...to ask how we fix the care system?

[TheABC]

The furore over the NI tax rise has obscured the fact that little will change on the ground for anyone giving or receiving care. AFAIK, there are no changes or help for the unpaid family carers and no extra cash, training, or appreciation available for the staff in care homes.

The number of over-80's is forecast to double in the next 10 years (ONS), so the demand for care is only going to rise. AIBU to say we need a National Care Framework, in the same spirit as Scotland's?

||www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/august2019||

Swedish care for the elderly looks pretty good.

sweden.se/life/society/elderly-care-in-sweden

We cannot have a sensible discussion about the entirety of care costs without a sensible attitude to assisted dying.

Everyone wants the taxpayer to spend half a million quid keeping grandma in existence (note, not 'alive') for five years. Very few willing to reach into their own pockets for the same.

My last surviving parent has made it abundantly clear that his wealth must not be used simply to keep him alive with no quality of life, and that all other considerations are secondary. He lives in a place with no government funded care, so recognises that he will probably die in Switzerland.

We legalise assisted dying.

Having sat by my df side for three weeks with terminal illness yes assisted dying

I'd rather have an assisted death for myself and leave my assets to my dcs who will need help because they have SN and might not be able to provide for themselves fully. I don't want my house to be sold in order to force me to remain alive in some grotty care home whilst my dcs go without a roof over their heads.

The government can't force people to train as nurses or care assistants, so how are they going to get staff to care for an increasingly elderly population? It's going to bankrupt the country if we end up having to pay carers £25 an hour which lorry drivers can now command due to a chronic shortage.

Very few people want to live out their days sitting in a soggy incontinence pad with the TV blaring out Naked Attraction whilst being looked after by a bored yob who's been forced by the jobcentre to work in a smelly care home.

I'm not sure legalising assisted dying will make much difference. There are around 300 per year in Switzerland, I believe, but that includes those from countries where AS is illegal (e.g. Germany). It's nowhere near the kind of uptake numbers that would make an impact on the cost of care. Also remember a lot of social care spending is on younger disabled adults where assisted dying is not an appropriate option.

There's no "nice" option, it is expensive and will have to be paid for. I think it should be a mixture of increased tax (but not NI, which penalises the young - Capital Gains Tax or even Income Tax would be fairer) and people having to pay for it themselves as per the current system by using wealth held in property and savings.

Assisted death for sure. I want to choose to manner and time of my death, prepare my family for that moment, ensure my wishes have been understood and then when all is settled and calm, enjoy a long sleep. I do not wish to end up in a nursing home. I am a nurse and god forbid what I see daily happens to me.

I agree about assisted death however there is a big problem with this. Those without any assets will not go for this, they will have their care paid for by the tax payer. This is surely already a problem with our current system, there is no incentive for families without assets to care for their elderly (other than loving them and wanting to) whereas there is more incentive for those with something to 'lose' to take over the care.

So is it logical that those with assets are more likely to go assisted death?

I havent seen stats on the people receiving care provided by the state vs paying privately. I would be interested to see this, is there a class divide?

Lastly I assume you would need to make the AD decision early since presumably once you have advanced dementia you are deemed unable to make this decision.

Yes to assisted dying.

And also for carers to receive greater salary, training and respect than they do.

@2021Vision those with assets are currently subsidising the care of those without, so presumably, the government aren't going to want to legalise assisted dying as they'll lose our money and be left with lots of people to look after. It's in their best interests to force people with assets to remain alive. Quite what happens when there's no staff left remains to be seen.

Much privately paid for care is good quality and easily accessible. State funded care is lower quality (because the state pays less per hour than private clients do) and less accessible because demand is outstripping state funding.

Basic arithmetic means we need to either reduce demand for care or increase funding. We could reduce demand through a less aggressive approach to keeping people alive, by making more people do without state funded care, and/or making people manage with less state-paid-for care. We can increase funding by putting more money in.

Bizarrely the only changes I've seen mooted at the moment are not going to put much more money in (most of the tax increase is going to the NHS not to Care for the first 3 years) and are going to increase demand by opening state funded care to more people than before. Not the solution I was hoping for.

Wow, this thread took a bleak turn quickly!

Whilst I agree assisted dying should be allowed (with safeguards), it does not solve the problem of the young disabled man who needs care throughout his life or the 60-year-old with her own health problems caring for her 80-year-old parents who are even more frail and have the capacity to want to stay in their home . The majority of residents in care homes stay for less than two years.

The Swedish system looks good and frankly a lot more practical than the set up in this country. Have hubs of accessible housing available to rent would reduce the trips, slips and falls seen in older people and reduce isolation. Likewise central meal hubs and a one-stop shop where people can apply for assistance or enquire about care without jumping through multiple hoops. At the moment, you can apply to social services, get the assessment, told you are not eligible/self fund and just left to get on with it. Even if you have to pay for it yourself, FGS let's have some decent information out there.

