Fundamental reset for social care?

Thanks LemonJam this is very helpful information. But I respectfully disagree that property owners with houses worth over £1million should be given free continuing NHS care. The country can’t afford it. It needs to be means tested.

ronib

There’s a fundamental unfairness about the present system for sure. Wealthy property owners are given free end of life care in nursing homes which goes on for years and not months. Others are inaccurately assessed and it takes forever for social services to correct their figures.

Then there’s the problem of who should monitor for mini strokes, kidney infections and the rest if an elderly person is at home. Care at home is time limited to washing, using the commode/changing pads, dressing, feeding, administering medications. Not enough time to ensure physical mobility and mental stimulation so not ideal.

Definitely agree about the well off people gaming the system and living in Nursing homes when they haveaa property worth a fortune.

You know running up hundreds of thousands of pounds in Nursing home fees. When there house is worth over a million pounds

This is made by legal moves like Trusts and Tenants in Common Agreements.

I know a family who have been doing this for years. Retired son pretends to live in the old family home..

But has his own very expensive Cheshire Countryside home.

An absolute disgrace. Total Deprivation of Assets. Needs immediate change and prosecutions.

I think Ms Casey did an OK job with her report. But she was told to do it to shut people up.

I will be very surprised if anything will be acted upon. And it will sink without trace, as this what tends to happen to such reports.

The term social care is meaningless when you think about it. It is all 'health'.

The great injustice in older adult care is that sufferers from diseases of the body (e.g cancers, heart, kidney and lung problems) receive free NHS care, whereas sufferers from diseases of the brain (dementias and I believe Parkinsons) do not.

At the moment it is impossible to predict who might develop dementia (that may change) making insurance policies actuarially difficult).

It was the Thatcher government that prohibited local authorities from running care homes because it was thought that gave them a monopoly of provision. The current for-profit system is the result.

The same thing happens in mental health services. Grossly underfunded compared to, say, cancer care.

I believe an additional tax is required to cover all aspects of health care. And the NHS must become more efficient. But reform must not start with tinkering round the edges which annoys everyone and gets nowhere.

NHS continuing healthcare is assessed by the Nuffield Trust at a cost of £6.5 billion a year.

knspol

Wealthy property owners do not get free care. In fact they pay a premium in any care home so that less wealthy people can live in the same place with the home only receiving a much lower amount for them via the local authority. Wealthier people subsidise the less wealthy.

Thats my first hand observation knspol.

All none Local Authority care homes set their fees. They get a lower amount for LA funded residents- so by default to balance the books and make a profit- the fees for self funders at each annual budget review rise proportionately the greater the number of LA residents in the care home at each review.

ronib

NHS continuing healthcare is assessed by the Nuffield Trust at a cost of £6.5 billion a year.

And if everone who was entitled to it but has not got it through misinformation were to get it, that bill would be exponentially higher!

ronib

Thanks LemonJam this is very helpful information. But I respectfully disagree that property owners with houses worth over £1million should be given free continuing NHS care. The country can’t afford it. It needs to be means tested.

You don't think wealthy property owners with homes over £1 million should be able to access NHS care? Thats a different argument.

NHS care is free at the point of delivery to all. Wealthy property owners would have to apply for NHS care when in a care home in the first place and I have not seen any that have made an appeal in my years of reviewing cases.

They are usually of a demographic that have opted for private healthcare in the past and much more likely to pay for packages of care privately so they can continue to stay in their wealthy, very desirable homes as they can afford to do so.

Plus, even if in a care home, they would only be eligible for free NHS care if they have a Primary Health Need.

You're not suggesting that wealthy home owners should be prevented from accessing NHS care? That would be discriminatory and completely change the NHS model and current legislation.

Your’e initial statement was “ There’s a fundamental unfairness about the present system for sure. Wealthy property owners are given free end of life care in nursing homes which goes on for years and not months. Others are inaccurately assessed and it takes forever for social services to correct their figures*.

I responded accordingly- it's an equitable system where health care needs are assessed on an equitable evidence based process. If an NHS PHN is identified NHS provides the funding to deliver that healthcare irrespective of the person's bank balance. That is the NHS service model has been since its inception. 


