Funding for long-term care

Transcription

1 Funding for long-term care Jane Vass, Head of Public Policy Age UK Bath and North-East Somerset 7 th November 2013

2 Overview 1. Why care funding matters 2. Social care system today 3. Government proposals for reform 4. How will this affect older people? 5. Conclusions

3 Why care funding matters 1 in 2 of us will use social care at some point in our lives - 1 in 4 will need intensive or long term care costing more than 50, million people have care and support needs but around 850,000 receive no formal help 87% of local authorities now only support people with substantial needs or above 1,288,000 carers aged 65+ in England in only 68,000 received carer-specific services and 37.4% (482,000) say that caring has adversely affected personal relationships, social life and leisure We are living longer and more people need care and support funding is not keeping pace

4 The social care funding crisis Numbers of people with unmet need difficult to calculate but trend is upwards: circa BUT many more with reduced (inadequate) packages of care

5 Meet Paddy The realities of life with frailty Age UK research project Paddy lives alone and has very limited mobility Has recently been discharged from hospital Receives home care visits three times a day

6 Social care system today

7 Social care system in England Individual or agency asks local council for an assessment A needs assessment is completed by a social worker or other health professional People are assigned a level of need (low, moderate, substantial, critical) The council will either provide a direct payment or contract services to meet their needs If someone falls within the council criteria a care plan is produced. 87% of authorities only fund substantial/critical Everyone has to take a means test to determine eligibility for state support

8 Eligibility tests - means Care at home Income, savings and assets (but not home) taken into account People can be charged for care as long as their income does not drop below pension credit + 25% (currently a week) Most local authorities use national means test thresholds for residential care Living in a care home Income, savings and assets taken into account - and home unless occupied by a dependent Lower means test threshold = 14,250 and upper threshold = 23,250 People can be charged their full income except personal expenses allowance of a week Savings and assets assumed to deliver 1 of income for every 250 held over lower threshold of the means test

9 Problems with the current system Many people fall outside of the system when: - their needs are not high enough - they are above the means test It is poorly understood and many people unaware that care is not free There are concerns about the quality of care and how this is inspected and regulated We are living longer and more people need care and support funding is not keeping pace The result is that: - many people are going without help until near crisis point - more pressure is placed on carers - more pressure is placed on the NHS

10 Government proposals for reform

11 Dilnot and Law Commission Dilnot: 35k cap on eligible care costs 10k annual cap on living costs in care homes Rise in the upper threshold of the means test to 100k National eligibility threshold set at equivalent of substantial Universal deferred payments scheme Law Commission: Bring together plethora of existing law and guidance into single act Clearly define the process of accessing social care in legislation so people understand their rights New duties to promote wellbeing and support carers New adult safeguarding duties rather than just guidance July 2011 May 2011

12 Government response: funding reform From National deferred payment scheme criteria will apply National eligibility threshold in line with new regulations although funding is based on current substantial From k cap on eligible care costs at home and in a care home (aprox 61k in today) 12k annual cap on general living costs in a care home (aprox 10k today) New residential care means test thresholds apply: lower = 17,250 and upper = 118k (aprox 100k today) Indexed in line with inflation

13 The impact on older people: Mrs A

14 Meet Mrs A Lives alone and has no dependents Home worth 160,000 and 20,000 cash savings State Pension of pw and employer pension of 100pw Attendance Allowance of TOTAL: Income pw Savings and assets 180,000

15 Mrs A: care needs Mrs A: One of the 25% of people who will need a significant amount of care in later life Initially assessed by the local authority as having substantial needs, qualifies to receive care at home at local authority estimated cost of 200 a week After 2 years is assessed as having critical needs that can best be met living in a care home at a current cost of 600 a week. Total care received: 104 weeks of care at home and 104 weeks living in a care home

16 Assumptions in analysis Have NOT modelled impact of new benefit system HAVE used 2013 prices, therefore for the purposes of this analysis: o Cap = 61,000 o Means test thresholds = 14,250 lower and 100,000 higher HAVE used existing eligibility thresholds and domiciliary care means tests Full details at:

17 Care at home - now Per week 200 paid from Income Savings 23 Council After 2 years 26,967-8,416 20,000-2,392 = 17, ,000-0 = 160,000 Total cost to Mrs A: 10,808

18 Residential care - now Per week 600 paid from After 2 years Income Savings, then home ,967-22,807 17,608-17,608 = 0 160,000-21,985 = 138,015 Total cost to Mrs A: 10, ,400

19 Care at home new system Per week Cap 61, paid from Income Savings 23 Council After 2 years 26,967-8,416 20,000-2,392 = 17, ,000-0 = 160, x 104 = 20,800 Total cost to Mrs A: 10,808

20 Residential care new system Per week Option 1: 600 Income Savings, then home A further 2 years: Option 1 26,967 17, ,000-22,807-17,608-21,985 = 0 = 138,015 Total cost to Mrs A: 10,808 + (Option 1) 62,400

21 Residential care new system Per week Option 1: 600 Option 2: (LA arranges) 480 Income Income Savings, then home Savings, then home A further 2 years: 26,967-22,807 17,608-17,608 = 0 Option 1 160,000-21,985 = 138,015 Option 2 160,000-9,505 = 150,495 Total cost to Mrs A: 10,808 + (Option 1) 62,400 or (Option 2) 49,920

22 What counts against the cap? Per week Option 1: 600 Living costs 192 Usual rate care costs 288 Top-up 120 Cap 61,000 Option 2: 480 Living costs 192 Usual rate care costs X104 = 29,952 Total cost to Mrs A: 10, ,400 [ 49,920] 200 x 104 = 20,800

23 To summarise Mrs A s spending will only be capped if she needs care for more than 4 years 35 weeks But if she chooses Option 2 (asking the local authority to arrange care) she could pay less for care home fees than at present How much less will depend on how the care market responds to lots of self-funders asking the local authority to arrange their care

24 In conclusion Age UK supports the overall aims of the reform but the high cap and lack of funding risk undermining the aims. Many questions remain: Is the balance between state and individual fair and will it be seen as fair? Will people understand it? How can government manage expectations? What impact will it have on local authorities and care markets? What effect will it have on quality? For top-ups, it must be clear what extra value people are getting Nobody should be forced to pay more just to get decent care