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All Talk And Maybe Some Action On The Care Crisis?

14/12/2016 17:12
Blend Images - Dave and Les Jacobs via Getty Images

An extraordinary second Monday in December may have heralded long-awaited government action to tackle the care crisis.

With more than a million older people not getting the help they need and cash-strapped local authorities squeezing fees to fragile care businesses, the care system seems close to collapse.

Now all eyes are on the government's funding settlement for councils later this week. Will it simply allow councils to raise council tax to fund care or will it offer something more fundamental?

If it's the former, it will be too little and it will increase the postcode lottery care.

In the meantime older people and their families are paying the price for the lack of action on care in the government's autumn statement last month.

One of the great unfairnesses in the care system for older people has recently been exposed, revealing the 'sharp practices' that many older people and their families face when paying for a place at a care home.

The main injustice relates to the fee that these 'self-funders' pay. Typically self-funders pay an average weekly bill between £603 and £867, depending on the area of the country. Some fees in London and the south east are well in excess of £1000 a week, according to Age UK.

This weekly fee is at least £200 a week more than local councils pay for the same rooms for older people who have savings/assets worth less than £23,250.

In total a self-funding older person may be paying more than £10,000 a year extra to help cross-subsidise those residents whose place is paid for by their council.

Because of the squeeze on council budgets, particularly since 2010, the amount of the cross-subsidy has increased rapidly in the last few years. Councils have restricted the fee increases paid to care home providers and care homes have faced rapid growth in costs, not least paying staff the national living wage introduced in April 2016.

The result is inevitable. Self-funders are paying an extra tax to cover the state's lack of funding. This stealth tax on the middle classes is hiding the full extent of the care crisis in the country.

With more older people needing care as our population ages and as the spending on care is squeezed further, this situation will get worse as self-funders are expected to cross-subsidise more and more those residents who are state-funded.

Care homes feel they have no choice to charge the differential rates just to help their business survive. In addition some homes suddenly implement fee increases in mid-year and charge for hidden extras.

The unfairness is not just restricted to families using residential care. Older people needing care in their own home and paying for it themselves often pay at least 50% more to a home care provider than the council does for the same service. The UK Home Care Association has revealed how the underfunding of homecare providers is affecting older and disabled people.

And of course there are millions of families who provide care directly themselves to their loved ones who are saving the state huge amounts of money - the latest estimate is that family carers save the NHS and social care some £132 billion a year.

Is there anything older people and families can do about this? Of course, but it does require more effort to ensure they make the right choice of care in the first place. Choosing a care home for example can be a very stressful, and often rushed, decision but families need to spend time visiting the home, talking with residents, families and staff, and reading the small print very carefully.

If families have complaints, they should raise them with the home manager/owner in the first instance. But if they feel nothing is being done, then I recommend they contact the Local Government and Social Care Ombudsman which looks into complaints from self-funders about private care providers and the regulator, the Care Quality Commission. The Competition and Markets Authority has also announced a review of care homes' fees and conditions.

But ultimately the stealth tax scandal won't go away until the government increases funding for care and reforms the way the care system works. One instant change they could make which would be fairer for families on low to middle incomes would be to increase the capital threshold to £250,000 (the price of an average home) from £23,250. This could be a step to funding care in the same way as the NHS.

We wait to see what, if anything, the government does this week to address the unfairnesses in the care system and make care more sustainable for our ageing population.

Stephen Burke is director of United for All Ages and Good Care Guide

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