* Care is care homes is means tested* as I explained.

NHS care funding is only provided to those who are assessed and have complex, intense, unpredictable care needs that need specialist NHS care. NHS care is free at the point of delivery to all.

winterwhite

The term social care is meaningless when you think about it. It is all 'health'.

The great injustice in older adult care is that sufferers from diseases of the body (e.g cancers, heart, kidney and lung problems) receive free NHS care, whereas sufferers from diseases of the brain (dementias and I believe Parkinsons) do not.

At the moment it is impossible to predict who might develop dementia (that may change) making insurance policies actuarially difficult).

It was the Thatcher government that prohibited local authorities from running care homes because it was thought that gave them a monopoly of provision. The current for-profit system is the result.

The same thing happens in mental health services. Grossly underfunded compared to, say, cancer care.

I believe an additional tax is required to cover all aspects of health care. And the NHS must become more efficient. But reform must not start with tinkering round the edges which annoys everyone and gets nowhere.

Yes!

My dear cousin has a DH who had early onset dementia and a very healthy body.

He’s now in residential care and she doesn’t get a penny from the state to help her with fees, because he doesn’t specifically traditional nursing care.

I don’t know what the answer is. But it seems so wrong that people at the end of life, and often their children who are not young themselves, should have this worry.

ronib

Thanks LemonJam this is very helpful information. But I respectfully disagree that property owners with houses worth over £1million should be given free continuing NHS care. The country can’t afford it. It needs to be means tested.

This needs to be part of the reset.

The reason for a rich person getting CHC funding lies in the 1948 National Health Service Act which provides health care free by law ... they are entitled to free medical care and, if they meet the criteria, to CHC funding too.

winterwhite

The term social care is meaningless when you think about it. It is all 'health'.

The great injustice in older adult care is that sufferers from diseases of the body (e.g cancers, heart, kidney and lung problems) receive free NHS care, whereas sufferers from diseases of the brain (dementias and I believe Parkinsons) do not.

At the moment it is impossible to predict who might develop dementia (that may change) making insurance policies actuarially difficult).

It was the Thatcher government that prohibited local authorities from running care homes because it was thought that gave them a monopoly of provision. The current for-profit system is the result.

The same thing happens in mental health services. Grossly underfunded compared to, say, cancer care.

I believe an additional tax is required to cover all aspects of health care. And the NHS must become more efficient. But reform must not start with tinkering round the edges which annoys everyone and gets nowhere.

The eligibility assessment is not based on *conditions e.g. e.g cancers, heart, kidney and lung problems, dementia, Parkinson's disease. It's based on the degree and severity of the care needs.

The assessment determines if the care needs in totality require specialist, professionally qualified NHS health workers to meet the needs or social care assistants ( simplification)

Basically and simplistically, but to give a flavour- can the persons car needs, in totality, be met by none professionally qualified care assistants whose skills are within the legal remit of the Local Authority. Or, are the care needs sufficiently intense, complex or unpredictable that specialist knowledge and skills of NHS professionally qualified staff are required on an ongoing basis.

So a person can have advanced dementia- be not aware, be incontinent, but straight forwardly managed by pads, have Parkinson's disease, and all care needs for all activities of daily living must met for them as they are completely unable to carte for themselves. If that care can be delivered by social care assistants (ie basic straightforward care) it is deemed is social care.

If that person becomes acutely ill at any stage- chest infection, fall, diabetes or Urinary tract infection has heightened confusion and delirium, condition is unstable etc etc and patient needs hospital admission- free care during NHS admission stay.

If the person is readmitted back to care home but condition has now deteriorated, its more unstable to extent now needs frequent input of District Nurse, and/or Mental Health services, and/or Diabetic specialists nurse, Specialist Parkinson's nurse or complex, time specific Parkinsons Disease or Diabetic medication, Speech and Language therapist for swallowing difficulties etc, or is deemed "at end of life" a new assessment is carried out which may now on reassessment now demonstrate a Primary Health Need as a result become eligible because now needs professionally qualified ongoing NHS input.

Currently the law in the UK is that NHS care is free but social care means tested. A Government would need change the law and the respective NHS and Social Care service models for that to change.

That's the fundamental issue that needs to be grappled with.

