/ Health

Have you planned for care in later life?

Pensions savings

Only a small fraction of us are planning for care costs in later life, according to our new research. How concerned should we be?

As I plan my day to day spending, I don’t think much further than the next holiday. Even home improvements that are a year away seem too far in the future to save for.

So it doesn’t altogether surprise me that only one in ten adults aged 55 years or over say they have put aside money to pay for any care needs as they get older, according to our new research.

Like me, more than half of those over-55s say they are prioritising other things they want or need to do right now, over planning for potential care needs.

And this is backed up by behavioural research: even if we get good information and advice, we don’t want to think about ageing and needing care.

Non-planners

So how can the government help people like me – the non-planners? Well, rather than encouraging me to plan, a new policy report by Which? says it can improve the system to help me live at home for as long as possible in retirement.

When asked to think about what changes they may make if their health and mobility did deteriorate, nine in ten people aged 55 and over said they would be willing to make adaptations to their homes to aid mobility and a similar percentage said they would be willing to use mobility aids outside the home.

This resonates with me. My parents have installed a number of aids and adaptations to help them enjoy their home: the bath lift that allows them a well-earned soak, the riser-recliner chair that looks like a very superior addition to their furniture rather than something you’d find in a hospital, the very smart trolley that also serves as a walking aid.

Such equipment – more acceptable when it looks desirable – could cut falls needing medical treatment by a quarter, and save the NHS and social care services £500m each year, the Centre for Ageing Better estimates.

Info deficit

The key to planning is also good information, but our research tells us that less than half of people know where to look for information about care. This is where Which? Later Life Care can help, which provides information on all aspects of choosing care, including financing and housing options.

The GP is trusted to give good advice and support, along with friends and family, but is the already packed 10-minute GP consultation really the best place to get care information?

What’s needed to make sure people get the advice they need from the places – like the GP surgery – they turn to?

Would you plan for your care? Is it on your list of things to save for? And – as the government works towards an Autumn social care green paper – what do you think is needed to support older people in the best way we can, given that many people use the care system for the first time at a time of crisis?

Populus, on behalf of Which?, surveyed 2104 UK adults online between 11-12 June 2018. The data were weighted to be demographically representative of the population.

Comments

Opportunist investors using care homes, for the increasing amount of elderly, to suck the house equity that many people have of a particular generation, maybe hence the let up in Inheritance Tax so as to enable the profits for these ‘people’… (I have previously been contacted in regards to this when I ‘ticked’ for investment information…8^[] – all planned and positioned in advance for maximum monetization…

You could start by campaigning for more transparency into a care homes general acquisition and distribution of their finances so that Prudent Peter, or his next-of-kin, can make an informed decision as to which care home his life savings are about to be relinquished to.

Marie Rumley says:
2 September 2018

As a nurse who brought up 3 special needs kids and with no pension other than a state pension ,had to work part time to raise children ,I can’t save ,nurses are poorly paid ,I’ve never had a holiday abroad ,or even in this country,I still help my mentally ill daughter financially,with bills rising over income I wonder what will become of me

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It’s to late for those of us who believe that our old age would be in place. We have paid taxes in full. For a full working life. I am 77 years old and paid taxes from 16 years of age 65 retirement age. I have never been out of work. What about the pension we were promised. But sadly it was not invested for us but was spent by the government on other things and other Countries. Had it been invested for us we could have paid for several careers or care homes. Plus our taxes have paid to build and care for others.

I agree your sentiments Clive. Over a period of 61 years, you have paid your income tax, your council tax, your VAT tax and probably interest on your mortgage payments, (if you had one) and if you have to go into care you will most probably be expected to sell all your assets in order to subsidise council places who pay less than you!
This is not a tax it is plain robbery by the back door!

Log onto: ft.com – Self-funding care home residents subsidise council places.

As care home fees were not intended to be provided for out of national taxation, and as local authority grants have been cut, with consequences on the services they can offer, I don’t see a way round this that is easy. We cannot, presumably, deny people without assets access to some sort of care, and if the council fees don’t pay enough, and there is no state subsidy, then I see no option but for self funders to “help out”.

It is not “fair”, but then not fair applies to many benefits.

If no state provision was ever made then it is up to individuals to make such provision, including selling assets. Should they be allowed to keep all their assets, to pass on to others, by taxpayers funding all their care costs?

Unless and until we have a scheme in place to compel individuals to make provision for their care I see no option. Regrettable though that might be.

As Malcolm has explained, adult social care was not part of the life-long NI-supported welfare state covenant. It is not appropriate to count council tax payment as part of one’s contribution since that pays for municipal services and has always required additional government grant. Council tax does not generate a surplus that can be invested as an insurance fund to meet residential care charges. Most councils’ reserves have been reduced to a low level, imprudently so in some cases. Mortgage payments are no more than the loan repayments on – in most cases over time – an appreciating asset.

If people needing residential care have financial resources [including the liquidation of assets] that can provide them with a better standard of accommodation and care than the basic minimum, is it not sensible that they should use them for that purpose in later life? If they die before the money runs out anything left over becomes part of their estate. If the money runs out before they die their local social services authority will be responsible for their continuing residential care until their death however long that is. This could, of course, involve a transfer to a lower standard provision. This continuing care would be funded by the council taxpayers at the time and almost certainly be cross-subsidised by other care home residents who are self-funding.

It’s a matter of personal choice, but I don’t think there is a moral obligation on the children to fund their parents’ care if that would compromise their ability to fund their own requirements when they are older.

I would at least expect social services to pay an equitable fee if I ever found myself without the funds to cover my own care. I would not feel comfortable in a home if I thought my fellow residents were subsidising my care.

