And a higher income generally means a better quality of life.

(Maybe people who aren't on a high income could feel that if they can't afford to save enough money to be able to have a high standard of care, that it is better to save little/not at all, as there seems to be a belief that apart from the very expensive ones, all care homes are the same and why spend your own money providing identical care to what the state would provide - I don't know)

1. Andrew could have been in the position of Jim with a high level of care, but decided to help his children and now has to be reliant on state care, which could vary enormously. Although he may end up receiving the same care as James, he will probably have had a much better life up until that point. He may also feel that he has beaten the system by not having to pay for his care, but we don't know why Andrew wasn't as worried about potential future care costs as Jim was, or perhaps he wasn't bothered about having a higher level of care.

I don't know, I get why 3 and 4 are different but at the same time, either it's ok to help your children out or it isn't? Is 3 more worthy of state care than 4 because he decided to give his kids their inheritance 20 years earlier? How do you prove that someone is giving away assets to avoid care costs rather than just helping their children? Is it better to give 100k to your children than 500k?

Everyone who plays the system believes that it's ok to do so because everyone else is doing it. Tax avoidance, benefits, MPs expenses, bankers bonuses. All these people are getting 'free' money and we feel we should get in on the act too. If you can't beat them, join them and all that. I'm a hypocrite, because if I had a house to give to my children, I probably would. Because I know how hard it is to try and save for a deposit whilst renting when house prices are so high (partly because of the parents giving their children money in order to pay the high prices in the first place )

(I meant break the law not break the " above last")

Yes, 3 and 4 are morally the same - giving money away earlier rather than later but only the latter could get you in hot water with the law and that makes sense. The fact I helped my daughters buy properties when I was 50/51 is not really giving money away in contemplation of imminently going into a care home so the law cannot easily stop that inequality.

I think English law used to tax gifts - capital transfer tax - so that people did not just give money to family rather than only giving it at death when estate duty/inheritance tax bites. That then changed and now life time gifts are not taxed with 40% inheritance tax if you survive for 7 years after the gift.

Yes, the main issue in the examples is that people in category 2 (my father) end up with better care which they can pay for and the person who chooses never to work and has no money gets worse care. However those who give away their capital and 3 years late go into a care home at the state's expense may get a worse care home but their children benefit and the tax payer is burdened. So it is this huge political issue of whether we have moral duties first and foremost to our own children or to a wider "state" and unrelated citizens.

Yes sorry, that's how I started but ended up on a bit of a tangent, apologies!

Totally agree with your point, LotusLight, about the moral issues.

I also heartily concur with Seffina's point 2 bracketed bit: those super care homes are massively expensive. At the affordable end, they're all much of a muchness and for £750/800, you will be in a room next door to someone who ain't paying a bean.

The pil's care home is shabby, sometimes smelly and obviously not somewhere anyone would aspire to live. That being said, the staff are kindness itself, they are all mature ladies and whatever time I have turned up, they are always beavering around. The pil are always well turned out and the food is excellent and the portions huge.

For dh and his brothers, the notion of choice was non-existent. This was the only home for miles that would take mil. Furthermore, en suites, trips out, cocktail hours... that's all very well if you are just elderly, but for an advanced dementia sufferer the provision of such frills is irrelevant.

thank you

Are there £800 a week care homes really cheaper than flying in a wonderful devoted filipino nurse or two nurses to live in your own home and devote themselves night and day to your care? A friend of mine had two Zimbabwean nurses fro his mother who lived at the top of his house with the lovely ladies until she died. Those ratios are surely better than in a care home and you're in the familiarity of your own home.

Whenever we go to mass at Brompton Oratory you get at high mass all the old ladies wheeled in for mass by their carers and it seems so much nicer than being stuck in a care home and I bet there is little difference in cost.

If the care homes are so expensive how come the care workers are on minimum wage or not much above it.

When I worked in a nursing home in 92 I was paid £2.50 an hour

LotusLight, in Italy they have "badante" - elderly carers who usually come from Russia. They are middle-aged ladies, often putting their children through university. There are hordes of them. It is definitely advantageous for an elderly person, although they do have Sundays off which need to be covered by family and of course for an advanced dementia sufferer or someone needing a lot of nursing care this route would be unsuitable.

If nursing homes were very lucrative we'd all set them up. You buy a big house, you convert so you need a lot of capital and pay a lot of interest, you follow a massive number of rules and regulations. I don't think it's much of a money spinner and some have gone bust. Southern Cross did.

Also see www.telegraph.co.uk/finance/newsbysector/supportservices/10266897/1500-care-homes-at-risk-of-going-bust.html

I doubt there will be enough money to pay for anyone's care costs in the future.
I think it will be up to the faimilys to either pay for or provide care like in other countries. There may be mass euthanasia vin the future too.
I personally plan to care for my parents myself.

Some have gone bust as they've been sold to private equity, then asset stripped so they go bankrupt and get the tax payer to bail them out.

Surely the point is that no-one actually knows whether they will need care or not, unless there is a diagnosis which indicates that.

If you're healthy there no reason at all why you shouldn't dispose of your capital and assets in whichever way you see fit.

If, however, you have any reason to believe you are headed for a care home, whether that is circumstantial, accidental or through a diagnosis of terminal illness, then you would be foolish to try to dispose of your assets at that point.

How exactly are you supposed to know whether your death will be a long or short affair? The only vague indicators are any chronic illness and your family history of longevity.

Not everyone lives long enough to need a care home.

I don't think it's much of a money spinner and some have gone bust. Southern Cross did.

Southern Cross was stripped of assets and made its parent company £1bn. Its homes were careless, neglectful and caused multiple deaths among its elderly customers.

It's a money spinner, especially if you treat humans so badly that you'd be prosecuted if they were animals.

Whoever was talking about care costs in Germany seems to have the wrong end of the stick, btw. Germany operates a matrix of health & social care insurers, with people paying into the system much as we do (but higher contributions, mostly.) Where elderly people are cared for by family members, the state pays the family members. en.wikipedia.org/wiki/Health_Care_System_of_Elderly_in_Germany#Long-term_care_insurance

Healthcare providers are buying homes overseas dedicated to the care of elderly Germans in what is clearly perceived in the industry to be a growing and highly profitable market. www.theguardian.com/world/2012/dec/26/german-elderly-foreign-care-homes