Elderly care: The other options

Elderly hand holding coins There is disagreement over how reform of social care should be paid for

There is now a growing consensus that elderly care needs reform.

Councils are increasingly having to ration the support they provided in people's homes and the care home places they fund.

But the big unsolved question is how to pay for change.

In 2011 the government-appointed Dilnot Commission recommended an individual's lifetime costs be capped at £35,000 in England.

But this would cost £1.7bn a year - a figure which would rise in the future.

Ministers have spent the best part of two years discussing how to proceed, but have yet to reach agreement.

In many ways that is not surprising. Reform of social care has actually been on the agenda since Tony Blair came to power in 1997, but a combination of cost and complexity has meant that no government has felt able to push ahead with reform.

Lib Dem MP Paul Burstow has waded into the debate by suggesting the winter fuel allowance should be means-tested to pay for a cap on costs.

But this has caused controversy among some and, what is more, David Cameron has always promised the payment - worth between £200 and £300 for the over 60s - would not be cut.

So how else could it be paid for?

Setting the cap at a higher level

The Dilnot Commission actually suggested a level of between £25,000 and £50,000 with £35,000 being the favoured amount.

The thinking was that this was a sum that was affordable enough to get people engaged with planning for old age, but low enough not to be a drain on the public purse.

The hope was the insurance industry would start to develop products safe in the knowledge that the catastrophic costs - one in 10 face bills of over £100,000 - would be covered by the state.

However, ministers are known to have being discussing whether it would be feasible to set the cap at a higher level, perhaps even as much as £75,000.

This, of course, would be cheaper for the government. However, some have expressed concern that setting it so high would discourage people from planning for old age.

Raiding other benefits and budgets

Since the Dilnot recommendations were published a variety of other funding sources have been put forward to pay for it.

Who gets what care

social care promo image

Last summer the Nuffield Trust think tank highlighted a range of benefits that could be targeted.

These included the free TV licences and travel concessions that older people are entitled to as well as the winter fuel allowance.

It also suggested the NHS surplus - which stood at £2bn last year - could also be used.

Others have looked at some of the tax-related benefits the elderly are entitled to, such as relief on capital gains tax at death and those related to pensions.

Get everyone to pay

This was actually proposed by the Labour government in its final months before the 2010 election.

The then health secretary Andy Burnham, who is now the shadow health secretary, called for a universal levy that everyone but the poorest would have to pay.

The figure put forward at the time was £20,000, which was thought to be enough to cover the costs of everyone who needs care.

One of the options floated was allowing people to defer the payment until after they die, prompting the Tories to dub it a death tax.

The idea was soon put on the backburner as the election campaign got into full swing, but many within the sector thought it was an excellent idea.

Pool budgets with the NHS

The NHS budget tops £100bn - six times what is spent on social care.

If just a fraction of health spending was diverted to social care, councils argue it could make a big difference to the services they could provide.

Even just a little more collaboration could make a difference as there is a great deal of cross over between the two sectors - particularly within NHS community services such as district nursing.

Such moves benefit the NHS as well. When vulnerable elderly people do not get support from councils their conditions can worsen, leading to hospital admissions.

To some extent this has already been recognised by ministers - by 2015 £1bn of NHS money will be reserved for supporting social care.

But some believe there needs to be a much more radical approach. In Labour circles there is talk of merging the two budgets.

How this would work in practice and whether it would negate the need for a cap on care costs remain to be seen.

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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  • rate this

    Comment number 189.

    It would be handy if they noticed that plenty of people use social care who are not elderly, but rather disabled. In Scotland, our care is means-tested while the elderly get it free. We're likely to use care for many more years than someone near the end of their life. I'm in favour of means-testing for all, and for all benefits, but set the threshold higher, as right now it's ludicrously low.

  • rate this

    Comment number 188.

    Educating the public that a long life is not necessarily a good quality of life is another aspect of where we do not use common sense. What is the point of undertaking life threatening surgery where prognosis is poor, or the possibility of recovery is minimum. Rationing is a dirty word because we do not want to face up to the costs in caring, whether for the elderly or the population at large.

  • rate this

    Comment number 187.

    Inspite of the millions being provided to care homes for the elderly and the young, social services is not fit for purpose, should be disbanded, the costs of running the service should be re-distributed to volunteer organisations which used to campaign for better services in the past, but are now providing levels of care superior to the private sector.

  • rate this

    Comment number 186.