Let’s have more transparency so that we have some inclination as to where our life savings are being spent and on whom, including shareholders as Dean has pointed out in his comments on 31st August.

One way to deal with this might be for local authorities, the NHS, or national government to set up their own care homes. We might then have transparency of costs. However, as long as care homes are largely run by private enterprise for profit I see no transparency forthcoming, no more than in any other commercial undertaking. Investors take the risks of balancing all their costs against their income, like hotels but more complex because of long stays and medical conditions.

I don’t think private care homes is the right solution for many, because of the commercial interest. It will suit those with assets who can pay the going rate for a higher standard of care (accomodation, food, entertainment for example), but we need another industry to do what hospitals try to do – provide a decent basic level of care for all who have negligible assets. It still needs to be paid for but I do not see why that burden should fall on the vagaries of local government budgets.

It is impossible to predict, Beryl, what the demand for and availability of care home places will be at any time, and although social services will be under a duty to be as economical as possible in their placements it might not be practicable to avoid placing someone in a home where the private self-funding fees are higher than those paid by the council on a negotiated contract basis. What they will seek to avoid is cascading residents down through the system with frequent changes of accommodation but transfers to smaller rooms in the same home are not unusual so that the best rooms are provided to the full-fee self-funding residents. But the dinners and TV programmes will be the same whatever your billet.

The usual complaint is from self-funding residents who are paying the full whack and see state-funded residents enjoying the same facilities at no cost to themselves other than a portion of their state retirement pension. Personally, if I were in that situation and was receiving the quality of accommodation and care that I was expecting for the fees I was paying, it would not bother me if there were other residents there who had made little or no contribution. They might make more agreeable company than the others.

A number of residential care homes have structured their fees, facilities and care modules to price out the need to take in council-funded residents, but they are only suitable for those with considerable incomes from their invested wealth and occupational pensions. However, if their money runs out they might have to accept a move to another place and a downgrading of their accommodation as the local authority takes over financial responsibility for them.

I didn’t fully understand the point that Dean Fergusson was making. So far as I am aware, unless they are collaborating with an equity release scheme in some way, private residential care homes have no attachment to the property of the residents. Private self-funding residents meet their fees from their own incomes, savings and investments held in their own bank or fund managers’ accounts; as mentioned previously, anything left over when they die becomes part of their personal estate. If people enter into an equity release scheme, the equity release company will retain the asset which is security for the advance but which will presumably be sold as soon as the person moves out and into residential care. The equity release company takes a risk [although heavily hedged by undervaluation] on how long the proceeds will last depending initially on the life expectancy of the individual and eventually on how long they survive. If they die before the money runs out there is no refund but if they live longer than forecast the company keeps paying the contracted amounts. This just a more complicated form of life assurance and should not be entered into without a full consideration of all the issues and financial illustrations from a number of equity release companies. The more risk that the company is taking [e.g. on the value of the property at the time it goes on the market] the lower will be the forecast benefits.

The whole care system is not fit for the purpose it was intended for. Care Homes seem to be coming
scarcer and more expensive, It has now come to the situation that we need a serious debate on how we
should finance our care in old age. The whole care system from top to bottom is not fit to be called a care
system. It has been woefully under funded for years. As we get older care in our twilight years is going to be financially crippling. Any relatives about could be in the ludicrous position that they could be expected
to be in the situation should there be any short fall incurred financially by the relative being cared for. It is
as though the administration for this country is sleep walking to go over the precipice. Being a wrinkly
myself it makes the mind boggle Why life is becoming such a chronic nightmare.

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This comment was removed at the request of the user

Every day it seems a private care home closes. To my mind it would not be difficult – if the will was there – for the state to take over such establishments by one means or another and run them through the local authority social services departments as used to be the case or by contracting out to not-for-profit, charitable, or commercial companies providing there is competent supervision of the contractual performance. Norfolk County Council does this very successfully for its numerous care homes through a county council-owned company that operates at arms length.

This is in respose to duncan’s post above. There seem to be aspirations but nothing unexpected. This gives the new terms: https://www.sehd.scot.nhs.uk/publications/CC2018_02.pdf

While I’m editing, in response to John I agree that not only would this give local authorities the opportunity to build up local care but it would also avoid disturbing settled residents when a private care home cannot continue. My only worry is whether all local authorities have the competence to properly manage such homes. I wouldn’t like to see the operation “outsourced” to even less competent organisations (G4S anyone?)

A definite thumbs up from me this time John 🙂

Thanks John. It’s good to see some good news, though you have mentioned Norfolk CC before.

I agree that the quality of the local authority management and contract supervision are crucial to making this work. I presume in such a scenario that all the staff employed by the former private home would have to be taken on by the local authority in the first instance just to maintain continuity. There would probably need to be a period of assessment and training while the establishment was prepared for either direct operation [I’m not sure if the compulsory competitive tendering legislation presently allows this] or for outsourcing the operation. In some cases the condition or suitability of the premises might not be satisfactory and substantial [and expensive] upgrading might be required to meet current standards. The reasons why the home closed would have to be explored so it could not be an automatic process. But if the government wants to redeem itself quickly in the adult social care sector this could be a better route than some others.