There is no deffiernec for hierarchy between mental health conditions, dementia or cancers, Parkinson;s Disease, Diabetes etc whatsoever. There will be posters. on Gransnet that may have diabetes, mental health issues, Parkinson's disease etc but manage to live at home independently.

It's the Care that is required as a result of the conditions that is key in the assessment.

The alternative of care in all care homes for all residents being free at point of delivery for social care ( ie not professionally qualified NHS care) is deemed none affordable for Local Authorities. The Council tax would increase off the charts! Are people happy to fund local social care by way of higher council taxes- orphans doubling or tripling? Plus the elderly population is increasing.

No government since 2000 has put forward a manifesto and plan to make social free by raising taxes etc. I think AB will propose something- time will tell.

What would posters suggest as an alternative plan and like to a government implement?

Gran22boys

I don’t know what the answer is. But it seems so wrong that people at the end of life, and often their children who are not young themselves, should have this worry.

Children ie under 18, always get free care.

When assessed as end of life, ie Palliative care stage- NHS care is deemed necessary and funded.

It is complex I agree- I spend a good proportion of my time listening to families and explaining. Legal firms representing families in such funding appeals don't always explain in my experience- they want their fees after all. Some firms are better and fairer than others.....

It's the management of the personal care budgets that can enter crisis. When the families are incapable of managing the relatives budget then in theory the Court of Protection steps in.

You can imagine the crisis situations this produces, when the very best outcomes take 4 to 6 months but that depends on SW's being available to move things forward. And locally (a friend of mine involved, she can't cope anymore with her very very ill MH wise daughter) people don't get a long term SW appointed, they are "Task Oriented"and pick up problems when they reach crisis not knowing the people.

Labour will be blamed, for sure, for actually daring to try and do what successive governments have dodged - sort out the care system.

BJ's promises in 2019, and no, no attempts post Covid.

The elephant in the room is the cost and staffing needs for adequately providing social care, never mind improving provision, I think. It’s a bottomless pit in terms of need, and the reliance on families to provide care is partly because of the lack of people wanting care as a career, rather than purely about funding.

Luckygirl3

ronib

NHS continuing healthcare is assessed by the Nuffield Trust at a cost of £6.5 billion a year.

And if everone who was entitled to it but has not got it through misinformation were to get it, that bill would be exponentially higher!

And that is the cost of the few that receive it.

If those that have social care needs received NHS CHC the bill would be astronomical. £2k fees a week not exceptional- say approx £100k per year.

I cover a UK region. We audit conversion rates of appeals at IRP stage. We know how many are many accepted and how turned down for NHS CHC funding, albeit not applicants appeal if found not eligible.

Possibly multiply that £6.5 billion a year figure 10 to 20 fold? Thats a lot for the NHS or alternatively local authorities to fund and the elderly population is increasing exponentially.

Further, important to highlight, following 13 years or so of Conservative austerity the health of UK late middle age and elderly population demographic has declined.

Could be even more £.

I wonder if the financial cost of keeping lifelong complex care cases in the community will figure in the consultation Lemonjam? Keeping one person in their own home on a CHC package can cost many hundreds of thousands of pounds a year, much more than it would cost for them in a care home, when the same amount could be used to provide social care for many.

Cossy

winterwhite

The term social care is meaningless when you think about it. It is all 'health'.

The great injustice in older adult care is that sufferers from diseases of the body (e.g cancers, heart, kidney and lung problems) receive free NHS care, whereas sufferers from diseases of the brain (dementias and I believe Parkinsons) do not.

At the moment it is impossible to predict who might develop dementia (that may change) making insurance policies actuarially difficult).

It was the Thatcher government that prohibited local authorities from running care homes because it was thought that gave them a monopoly of provision. The current for-profit system is the result.

The same thing happens in mental health services. Grossly underfunded compared to, say, cancer care.

I believe an additional tax is required to cover all aspects of health care. And the NHS must become more efficient. But reform must not start with tinkering round the edges which annoys everyone and gets nowhere.

Yes!

My dear cousin has a DH who had early onset dementia and a very healthy body.

He’s now in residential care and she doesn’t get a penny from the state to help her with fees, because he doesn’t specifically traditional nursing care.