    Re. 185
    Thank you so-called moderators. Think about what has happened at Stafford Hospital and the abuse that has occured in many so-called nursing homes and finally take a reality pill.

  • Comment number 185.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 184.

    Just diverting the £10 Xmas bonus which is paid to millions of state pensioners and others entiltled people (https://www.gov.uk/christmas-bonus/eligibility) would yield a tidy sum which could be used for elderly care.

  • rate this

    Comment number 183.

    Dilnot said any cap on costs applied only to the "nursing" element, so we will still have to pay for accommodation which is the major expense.
    Don't think our estates will be protected from the costs of Care even if the government suggest a cap as a part of their election PR spin. Remembers when the Tories dangled a £1m IHT threshold for us, and that disappear as soon as they got in power.

  • rate this

    Comment number 182.

    The subject of right to die should be revisited, not on moral grounds but economic.........what quality of life is left in most cases?

    I think you have the right to die argument confused with forced euthanasia! The cases should be based purely on moral grounds and the right to choose, not forced because we cannot afford it!

  • rate this

    Comment number 181.

    Its quite simple if it is just care with day to day living then I am afraid we have to pay - or get family members to do the caring. However what really get my goat is that Alzheimers and Dementia both of which are illnesses are not classified as such We pay nearly £40,000 a year for mum other who has both conditions and no help at all from the NHS

  • rate this

    Comment number 180.

    Taxing multinationals who currently don't pay any would easily cover the cost of elderly care. Funny how that wasn't considered an option.

  • rate this

    Comment number 179.

    The subject of right to die should be revisited, not on moral grounds but economic.
    My grandparents on maternal and paternal side suffered for years with Alzheimers. My father has early onset Alzheimers.
    It's all very well and good encouraging people to live healthier so they live longer; but who picks up the cost and at the end, what quality of life is left in most cases?

  • rate this

    Comment number 178.

    I think you will find most pensioners live in fuel poverty, This means they use 10% or more of their disposable income on energy needs,
    and you will find people were encouraged to have children after the wars as we lost so many young men and women.

  • rate this

    Comment number 177.

    So we can not afford to spend £!.7bn on the elderly who have worked all their lives but can spend £9.4bn on a sporting jamboree.

  • rate this

    Comment number 176.

    Yes, pensioners have paid National Insurance all their lives, but that money was spent on supporting other needy people/retirees (& MP's expenses) long ago. Those of us currently working pay for the pensions & care of older people now. No-one can expect to get back what they paid in. It doesn't work that way. And if you can afford to pay for your own care, you should.

  • rate this

    Comment number 175.

    @172 laughingman

    The tories have never hidden the fact that they prefer to support the rich, not the poor - people have voted for them so this is what we should expect. Remember the other tory who made life miserable for women even though she masqueraded as one?

    As for sterilising mothers or taking children into care - these are not solutions which would be used in a so called democracy.

  • rate this

    Comment number 174.

    @John 156 the number I quoted were adjusted for inflation though. In cold hard cash terms today's OAP get back about double what they paid in. It's only when you adjust or inflation that the extra they are taking out drop to about 25% more than they ever paid in. Whatever way you calculate it they are getting more out than they ever put it and that extra is being paid by my generation.

  • rate this

    Comment number 173.

    Will the idiots going on about "baby-boomers" give it up! Todays birth rate is more than it was after WW2 (Tonight program last night).

    Care for the elderly is totally affordable. It must be as we can afford £bns for phoney wars, aid to India & China who have their own space programs whiist we don't. Surely if we can't afford to look after our elderly we wouldn't have money to give away?

  • rate this

    Comment number 172.

    @170 josy

    It is not a question of radical reform, just educating a population that the reality for many across the world is that you rely on your family & your own initiative...
    Education agreed, but you didnt answer the question.

    Vodafone, Starbucks, Amazon etc are worse criminals, but the Tories prefer to attack the unemployed/disabled using distorted anecdotes rather than their rich mates!

  • rate this

    Comment number 171.

    My problem is that the state encourages indolence, rewards people for being dishonest, while penalising those who actually work very hard to make a living, paying their bills & keeping politicians in their jobs which include so many perks, no wonder we have so many dishonest politicians at westminster, which is closer to Mugabe than they may think in terms of integrity or lack of.

  • rate this

    Comment number 170.

    @169 laughingman

    It is not a question of radical reform, just educating a population that the reality for many across the world is that you rely on your family & your own initiative, not the state to provide for you, with taxation being misused because the public purse is a cash cow for politicians


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