Once it was a declared policy there could be a number of homes offered to the state where the owners could not run them safely or economically. Given that the UK probably needs more places rather than fewer there could be pressure to transfer every establishment offered to the state but I think alongside such a policy there should be a programme of new-build care homes to provide short-term spare capacity so that local authorities had a choice and owners could not threaten to close knowing the council would automatically take it over. Protecting the residents’ interests must be paramount and they must not become a bargaining chip in any negotiations, although that is easier said than done. This would all have to be handled very sensitively to minimise disruption to residents. It is well known that transfers of settled residents from a care home in the later stages of life can be fatal, if not immediately then quite shortly afterwards. Running a home down to a handful of residents does not work either so while this idea might appear to be a possible solution it is not without many complications. Basically the objective is to substitute competent management by an accountable authority in accordance with good policies and standards for private proprietor management governed entirely by the profit motive. It is almost certain that the cost to the state in one form or another would be higher but that is the price the country needs to pay to get the system right. We should not overlook the possibility that if the money were available it might be better for social services authorities to pay more for each placement and enable existing private care homes to operate them to a higher standard and avoid [or reduce] the likelihood that one set of residents was subsidising the others. I believe there are some well-run care homes with good management and staff who have to accept low weekly rates from the local authorities or go out of business entirely; it might be better in a crisis to prop such establishments up through additional funding than see them collapse or refuse to take local authority placements.

Other reforms as suggested in previous Conversations on care homes would need to accompany these measures.

The impact on the elderly and infirm, including their relatives, is very apparent when you read through the many comments on this website and the anxiety about their future welfare and their availability to pay for it starts long before they actually need it. Elderly partners will struggle to provide care in their own homes and I have it on good authority they often suffer more than the patient, especially in cases of dementia.

Care homes employ support workers because most earn a minimum wage and.cost a lot less to employ than professional help, but the evidence clearly demonstrates that care is often compromised. The advanced stages of dementia, as previously stated, needs specially trained psychiatric professional help in a psychiatric unit and paid for by the State on the NHS. Dementia is, as yet, incurable and remains an incurable psychiatric illness and should be treated as such.

I watched my father, a tough and extremely independent guy struggle to cope with my mother with a daily outsource visit from a registered nurse, until she passed away at home from a major stroke. He passed away 6 years later from metastatic cancer in hospital and paid for by the NHS, choosing to refuse all medication apart from strong painkillers, rather than be transferred into a care home. He left the proceeds of his estate to his children in his will.

Life in later years does not get any easier despite what anyone tells you, and I talk from someone who has actually arrived, but the final blow hits you even harder when you are left with no option other than to part with all of your hard earned savings into a system that continues to falsely promise free care at the point of need – but that also fails to add………….until you are 65.

The system does not promise free care homes for all. I think it quite reasonable, under the present circumstances, for people who have assets to pay for their care. Why should taxpayers subsidise them just so they can pass on their money to others? As I have said earlier, for those who have no assets there is a safety net; inadequate though. It needs addressing. How do we want the uses our taxes are put to – that’s where the money will come from – to be prioritised?

The system promises free care at the point of delivery, that it is based on clinical need, not ability to pay.

It does not say anything about free care homes but on the actual care at the point of delivery, based on clinical need, not ability to pay.

No, that’s right, but we were, I thought, talking about care homes.

Yes, the welfare state promises medical treatment free at the point of delivery, not free residential care. Those who need medical treatment and cannot remain in their own homes probably need a nursing home and that should be an NHS responsibility rather than a local authority one. This could be the recuperative part of a course of hospital treatment or, in extremis, a place in a hospice.

It is important to distinguish between “care” and “treatment”. I don’t think residential care should involve any professional nursing [like wound dressing, therapy, or application of ointments] but should include facilitating the attendance of the residents’ GP and district nurse, collecting prescriptions, and routine assistance with the administration of prescribed medications by appropriately qualified personnel.

I’m not sure distinguishing care from treatment or vice-versa is altogether appropriate as any treatment would constitute an act of care. For example, on a psychiatric ward, which might well include dementia, nursing staff are trained to constantly observe patients and to anticipate any deviation from normal behaviour and administer medication as and when it is needed.

The elderly gentleman on the admission ward with me in March, whose advanced dementia was causing some disturbance at 3am, was fully dressed and packing his suitcase ready leave. A nurse was having a hard time convincing him it was still the middle of the night and he needed to get back into his bed and sleep until morning, but he was having none of it. The staff finally had to administer medication to sedate him.

This gentleman who was in a heightened state of anxiety and extremely distressed at the time was suffering from a psychological illness that needed 24/7 care and treatment with appropriate medication administered by qualified nursing staff in a hospital that specialises in psychological illness and funded by the NHS.

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I am sure you are right, Beryl, that treatment includes care, but the converse is not true, In the context of what the state provides free at the point of delivery, the adult social care provided in residential establishments is not included. For this purpose, “care” does not include medical treatment and is not part of the welfare state provision except as a last resort and then with a financial contribution according to the individual’s means.

The NHS is responsible for medical treatment [including any care that goes with it] but is not responsible for social care which at the basic level is accommodation with various personal attention functions and meals. It is primarily for people who cannot manage on their own at home but do not require hospital treatment.

Many people choose to enter private residential care homes so they can have an easier life without having to do cooking, cleaning, laundry, other housework, gardening, and property maintenance, and have on-site facilities like hairdressing, manicure & pedicure, exercise classes, social activities and entertainment. Obviously there are many types of care home and the fees reflect the range and quality of the services and facilities offered. The care homes at the budget end of the scale are the ones likely to be used by the local authority social services departments to place people in who have no one else to look after them, cannot manage on their own at home, and cannot be supported adequately by domiciliary care.

One of my uncles spent three years in a care home but had no medical conditions requiring treatment. By selling his house and avoiding the costs of running it he was able to afford to live in the home entirely at his own expense. This necessity can affect anyone in later life so this Conversation is recommending that people try to plan for this eventuality and either make separate financial provision or be prepared to sell their significant assets in order to release the funds required.

