...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||

[quote Mercurial123]Swedish care for the elderly looks pretty good.

sweden.se/life/society/elderly-care-in-sweden[/quote]
It does, but many on here will not like the tax rates.
Income up to £1,700 - tax free
£1,700 - £45,000 - 32%
£45k+ 52%
Their payroll taxes are 31.4%, vs 14% for er's NI so it is a lot more expensive to employ someone.
Their VAT is 25%, with a 12% rate on food.

I would be all for taxing at their levels, for the levels of public services Swedes get, but by the look of in on here, when NI has been put up 1.25%, the majority of Mumsnetters would lose their shit entirely.

Do we need a National Care Service rather than for profit, private companies providing it and making money out the system?

The spirit of the National Care Framework in Scotland does not bear any reality to the delivery of care in Scotland.
Personal care is free , if and once you are assessed as needing it. My mother died waiting while my siblings and I struggled with work and care. Like most carers, we did not qualify for any carers allowance as we a) worked and b) shared the load.
Homes in Scotland still need to be sold to fund care and I am completely fine with that. Oh and we do pay higher tax too. Not so excited about that.
Fixing the care system requires a societal attitude change. We are a society that expects to outsource our care needs. We need to get our heads round the fact that to do that to a decent standard takes money & that’s raised via taxes, probably looking at all types of personal taxes including inheritance, etc.

@ilovesooty

We legalise assisted dying.

ffs when will people realise NOT ALL PEOPLE LIVING IN CARE HOMES ARE OLD, OR AT END OF LIFE. DISABLED PEOPLE LIVE IN CARE HIMES TOO.

1. Legalise euthanasia
2. All care homes state owned with set fees
3. Set fees allows people to insure ahead / have an ISA to help with fees
4. Wait for all the "I will not sell my massive house to pay for care as I want my almost-as-old-as-me son to inherit" to die
5. Pay caring staff better (with the profits no longer going to private care home providers)
6. Educate people on DNRs and Power of Attourney at a younger age so they can plan ahead (eg I'd have a DNR if I was past X age and diagnosed with A, B or C).

[quote Cocomarine]@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.[/quote]
I think she would.
But she would need to have done this years ago.
By the time she was diagnosed with dementia it was too late. She still had capacity (legally) for a while but was altered enough that her personality was significantly changed. She wouldn't sign POA for example.

ffs when will people realise NOT ALL PEOPLE LIVING IN CARE HOMES ARE OLD, OR AT END OF LIFE.
DISABLED PEOPLE LIVE IN CARE HIMES TOO

No ones saying that us the case. Stop shouting.

Of course care homes facilitate a broad range of ages and abilities. The suggestions dont have to cover every single type of resident.

@Candleabra, could your mother have consented? Would she had given you the power to do so when she was well? The percentage of the budget taken up by people in your Mum's position is tiny. I'm not prepared to sacrifice people who are disabled, but healthy and living their lives quite happily to save it.

@BernadetteRostankowskiWolowitz, what do you mean by euthanasia?

@Samcro

Stop shouting. Nobody is assuming that.
If we can cut the bill for elderly residential care (like my suggestion that people actually do have to sell their house, tough cheese) then we have more money left for disability care earlier in life.

Though I don’t have the statistics, I’m willing to bet that the huge increases (percentage and actual people) predicted for elderly care requirements far outstrip projected increase in disability care for younger people.

[quote Ponoka7]@Candleabra, could your mother have consented? Would she had given you the power to do so when she was well? The percentage of the budget taken up by people in your Mum's position is tiny. I'm not prepared to sacrifice people who are disabled, but healthy and living their lives quite happily to save it.

@BernadetteRostankowskiWolowitz, what do you mean by euthanasia?[/quote]
Sorry probably wrong word - Dignitas, basically.

Don’t forget 1/3 users are under 65 and half the cost goes toward that age group. Mainly for children and young adults with disabilities and complex needs. None of this just sell your house will work for most of this age group. We need vastly improve what care is giving above and beyond the washed dressed fed. That’s no way live a whole life and just stay home rest of the time watching Tv

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.

Wow. I'm a carer, and this has really upset me. I've got 24 years' worth of experience, and my skills and compassion have meant that I've been extremely well regarded by everyone I've looked after in their final stage of life.
Reading that is like a kick in the stomach, particularly in light of what carers have been through over the past 18 months.
Plenty pp saying that carers should be more valued and respected, yet perceptions like this go unchallenged. Awful.