My understanding (which may well be wrong) is that social care is free if there is a surviving spouse. If the care resident has savings in their own name they will be used, as will pensions, but even then, I thought that if the spouse would be disadvantaged by the resident's pension being spent on fees that could be disregarded. Joint savings are assumed to belong to both partners equally (ie on a 50/50 basis), so only half will be used in an assessment.

Either way, as I understand it, if the surviving spouse lives in a jointly owned house it won't be sold, and there won't be a debt payable when the client dies. It is when the surviving spouse needs care that the house is taken into account.

Is that not the case?

ronib

Thanks LemonJam this is very helpful information. But I respectfully disagree that property owners with houses worth over £1million should be given free continuing NHS care. The country can’t afford it. It needs to be means tested.

A property valued at over £1 million in the South East is often just an ordinary family home, whereas the same amount could buy a mansion in parts of the North East. Penalising pensioners because of where they happen to live is unfair and ignores the huge regional differences in house values.

Doodledog - yes- as I understand it when a married person goes into care home the house equity is usually protected if their spouse continues to live in that property. LAs apply a mandatory property disregard meaning the home value is ignored.

The patient's savings and most of their pension/s ( retaining a small amount for toiletries etc I think- I am not a SW) will be used towards care fees. Thus the spouse in the home has their pension and must pay all household expenses alone. It can be the case the spouse in the home may find it difficult to maintain the home on one pension and may not wish to continue living there alone.

So- If the house is sold , and the remaining spouse moves out or passes away, the Local Council will then *include the resident's share of the property to use against care home fees*- equity released at time of spouse's death or point of sale on moving out.

Usually females outlive males, and many of the cases I see the husband has died, the wife continued to live in the property and then subsequently became unable to live independently and went into a care home. At that stage the home was her asset alone. Thus now a self funder and sons and daughters set about selling the property to fund the care fees if not found eligible for NHS CHC.

The problem is that those making assessments on the ground for CHC simply get it wrong a lot of the time. I have sat through meetings or talked to people where completely wrong information is given:
- people are wrongly told that they need not do the quick assessment because they would not qualify anyway.
- your relative is not terminally ill so does not qualify
- you have to be in a nursing home to qualify
- it is a mental health problem so you do not qualify
- you are receiving care at home so you do not qualify ......

And so it goes on. District nurses are the worst culprits in my experience!

But ..... it is a complicated specialised area so why should they understand the complex details? ... they have got nursing tasks to get on with and are madly busy.

I refused to fill in the forms for SSD care as this is means tested and I knew my OH qualified for CHC. I insisted that a decision should be made as to whose financial responsibility it was before going ahead to organise care.

He was turned down twice .... each time on the basis of forms completed by people who did not know the rules. He then received the funding on appeal ... the appeal panel agreed it instantly as they could see he qualified. They were very kind and vrry apologetic.

But .... did I need all that hassle or the energy-sapping battles at that sad and difficult moment in our lives?

And ... if I had not known the system and been articulate and persistent the outcome would have been different ... this is not what it should depend on.

However, as I said upthread ... if this informal and unfair weeding out of potential legitimate recipients on the basis of wrong information were not happening then the NHS would go under because it would cost too much.

What we have is funding given to those with the confidence, education and knowledge to fight their corner at the expense of everyone else. It is fundamentally morally wrong.

In order to change this unfair system I suspect the NHS Act would need amending .... but good luck to any government doing that!

Until we sort out this false dichotomy between nursing and social care this mess will go on. Patients do not need to be caught in this crossfire ... they just need proper professional help at a cost that they (and the country) can afford.

It truly is a can of worms and every government has ducked it so far ....

I’ve been to two CHC meeting for my daughter. Both lasted almost the whole day and both times funding was refused from health

I would not care so much but the NHS caused her disability in the first place

People forget social care funds other people outside of ‘elderly cate’

Luckygirl, a friend aged 79 caring for his wife was told by district nurses he would not qualify for support in her care. She was immobile, blind, diabetic and demented. She needed care 24 /7
Mr I had managed services for adults, he helped our friend complete the necessary forms. He qualified for carers four times a day.
It was shocking