If you are seeking a hotel type comfortable existence as opposed to outsourced home care and are prepared to sell all your assets to pay for it then that is your own choice. There are many insecure elderly people (and indeed young people) who just cannot live alone.

The horror stories we are witnessing here however, are not representative of the privileged minority but are of people who are suffering from both terminal psychological and physiological illness that go beyond the care provided by unqualified ‘nursing’ staff because it is cheaper to do so, which begs the question, are they receiving value for their life savings which they have been forced to relinquish?

The overwhelming evidence displayed on this very medium indicates they are not.

There do seem to be a variety of reasoned and informative views throughout this Convo. I wonder what tack Which? will take when it tries to make use of them?

I endorse your comments, Beryl. It is highly likely that many people are in inappropriate accommodation relative to their needs for treatment and care. People who are suffering from both terminal psychological and physiological illnesses should not be placed in residential accommodation that cannot provide the treatment they require and should probably be under the umbrella of the NHS, or, depending on how terminal is their condition, in a hospice or at least a nursing home. This situation could be due to a failure [or misdirection] of the assessment process or by acceptance by the care home of a resident for whom they do not have the necessary qualifications and competence.

Yesterday a glossy flyer came through the door advertising a modern, purpose-built residential care home. It is clearly expensive although no prices were mentioned. The leaflet was aimed at the relatives of prospective residents because throughout it referred to “your loved one”. It stated that the home provides “a full range of personalised care services for older people, from residential and nursing care through to dementia care”. At no point were there any references to skills, qualifications or professional competence, so my deduction is that it is not a suitable place for people who need medical treatment or have physical or psychiatric conditions that need to be professionally monitored day-by-day.

I guess many sons and daughters of elderly parents get hoodwinked into placing their relative into homes like this in the belief that they will receive a quality of care and treatment comparable to a hospital whereas they will just be looked after, with some help with personal requirements, and left to enjoy the many facilities and activities provided. They might as well go on a round-the-world cruise and take a nurse with them; it could be less expensive.

One of the problems seems to be getting the NHS to take responsibility for old people who have an illness or condition that requires treatment, especially of a psychiatric nature where there is not equality of provision. I think that needs to be tackled as a priority. Value for money does not arise if people are being treated correctly via the NHS as no payments are required.

That leaves the question of funding for those entering social care, where it is basically just an alternative to living at home but with most things done for you and for which the state will not pay except as a last resort. It is very difficult to assess the value for money of one establishment versus another without direct, or at least reliable witness, evidence. Management and staff change affecting the quality of service, and the occupation ratio possibly determines the level of support provided.

People who go into a private home on a self-funding basis [whether directly or through relatives] pay as they go, so there is no question of surrendering their life savings in advance and they can leave and go somewhere else if they do not think a place is suitable for them. People whose social services needs assessment supports their being placed in a residential care home do need to make a financial contribution [if their capital and income exceed the thresholds] but that is paid to their county/shire council or London/metropolitan borough council, not to a specific care home. They will not see their money again but it is not at risk and at least they will not have to find it again if the home closes; furthermore the care they receive is unlimited and will continue until the end of their life.

Seeing the number of new care homes, retirement villages, and other commercial establishments serving the senior sector that are cropping up everywhere I wonder whether the number who see it as a “hotel-type comfortable existence” are not in the majority of care home residents rather than a “privileged minority”. Privileged they might well be by normal comparisons, but there seem to be a lot of them and they possibly live longer so they form a larger percentage of the care home population at any point in time. Just guessing.

Since writing the previous comment I have been looking at the Care Quality Commission’s latest report on the care home I referred to. The inspection was carried out in January 2018 and the report was issued in May 2018. There were three CQC inspectors, a specialist medicines inspector, and two experts-by-experience. The first day of the inspection was unannounced.

The inspection followed two previous inspections during 2017 where breaches of regulations were found in respect of the management of medicines and the May 2017 inspection also found that the service [care home] Required Improvement in the areas of Safe, Effective, Responsive and Well-led.

The 2018 inspection found that the areas of Safe, Effective, Caring and
Responsive all Required Improvement while the the Well-Led criterion was found to be Inadequate. The overall rating was Required Improvement.

Perhaps a lot has happened in the months since the January 2018 CQC inspection to justify the glowing terms in which the establishment is described in the glossy leaflet – but then it concentrates on the nice communal amenities, pleasant grounds, and enjoyable activity programme, not on the quality of management and care. The picture of a chef suggests that the meals are good and nourishing and not as discovered when the inspectors asked the residents [“the chef should be called a warmer-upper – we’ve had mince four days a week”].

There were deficiencies in staff competence, adherence to care assessments and care plans, administration of medication, response to call bell summons [including turning them off], shift-handovers involving the numerous agency staff, and management supervision and control.

The [unregistered] duty manager was absent on the first day of the inspection and resigned on the second day. Regional management representatives were obviously called in to assist the CQC inspectors and were clearly unaware of various unsatisfactory situations. The quality of the accommodation and the friendliness and caring approach of the staff were praised by residents and relatives, as well as the compassionate response of the home at times of bereavement.

So, a mixed picture, but on the critical factors the establishment was unsatisfactory in January 2018 and it is doubtful whether everything has been put right in the mean time. The home has a capacity for 80 residents in three categories – residential care, nursing, and living with dementia – but only 54 places were taken in January 2018; a marketing exercise is presumably therefore under way to attract more residents. No mention whatsoever is made in the leaflet of the CQC inspection [not surprising] nor of the existence of the CQC standards and inspection regime. I think it should be mandatory in any publicity to make reference to the CQC and provide a link to its website which includes all inspection reports.

