Taking good care

30 Jul 09
The recent green paper on social care was a step in the right direction. But, as well as focusing on the long term, short-term measures still have to be made for those in need now. Sue Collins explains
By Sue Collins

30 July 2009

The recent green paper on social care was a step in the right direction. But, as well as focusing on the long term, short-term measures still have to be made for those in need now

With the number of older people expected to quadruple by 2030, many of us are concerned about the provision of care for current and future generations of older people, and with good reason. By the government’s own admission, the current care costs system is inadequate.

Last year the government said it was looking to sort out a £6bn black hole in care funding; and that was before the recession had begun to bite. Many of us have been wondering whether we will ever reach a satisfactory outcome for older people when money for extra public spending grows ever more scarce.

The publication of Shaping the future of care together, the government’s green paper on social care has at least brought the issue of care for older people to the public’s attention and encouraged debate.

Health Secretary Andy Burnham is proposing ‘radical reform’. He wants to establish a National Care Service. ‘We need a system that’s fair, simple and affordable for everyone – a system that gives excellent care wherever we live and whatever our needs,’ he said at the launch of the green paper earlier this month.

‘Everyone will come into contact with the care system at some point – whether it is ourselves or our families and friends. The National Care Service must be shaped by the people who will use it so we want everyone to tell us what they think.’

A ‘Big Care Debate’ will run until mid-November.

The Joseph Rowntree Foundation broadly welcomes the long-term vision for the adult social care system set out in the green paper. But we also believe that it is vitally important that immediate changes are made. Evidence shows that older people find the UK care system unclear, unfair and unsustainable and this is something that needs to be addressed right now.

Earlier this year the JRF published a number of costed reforms that could make a big difference very quickly while long-term reform is still being considered. These included:

  1. equity release: allowing older homeowners to pay for home-based care by deferring the costs until their home is sold
  2. higher capital limits for care home fees: helping those with modest assets by raising the ceiling for local authority ­support from £22,250 to £42,500
  3. doubling the personal expenses allowance to £44: to give more dignity to people in council-supported care homes
  4. free personal care for all people requiring nursing care: to remove inconsistencies between care funded by the NHS or by the individual.

Although everyone agrees that England needs a new long-term care funding system, it might take a decade to establish it. These reforms could quickly make a difference to older people and their carers struggling to cope under the present system. In addition, these solutions, which draw on evidence and research collected by JRF over a number of years, would help make the current system fairer and more focused on the individual and their particular needs.

A JRF report published last year, Rethinking social care and support, brings together different approaches to funding adult social care in other countries:

Austria – a cash care allowance funded from general taxation was introduced in 1993. It is paid regardless of age, income or assets. The care allowance is paid at one of seven levels, depending on the amount of help needed, and can be used to pay for care at home or in an institution

The Netherlands – since the 1960s, the Netherlands has provided universal coverage for long-term care for people of all ages through a non-means-tested social insurance programme. Revenue is raised from a premium levied on income. Only those with incomes over a given threshold are required to contribute this premium. Additional revenue from general taxation also contributes to the programme budget

Japan – long-term care social insurance for people aged 65+ (and those aged 40+ with age-related disabilities) was introduced in 2000. Eligibility is determined by a 79-item questionnaire of physical and mental status; this is used to calculate which of the seven levels of service provision an applicant is entitled to. All beneficiaries pay a co-payment of 10% of the value of their care

France
– the universal Allocation Personalisée d’Autonomie was introduced in 2002. The APA is paid at one of six levels of ‘dependency’. It is a national, universal scheme. People with incomes below a certain threshold pay no charge or co-payment; people with incomes above this threshold pay co-payments.

Social care arrangements differ significantly but, as these examples demonstrate, universality – the eligibility of those who are not poor as well as those who are poor – is a founding principle in many other countries. 

At the local level, there are also smarter ways we can structure funding and care provision.

The Joseph Rowntree Housing Trust is a registered social landlord that provides a number of care services for older people. It has found innovative ways of using capital to fund housing with care.
The trust has concluded that pooling risk in relation to care costs is an effective funding mechanism, which also allows older people to plan for the future.

Hartrigg Oaks, the ten-year-old continuing care retirement community based in York, demonstrates how this works in practice. Through this, residents are able to access up to 21 hours care per week without having to move home. This type of lifetime community offers peace of mind and safe, vibrant environments for older people and their families.

In the next few months, the JRF will encourage debate on issues around fairness, equity, and the relationship between state, family, citizens and communities.

Older people’s voices will be at the heart of a new JRF programme, A Better Life. This will look at how life can be improved for those with high support needs, whether they are in residential care, housing with care schemes or their own homes.

We know that difficult spending decisions are going to have to be made in the current economic climate. However, it is crucial that the needs of the increasing number of older people remain high on the agenda.

It is important for all political parties to commit to the reform of the care system and implement immediate improvements, to ensure real, lasting change and ensure all older citizens enjoy true quality of life. This is something we would all want in our old age.

Sue Collins is programme manager at the Joseph Rowntree Foundation
http://www.jrf.org.uk/  http://www.jrht.org.uk/



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