@Candleabra, could your mother have consented? Would she had given you the power to do so when she was well? The percentage of the budget taken up by people in your Mum's position is tiny. I'm not prepared to sacrifice people who are disabled, but healthy and living their lives quite happily to save it.

I don't know if she would have consented years ago when she was well. Perhaps not. Noone thinks they'll end up in such a position. I only know that she would hate what has happened now. And having seen it first hand I would consent to my daughters having the power to end my life at an appropriate time. To spare them the pain and stress of what I've been through. Leave them with happy memories.
I know that could be hugely exploited. I don't know what the answer is on a population basis. I only know that those are my wishes.

(And I would have thought that dementia patients near the end of life makes up a huge proportion of care and NHS costs. I'm obviously not suggesting that people with good quality of life would be subject to euthanasia).

To the poster advocating the Logans Run solution - what age do you suggest. I'm 63. How long will you give me?

My parents are both 86. Still drive. Still in their own home. No carers. Do their own shopping. But getting frailer. Guess they should be off soon then.

A National Care Service would be a good start. Have a look at the profits made by care homes it does not cost what they charge, it is about making money out of people with no other options

So sorry @JockTamsonsBairns, I’m not surprised you’re upset. My mum’s carers were absolute saints. They cried when she died and several of them took time off work to go to her funeral. It’s absolutely shocking that people have such an appalling misconception of carers.

the 60-year-old with her own health problems caring for her 80-year-old parents who are even more frail

Why is a 60 year old frail? I’m 57, Dh is 62. We are both absolutely not frail! You have to work until 67. We can’t have health problems!

It bears mentioning there is no “deprivation of assets timescale”. Councils can look back as far as they want when deciding if there has been intentional deprivation of assets. It’s a common myth with comes up here a lot.

I don’t have time to Google for it now, but I read an interesting piece in the press not long ago.

It was about the US system for end of life care, and insurance. Not elderly, any condition. There was some issue that you basically only got one chance to pick a pathway - end of life palliative only, or medical intervention. So they did a study with agreement of insurers that people ours switch between. More went for palliative care. There wasn’t much difference in remaining life, and quality of life was judged far higher by those on palliative.

It quoted a huge percentage of overall medical costs (not care) falling in the last 6 months. For an individual to get some extra weeks? Hard to say that’s a bad thing. But on a population level… it’s certainly an interesting ethical debate.

@ZoBo123

A National Care Service would be a good start. Have a look at the profits made by care homes it does not cost what they charge, it is about making money out of people with no other options

This is start. Donkeys years ago council had home helps who paid well and a offered good service. Then it started being charged then went private and out to lowest bidder. Make vast majority state control And no profit with option like now for private care above NhS level.

@GingerAndTheBiscuits

It bears mentioning there is no “deprivation of assets timescale”. Councils can look back as far as they want when deciding if there has been intentional deprivation of assets. It’s a common myth with comes up here a lot.

That’s true, and I mentioned extending the time period for deprivation of assets myself.

But if an 80yo sold her house at 60 (fully well) to fund a purchase for an adult child, I think currently a council would have a hard time pursuing that.

I’m saying that even at 60, you should know that you can’t give away assets beyond a set sum, or it WILL be clawed back. Not might. Obviously not retrospectively! We need to plan for potential care home fees, and for many that will be knowing their equity is the answer.

I say 60 - I’m not trying to put an actual age on it here, just picking a 20 year period that I think a council would struggle to justify today!

It's not just assisted dying it's taking a far more real world on what is provided during end of life care.

We now seem obsessed with keeping people alive for the sake of it regardless of quality of life.

I fully appreciate the oath doctors take but is it right to keep someone going just because you can?

As for assisted dying, if we did extend it's provision we very much have to ensure that sufficient deterrent exists for those who will abuse the system.

Any actuaries around?

How much would you have to pay as a private insurance premium for a care home payout?

What impact would voluntary care home insurance have? People pay for life insurance, critical illness cover, medical cover, income protection…

@Cocomarine

Any actuaries around?

How much would you have to pay as a private insurance premium for a care home payout?

What impact would voluntary care home insurance have? People pay for life insurance, critical illness cover, medical cover, income protection…

Didn’t Dilnot look at that and found no insurance company would touch it because there would be too few premium payers to spread the risk?

@Cocomarine absolutely, there are criteria the council needs to satisfy (did the person have a reasonable expectation of needing care when they disposed of the asset, did they know they’d need to pay for care and was the asset disposed of with the intention of avoiding paying for care). But too often people here suggest “signing your house over” as a solution to paying care fees and it’s misleading, that’s all