The home’s website does carry information about the CQC, states that the latest report rates the home as Requires Improvement, and provides a link to the CQC inspection report. It also adds the following comment:”We are working very hard to ensure that the service we provide is of the highest quality. We are aware that CQC have highlighted we need to make improvements to our service, we have a comprehensive service improvement plan in place to ensure we are acting to make changes that will be sustained and embedded. Please ask the manager if you wish to discuss the contents of our service improvement plan“.

The care home’s postcode is NR4 7SW. It is operated by Care UK. The home’s website is http://www.careuk.com/care-homes/cavell-court-cringleford

The CQC inspection summary and other information can be found at –
https://www.cqc.org.uk/location/1-2104937207

You can follow the links to the full 21-page report or go direct to –
https://www.cqc.org.uk/sites/default/files/new_reports/INS2-3982557636.pdf

There is a link to the CQC report on the home page of the care home, albeit near the bottom.

Yes, I did mention that in my final paragraph above, Wavechange. I wonder if that is a CQC requirement or is included of their own volition by the company. I still think it should also be included in any promotional literature such as that recently delivered door-to-door.

I must say the care home looks very impressive in the pictures shown on its website. I don’t think I would mind living there if I was fairly fit and well.

Sorry John. I’m not sure how I missed that. 🙁

I agree that it would be useful for literature to carry CQC ratings but there is obviously the danger that printed information can go out of date as I have found with food hygiene ratings.

I have found CQC ratings to be a trifle vague in as much as their reports use such terminology as “room for improvement” which in my opinion is more reminiscent of a school report than an official regulators findings.

For example, why can’t they use hotel-type star ratings so that prospective users can make a more informed choice according to the number of stars awarded. A system such as this could improve care standards and also determine fee charges according to star rating.

From the CQC website:
Overall location ratings are produced on the basis of the following principles:
1. In line with our enforcement policy, the overall rating for a service cannot be better than requires improvement if there is a breach of regulations.
2. The five key questions are all equally important and are weighted equally when aggregating. Please note: for focused inspections, the new ratings for the key questions inspected will be aggregated with the existing ratings for the key questions not inspected.
3. At least two of the five key questions would normally need to be rated as outstanding and three key questions rated as good before an aggregated rating of outstanding can be awarded.
4. There are a number of ratings combinations that will lead to a rating of good. The overall rating will normally be good if there are no key question ratings of inadequate and no more than one key question rating of requires improvement.
5. If two or more of the key questions are rated as requires improvement, then the overall rating will normally be requires improvement.
6. If two or more of the key questions are rated as inadequate, then the overall rating will normally be inadequate.

As far as I can see the key questions are:
1.By safe, we mean people are protected from abuse* and avoidable harm.
2.By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence
3.By caring, we mean that the service involves and treats people with compassion, kindness, dignity and respect.
4. By responsive, we mean that services meet people’s needs.
5. By well-led, we mean that the leadership, management and governance of the organisation assures the delivery of high-quality and person-centred care, supports learning and innovation, and promotes an open and fair culture.

https://www.cqc.org.uk/sites/default/files/20171020-adult-social-care-kloes-prompts-and-characteristics-final.pdf

I would award 5 stars if answers to all 5 questions were positive meaning (yes) and reduce stars accordingly. It would appear the CQC’s approach is somewhat non- committal. Stars would give the necessary reassurance that all 5 questions were affirmative and anything less would be open to question by prospective users.

Having spent a lot of time reading CQC inspection reports I have no concerns over the ratings which I think are a fair indication of the conditions found according to the detailed reports. I consider that a range of “Inadequate” to “Outstanding” is reasonable and comprehensible, and less confusing than giving one star for inadequate. “Requires improvement” and “Inadequate” are quite clear and the category [e.g. “safe” or “caring”] will show its significance to a prospective resident or their relatives. More than one “Inadequate” or two “Requires improvement” would ring warning bells for me. The home I commented on recently had one and four respectively [January 2018] so no “Good” or “Outstanding” in any category.

There is no ‘value for money’ assessment in the CQC ratings and it is difficult to get information on the charges without actually speaking to the management face-to-face.

One problem is that the rate of staff turnover in many care homes can have a significant effect on the quality of service and CQC inspections are only a snapshot at a particular time.

The reality is, most people don’t contact the CQC unless a problem arises, but if a care home bears a low star rating, it would be advertised as such and most probably avoided by prospective users, resulting in improved standards or faced with closure.

I had to go through extensive channels in order to initiate steps to close one care home, submitting lengthy written reports to health authorities, attending hospital management meetings and finally appointing the services of a solicitor before decisive action was taken.

The care home was eventually closed down but It was a long and extremely stressful procedure which I wouldn’t want anyone else to have to endure.

The CQC online reports are often out of date and are based on random visits that took place a year or more ago. Appointing a star rating system would entail more frequent visits and star rating updates on an annual basis, more practical accountability by the regulator and fewer rhetorical and inconsequential ramblings.

Joanna’s introduction mentions home adaptations that could be used to help us live comfortably and longer in our homes. Hopefully most of us here don’t have much need at the moment but it’s worth looking at what people are struggling with. I remember arming my mother with various tools to tackle the caps of jars. Mobility scooters have come a tremendous way and are ideal for those who have lost confidence in driving a car or are not permitted to drive. I met a 93 year old recently who was in a wheelchair but managed to negotiate a set of steep steps slowly but without assistance.