@Purplewithred

Much privately paid for care is good quality and easily accessible. State funded care is lower quality (because the state pays less per hour than private clients do) and less accessible because demand is outstripping state funding.

Basic arithmetic means we need to either reduce demand for care or increase funding. We could reduce demand through a less aggressive approach to keeping people alive, by making more people do without state funded care, and/or making people manage with less state-paid-for care. We can increase funding by putting more money in.

Bizarrely the only changes I've seen mooted at the moment are not going to put much more money in (most of the tax increase is going to the NHS not to Care for the first 3 years) and are going to increase demand by opening state funded care to more people than before. Not the solution I was hoping for.

I can see both happening - with an aging population, we will need to increase money flowing in, but equally there will be a cut off point where certain treatments cannot be justified based on outcomes/life expectancy. I know NICE do that to a certain extent now, anyway. It might just become more prevalent.

I agree with you, this change seems counterproductive.

I think it's all very well quoting systems like Sweden but they only have a population of 12 million and the make up of their population is different too. It's like the comparison of the UK to NZ in pandemic, it's not a good comparision.

Anyway the issue I have with most things governments do is that they think just throwing money at it will solve it. It won't. I would like to know how a care home can cost 1.5 to 2k per week. I get it if there are specialist nursing staff however it generally seems that carers have caring skills but that is it so relatively 'low' skilled earning low pay. I appreciate care homes are private businesses however it doesn't sit well with me that, like landlords, the tax payer is basically paying private individuals lots of money and they are naming the price.

gnarly - that's a good point, I hadn't thought of that and I agree. Surely a good option for someone with a relative that needs looking after and is willing to do the caring, is for them charge the relative to look after them. If a parent moves in with a child and sells their property then surely they could charge the parent 'rent' and charge them for the caring thus transferring funds to them?

@2021Vision

I think it's all very well quoting systems like Sweden but they only have a population of 12 million and the make up of their population is different too. It's like the comparison of the UK to NZ in pandemic, it's not a good comparision.

Anyway the issue I have with most things governments do is that they think just throwing money at it will solve it. It won't. I would like to know how a care home can cost 1.5 to 2k per week. I get it if there are specialist nursing staff however it generally seems that carers have caring skills but that is it so relatively 'low' skilled earning low pay. I appreciate care homes are private businesses however it doesn't sit well with me that, like landlords, the tax payer is basically paying private individuals lots of money and they are naming the price.

gnarly - that's a good point, I hadn't thought of that and I agree. Surely a good option for someone with a relative that needs looking after and is willing to do the caring, is for them charge the relative to look after them. If a parent moves in with a child and sells their property then surely they could charge the parent 'rent' and charge them for the caring thus transferring funds to them?

There are 168 hours in a week.

If the fee is 1500 a week, that is 8.92 an hour.

That 8.92 an hour needs to cover
Staff wages - national minimum wage is 8.20 an hour (although do you want carers on just nmw is another question plus you might also need nursing care which is more expensive.
The building
Food
Laundry
Cleaning
Insurance
Back office staff like finance, HR

If you need 24 hour care, it won't be cheap. Plus private companies need to make a profit.

However many people don't actually need 24 hour care or if they do, it's for a fairly short period ahead of dying. (There are obvs people who do for a long time but they are a relatively small share)

There needs to be much better care at home with 2 or 3 visits per day plus proper remote monitoring.

And better options for sheltered/supported accomodation where people live independently but also as part of a community and with support staff on hand.

I'd nationalise it all, making a National Care Service alongside the NHS and run it in a similar way with local commissioning groups responsible for providing services in their area.

NI is regressive so I would increase the top rate of income tax, increase divided and capital gains taxes (the rich don't pay income tax) and increase inheritance tax on all but also remove all trusts and other exemptions the super rich use.

The next Duke of Westminster should be paying a solid 40pc inheritance tax on all his wealth.

Take it out of the hands of companies who run for profit.

We need to treat carers better.

My friend had a job as a home carer, she was only paid for the time spent with clients. She might do a 7am call for 15 minutes, then have to travel 10 minutes to the next client, spend 15 minutes with them and so on. She was also asked to step in at the last minute in an emergency, sometimes the drive would be 20minutes so that is another 40 minutes unpaid time.

In a 6 hour shift (because they didn't even give her regulat hours) she might be paid for 4 hours.

She lasted 6 months and said she was the only person left amongst those who trained with her.

@Purplewithred not really so. A lot of state care is exactly the same as private. My mam is self funding in a care home with the majority of other residents being state paid for. They get exactly the same care, or probably more care, than my mam who is paying for it.

Does anyone remember a program from years ago? It was called Logan’s run. Basically people were “terminated” at 35 (I think). Well there’s something to be said about that. Obviously not 35, but ….