Mobility scooters have given a lot of people much more freedom and at last local councils are making the footways fit for use by them, especially with dropped kerbs at junctions. Despite concerns, those who have them seem to be quite good at riding them and I have not seen any accidents. I have seen some riders use the carriageway at maximum speed and have worried for their safety amongst the traffic but they seem to manage quite well. Unfortunately some seem to be reluctant to have high-visibility clothing or warning features on their scooters which is not fair to other drivers especially in poor light. There is also an annoying tendency for some mobility scooter riders on the pavement to assume that they have priority over pedestrians but I find it best to stand back and let them get on their way. I think most users are considerably happier than they might otherwise be and are enjoying their additional liberty. Self-propelled wheelchairs can rarely be as pleasant or convenient and today’s vehicles are a vast improvement on the Invacars and earlier contraptions that elderly and disabled people had to use.

I have not had much problem with mobility scooters, but I too get out of their way. For those who would otherwise be housebound, the freedom to get out and about is very important. I don’t know anyone who has a mobility scooter but storing them at home must be a challenge.

Paid taxes all my working life, National Insurance, get taxed gain on a private pension if we are lucky enough to have one, fuel is heavily taxed. We are a country of heavy taxation and yet we can’t afford to look after our elderly and the NHS is struggling. Where’s the money going!
What a mess.

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Surely, Duncan, you are not suggesting that the money we pay in PAYE, NI, VAT, excise duties, and other taxes is being sent, via the City, to overseas tax havens?

I think Mick’s point was that despite the vast amounts we pay in taxes of all kinds we still do not provide social care for all the elderly people who want it. This is a question of expenditure priorities.

I don’t accept his point on the NHS. The government keeps pouring more and more money into the NHS yet it is still regarded as struggling. I think much of the problem is due to waste and inefficiency as well as the wrong priorities in some specialties.

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I think you only see the negatives, Duncan. Immense amounts of foreign investment pours into this country via the City, and UK manufacturers and service industries are earning money all over the globe. It could be better but it certainly isn’t as bad as you make out.

I should be interested to know what is your recipe for rectifying all the problems you list. Given that there are minimum wages – which are enforced – I cannot accept some of what you are saying.

A zero hours contract is not necessarily a low-wage one. I would like to see them outlawed but so long as they remain legal they are necessary in some circumstances for employers to remain competitive.

Ex-military chiefs always have an axe to grind about our military capabilities. We can’t send warships into French waters to stop their trawlermen throwing stones at our fishing boats. There are three fishery patrol vessels in UK waters and a number of other RN ships are available if necessary. One new specialist vessel has already joined the fleet in March this year and four more are on the way at six month intervals. Aerial surveillance is also available. My view is that that is adequate in peace time to deal with a minor incident.

None of this has any bearing on paying for adult social care which is a personal liability, not a state one [except as a last resort].

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Former Governor of the Bank of England, Lord (Mervyn) King, has summed it all up today with the following in his comments on the UK’s approach to Brexit;

The biggest economic problems facing the UK are, we save too little, we haven’t worked out how to save for retirement, the pension system is facing I think a real challenge, we haven’t worked out how to save enough for the NHS and finance it, we haven’t worked out how we’re going to save enough to provide care for the elderly“.

Oh dear. He’s right too.

Governments have, seemingly, supported the profligate use of credit in the past to “help” the economy. Largely uncontrolled offering of credit cards, mortgages at silly loan to income ratios, interest only mortgages………. Perhaps it was not the right way to behave? The welfare state maybe didn’t encourage saving – if you didn’t have much money and you spent it, the state would always step in to bail you out.

There is also something to be said for a living for the day, when you don’t know what might be round the corner.

However, many people do save for their retirement and care, some because they do have foresight and the means to provide for the future, and others because they go without now to provide for harder times to come.

Compulsory saving would be the only way to get more to save. Spending a little less for many may not be that onerous. Take a look, for example, at how many unnecessary clothes, gadgets, and other possessions many of us have bought. Savings could go into investment in UK industry – shares have always produced a better long-term return than other personal savings (apart from property perhaps). Maybe that would be better for the economy, make us a wealthier nation that could then afford to spend more on pensions, care and the NHS.

For those who will criticise me for suggesting saving, when there are also many who cannot, I have said “many”, not “all”. A wealthier nation by virtue of its enterprise will better support those who cannot properly support themselves.

Germany introduced an obligatory insurance about 25 years (!) ago. Everyone has to pay into it, and where people do need care (it’s on application and assessed) the insurance covers it to whichever standard the assessment resulted in. Don’t know what other countries do, but England appears to do nothing except cutting funding down whilst need goes up….

If I am correct German people without children pay a marginally larger amount into the system as they will not have the benefit of children to look after them in their dotage.

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Hi there ‘Like minded PEOPLE (Friends) I have an advantage? Over others. I and my wife are already in the VATE system already. So at 61, Me & my wife Andie 63. We are both mostly housebound and have a carer come in twice a day for one hour paid for from the Benefits system. Plus I am a War Pensioner (Ex. Royal Navy, 75 – 89) And cam assessed at 60% disabled for my O/A which got me a P7R discharge. And with that a range of benefits. ESA, PiP, War Pension and my Naval pension among others. Andie has PiP and we both have Mobility too. So having all of this means we are one step ahead of the crush and are already in the system ,so to speak.Plus all the Ex. Forces Charities able to help if o do need to ask, we are VERY. fortunate. We have no property and so don’t even have that worry!
But my heart goes out to those people who nowadays DO. have to make provision for later life! Provision for care and a good chair, bed, bath or shower and of course the stair chair to get upstairs! (And you buy the latter around 2 weeks to around 6 months before meeting our maker! Which of course leads onto the OTHER new target MARKET! YOUR funeral. Well as my Grandad always said, “How many get LEFT above ground??”
I wish you ALL you would wish yourselves FRIENDS.

Chris.

Leslie Pritchard says:
6 September 2018

I am one of those who have not been able to put money aside for future care needs. I was told that the NHS was founded to ensure that all health care needs would be provided from the cradle to the grave, be free at the point of delivery and available to all British citizens. I totally agree with that reasonable concept, and I well recognise that in the foolishness of my youth I assumed that was what would happen. Of course it hasn’t, so like all the others, I can but hope that the original pledges made to this nation are honoured in the very near future.

Health care needs are met by the NHS, Leslie, but social care needs are not and there is a means test to see whether or not people are eligible for complete or partial funding for either additional assistance in their own home or to go into a residential care home. There was never a pledge on basic residential care without nursing or medical treatment. The picture is quite confused because there are disagreements over the borderlines between the different types of provision. When the welfare state was introduced in 1948 the average lifespan was much shorter than today’s and most elderly people were looked after by the next generation in their own homes with doctors calling to prescribe medication or hospital admission. Policy base on those circumstances is no longer relevant to today’s situation.

The situation in Germany is interesting but we only seem to have limited knowledge and even less information on the system in other European countries. It would be good to have more reports and experience of how other nations manage care in later life.

What matters at the moment is what happens in the UK and whether people are adequately informed. It is worrying that, apparently, a large number of people are under the impression that the welfare state ‘covenant’ guarantees free social care in later life. This has never been the case and there has always been the need for a financial contribution depending on the means of the individual. Where there is no capital or significant income the only contribution might be a portion of the state retirement pension every month.

The thresholds for savings and assets above which you have to pay for your own care are –
England :£23,250
Wales : £24,000 (care at home) or £40,000 (care in a care home)
Northern Ireland : £23,250
Scotland : £27,250

Whether people pay (1) through a compulsory state-run social care insurance scheme, (2) through higher general taxation, (3) via an increase in National Insurance contributions, or (4) through private savings, investments and other assets or life assurance, financial provision will have to be made at some point. At present, Example 4 is the mechanism and for people who are beneath the threshold and therefore eligible for free for funding [subject to an assessment of needs] their local authority social services department will provide a basic level of accommodation and care.

After the care needs assessment there is a financial assessment the outcome of which will be that the local authority will either –
•agree to meet the full cost of your care needs
•agree to meet some of the cost (and you’ll need to top up the rest)
•leave you to meet the full cost of your care.

There are serious drawbacks in the present system, outlined throughout this Conversation, because large numbers of people cannot necessarily make financial provision for care in later life, do not know how much provision to make or how long it might need to last, or decide to make no provision for the future for any number of reasons so that their eventual care needs fall on the state to fund which gives rise to resentment from those who have managed to plan and prepare.

From a government’s point of view the present system [Example 4] is probably the most economical as public expenditure is required for only a small minority of people over 65 – around 1-2% for an average of 2-3 years [I am guessing the percentage of fully-funded LA placements in residential care homes because I cannot find any figures and I have therefore assumed that about half the care home residents are publicly
funded].

Example 1 would probably be the most expensive system for the state to administer because it would be fully comprehensive and unlimited leading to a much higher uptake and a greater resistance to making any private provision. Requiring every person to pay into the scheme might be resented by those who wish to make their own independent provision entirely at their own expense. Private education raises similar concerns but the state has always refused to allow any opt-out from taxation for those who make their own arrangements and would be unlikely to wish to create a precedent in the social care system that would lead to pressure for similar dispensations in the fields of education and healthcare. While the insurance principle of spreading the risks and costs across a large population should restrain the overall cost and maintain an adequately funded scheme, the burden would mainly fall on the 18-65 age group and it would be perceived as another tax with all the political implications that go with that. An important issue is whether the insurance contribution should be at a uniform personal rate or pro rata according to income; the former would be regressive and impact on those with the least ability to afford it, the latter would raise the objection that in an equalising insurance-type scheme there is no justification for a means test.

Higher general taxation [Example 2] and increased NI contributions [Example 3] raise similar issues and would be less transparent in terms of the origins and destinations of the money raised as well as its susceptibility to political interference and manipulation. Using general taxation, however, would allow for decisions to be made on expenditure priorities because cutting expenditure on ‘vanity’ projects and wasteful or inefficient government [and local government] activities is an important component of a funding policy.

While we wait for the government’s Green Paper, which I would expect to steer well-clear of a monopolistic state-run scheme, there remains the need to make sure everyone knows what they can and cannot expect and to help them make an informed and responsible decision on financial preparations for their later life. Clearing away the present misconceptions will contribute to the debate that is yet to come.

Private insurance for later-life care would presumably be at the same rates for all, like private pension contributions, with no cross subsidy. A state scheme, if tagged on to NI, would almost certainly be earnings related. A private scheme could allow a choice of standard of accommodation and facilities, depending upon how much “credit” you had built up. A state scheme would, rather like now, probably provide basic care without choice.

Maybe, as happened with SERPS, you could opt out of the state scheme if you were able to, and preferred to, pay into a private scheme, but that would deprive the state scheme of substantial funding.

I expect private schemes would not (should not) be subject to tax relief. The state contributions would as NI is from pre-tax income.

As with all state benefits there will never be what many might regard as “fairness”. We cannot allow anyone, however little they have contributed financially or socially, to come to harm. Some might resent their feelings of entitlement without contribution but that is the way an inclusive society should work. Their entitlement might, however, be pretty basic.