For starters we need proper training and registration of carers. I use social care I’ve had amazing ones with high skills who get sent to some really demanding high spec clients (not me!) and get paid 50p more hour than someone’s who’s really rubbish barely does basics and not trust with any kind skilled job at all. No benefit to being really skilled it gets your no where and you literally get all the shitty jobs.

Having proper training and banding of carers would mean you could move up ranks and you would be able find carers with skills you needed. But this need huge cash injection from social care funds. They have been saying for years can’t get staff but this winter will be tipping point. Like lorry drivers you will have to start paying at some point. Don’t know why can’t start taking the money out soon as xtra NI kicks in.

Proper action taking against agencies who don’t pay travel time. Every year we have one day where some naughty companies get publicly named and shamed but only tiny percentage of those who are guilty. I’ve never had carer who gets paid travel time used 4 agencies so far.

Start paying family carers least living wage. We wait until family carers is at breaking point then we go from £67 week support to paying thousands especially if they have no
Income of their own. Makes no sense at all. Family carers could carry on for longer and fee properly supported. Additional funding could be given like respite to enable them stay home for longer.

@ThreeLittleDots

Yes to assisted dying.

And also for carers to receive greater salary, training and respect than they do.

Agree with both. My mum is self funding in a care home. She is functionally as low as you can be whilst still being alive. Yet as long as she opens her mouth to receive food and drink, she is kept alive. But not living. She is young (early onset dementia). This could go on for years. The doctors meet every crisis with treatment and medicine. It's devastating. She'd be horrified at the position she's in now. There is a fate worse than death sometimes.

All assisted dying would mean is that every person who has LDs and needed complex care, would have their lives ended. What the doctors did during Covid, shows that. They didn't 'waste' resources on them and put Danes on previously healthy younger people.
Assisted dying won't make a dot of difference to the costs and the two shouldn't be put together. It will change people's thinker further that those who aren't working are a drain. It's a dangerous road to go down.

Purely on the financial side, I think people who are making a permanent move to residential care need to exhaust all their assets on care fees, with a deprivation of assets rule starting earlier than it does.

I’m not rich, though I’m extremely fortunate that I’ll likely retire with a paid off mortgage and a house worth £250K. So this would affect me.

The state (everyone else, and me now, via tax) should not pay my care so that my children - who have done nothing to earn it - get quarter of a million.

Is it unfair that I get sick or frail and my sister doesn’t, so her kids inherit? Not really. But them’s the breaks. Plenty not fair in life.

Is it fair that I save all my life and my neighbour doesn’t, and I lose mine to care fees? Not really, but again - that’s life. She already gets tax credits that I don’t (and that’s fine by me). You could have a 2 tier system. Quality of care should be equal, but maybe I’ve got a sea view and she doesn’t. Then I’m in the cheaper room when my money runs out. We have these disparities all through life - shitty house shares vs own penthouse. We accept them for in the pre care home years.

I don’t know how to model how that would change behaviour. Would I stay in the smallest house I could, downsize in retirement and spend spend spend? (or outside of the deprivation rule timing, gift gift gift?) Well - good for the economy and good for movement in housing market.

I’m happy to be challenged if the reality is that most people in elderly residential care don’t have many assets and my proposal wouldn’t generate much. But in principle - you need care, I think you pay.

My FIL went into a home in 2019. He and MIL split the house so she wouldn’t lose her home whilst he needed care. All legal, very fair. But my husband has inherited £90K now FIL has died, as he willed his share to his child. In my opinion, the cost of FIL’s care in 2019 should be repaid from that £90K when MIL dies or goes permanently into a home herself.

Why are people squeezed even more on NI, yet my FIL gets free care and my husband gets to pocket £90K that he didn’t earn?

Assisted dying won't make a dot of difference to the costs and the two shouldn't be put together.

Of course it would make a difference. With my mum, fir example, she has lived at least 18 months longer than she would have wished. All involving huge amount of social care, and NHS resources. But I'm not saying this on the basis of cost.
I know it seems like a slippery slope, but I would honestly rather end my life whilst I'm in control. Maybe this is after being involved with a close relative. Dementia in particular is a completely dehumanising experience. We treat animals with more dignity at end of life.

Assisted dying, much as I support it being legal, is a red herring.

The main reason for most people needing care is dementia. You can’t consent to euthanasia if you don’t have capacity. By the time it’s an option, you can’t consent to it, however much you might have wanted it previously. My living will states that, following a diagnosis of dementia, no other conditions are to be treated so hopefully a chest infection or pneumonia will carry me off. That’s the best I can hope for.

@Candleabra would your mother have been prepared to sign authority to you to make that decision? My husband watched his first wife suffer horribly and would do so. But I think if we added up the number of people prepared to do that, and those who were still competent to make the decision themselves it would be a drop in the ocean, financially.

I don’t disagree with you on the principle - but I won’t do much on its own.