I agree, Malcolm. I would expect a compulsory state-run scheme to start as soon as the individual starts earning and there would be breaks for periods out of work or not earning. The more the scheme is complicated by opt-outs etc the more bureaucratic it becomes and more costly to administer.

I must say I prefer modification of the present, largely privately-funded, system but with a lot more education and encouragement to get more people to make forward provision. So long as there is a reasonable safety net I believe it is better to leave people in charge of their own money and destiny. In the days when nearly all residential care homes were provided and run by local authorities there was a general consistency, if not uniformity, of basic provision which was adequate and reasonably satisfactory. Today, publicly funded residents are likely to be placed in whichever local care home has a spare room and although the social services department will be looking for the most economical service there are wide variations in service quality and provision and a much greater likelihood of there being state-funded residents and private self-funding residents in the same establishment.

An attractive pay-as-you-earn private insurance scheme would offer much more choice and flexibility. The flat-rate contribution would no doubt have to have an actuarial basis to cater for those joining it at different dates but those in the same category should all pay at the same rate irrespective of income.

A major step forward would be to break the widespread assumption that the state will provide. It hasn’t and it won’t, except at the basic level of last resort.

Many are able to continue to live in their homes with the aid of help. That could be as simple as paying for help with tasks such as gardening, cleaning and shopping. If care services are needed, this can be much more expensive but for many a more attractive alternative to going into sheltered accommodation or a care home. I presume that as with care homes, users of home services are expected to pay the costs unless if they can afford to.

Yes, if the care needs assessment indicates that supported living at home is the best arrangement, the financial assessment that follows will determine what financial contribution if any they will need to make.

One problem with the social services-organised home support plans that I have heard is that they cannot be upgraded to provide more hours or more frequent visits. What is laid out in the care plan is all you get. This might not be the case in all areas, however.

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Maybe this is an explanation?. We could do the same, but is higher income tax likely to be popular?

“Scandinavian income taxes raise a lot of revenue because they are actually rather flat. In other words, they tax most people at these high rates, not just high-income taxpayers. The top marginal tax rate of 60 percent in Denmark applies to all income over 1.2 times the average income in Denmark…….

Sweden and Norway have similarly flat income tax systems. Sweden’s top marginal tax rate of 56.9 percent applies to all income over 1.5 times the average income in Sweden.

This also shows in the tax as %GDP:
UK 34.4; Germany 44.5; Sweden 49.8.

The UK also spends 21% more per head on defence than Sweden. Perhaps they also have different priorities.

Are local/municipal taxes in addition to these?

Sweden is a neutral country and is not a member of NATO. That makes a massive difference to its military capability requirements. It has a small navy consisting entirely of small warships and a few submarines. The Swedish air force is relatively small and the army went down to 13,000 soldiers but is building back to a target of 50,000 by 2020 in order to undertake UN commitments where it has a good reputation for peace-keeping.

The UK’s military has also declined since the end of the Cold War but we believe we have a world-wide role and need much greater resources and a nuclear deterrent. So long as we have a special relationship with the USA that is understandable because it makes us vulnerable. There is also a current risk that America will reduce its protection of Europe.

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This is going well off topic and I am not going to respond. We were discussing how different countries organise and pay for their adult social care not their weapons replacement policies

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I have not specifically saved for my care if ever required but have enough if I needed to pay for it. What really annoys me is I know peeps who have had plenty of money, blown the lot on having a good time and then expect to be looked after by the government or whosoever for their housing and their care if needed. Additionally I have saved, been careful and have money to pay but it makes me liable for hefty inheritance tax. If we are careful we appear to get heavily penalised so do I blow it all on a good time, give it all away and forget about care needed in later life? I have no problem with peeps who have not had well paid jobs which enabled them to save to getting help, we have a very unfair society and many wages do not allow people the opportunity to save for later life.

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The well-off people you refer to Carolyn will not get their care in later life entirely free of charge. They will lose some of their income to pay for their residential care and if they own a house or have any savings or other assets that will also be taken into account. Only if they really have converted everything into cash and blown it might they get a free ride, but I don’t think many people who have become accustomed to the good life are making that sort of sacrifice for an unpredictable period just to avoid contributing to the care they will need when they can no longer look after themselves . . . well, not if they have got any sense.

An asset is an asset, Duncan, no matter where it is stored. If people requiring state assistance with their later life care fail to declare an asset under the financial assessment they will be committing an offence. Those who wish to conceal an asset should also consider how they will access it when they are living in a care home at the state’s expense. It could also get discovered after their death and have to be declared during probate otherwise no one would be able to benefit from it. Any unpaid tax would be the first charge on the estate and the undisclosed asset, when realised, could add to any inheritance tax liability.

It’s probably best to come clean. I would caution our senior citizens against taking financial advice from a US website however attractive it might appear.

What Duncan is referring to sounds suspiciously like the scaremongering video and article published by MoneyWeek predicting an imminent collapse of the British economy.. in 2012. The faulty reasoning and deductions have been de-bunked numerous times, as John Ward says if you put your money offshore HMG can still get at it when you bring it onshore to spend.

http://anotherangryvoice.blogspot.com/2013/01/moneyweek-and-their-end-of-britain.html

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Duncan – This has absolutely nothing to do with the subject of this Conversation. It doesn’t even connect with anything else written in this thread in response to Carolyn Gyseman.

As has already been suggested, such comments should, if necessary at all, be made in the appropriate Brexit Conversation.

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Hi Duncan,

As John Ward rightly points out, can we try to keep comments on the subject of the convo? Might this be a discussion for the lobby?

Thanks,

Oscar