An ageing population means more elderly people in need of care. However, government-funding for care has been insufficient to meet demand and we are left with a struggling care sector. What can be done?
How does the care system work in the UK?
Care for the elderly refers not only to nursing homes, but also personal care where support at home is provided. Unlike NHS services, care in the UK is not free and costs can differ between countries. Those with low incomes may get financial support from their local council but even then, they contribute to the cost of care. Most care homes are not directly managed by public organisations but by private providers. Care for the elderly is only part of social care, which also covers those with disabilities. However, with an ageing population, rising care costs and funding cuts have largely affected the elderly.
In England, funding for social care is means-tested, with support only provided to those with the highest needs. Those with assets above £23, 250 must pay for the full cost of care whether they receive care inside or outside their home. In the case of moving into a care home, this asset evaluation can include the value of real estate. This leaves many among the elderly selling property to be able to afford care costs.
In Wales, if an individual has assets valued over £24,000, they must pay the full costs, but home care costs are capped at £60 per week. In both England and Wales, those in nursing homes receive support from the NHS, and under a system known as continuing care – where patients are assessed for eligibility based on severity of their needs– the NHS may fully fund some care.
In Northern Ireland, the system is similar but instead of councils interacting with private providers, there are five “health and social care trusts”, which assess the needs of those requiring care.
In Scotland, the government provides free care at home for those over-65s requiring substantial care but not financial support. Those in a care home are provided some funds, although balances are paid by the customer. If asset values are below £26,250, the individual will be assessed on how much they can contribute although they may retain at least £16,250 of assets.
Why is the system in a crisis?
According to a report by the King’s Fund and Nuffield Trust published last September, cuts to local authority budgets have led to less financial support being available for those who need it to afford care. Over the past six years, there has been a 26 per cent decline in the number of people getting support. This has inevitably led to wealth inequalities in care. As the NHS provides healthcare free at consumption, a similar philosophy should be extended to the care sector as geriatric diseases will make up the future health landscape. Therefore, affordable care services should be universally accessible. The crisis has reached the point that one million people “with care needs now receive no formal or informal help”; these are the consequences of an unprotected care services budget.
The government responded by allowing councils to increase taxes by two per cent for 2015-16 to prevent services being underfunded and providers cancelling contracts. Even then, the deficit was £1bn, putting pressure on councils to reduce services in this “unsustainable” system.
The private providers are increasingly relying on those who can fund themselves, as fees paid by councils have declined, meaning that care homes make little profit and a quarter are “at risk of closure”. Many are cancelling contracts with local councils, and there are warnings of inevitable failures such as the collapse of Southern Cross in 2011, requiring the government to transfer care homes to other providers to prevent care being compromised. To prevent market failure, the government has been called to regulate more strictly care provider finances.
A lack of a cap on care costs has also led to increased stresses on those who need care. The government did have plans to cap costs at £72,000 for the over-65s and younger adults with disabilities from April 2016, as well as raising one’s asset value above which one must fully pay for care from £23, 250 to £118,000. However, this has now been postponed to 2020 after concerns from local authorities about insufficient funding to cope with such changes.
What could be done?
To tackle insufficient funding, the government should increase tax revenue; for example, through raising indirect taxes such as the sugar tax as well as the income tax at higher earning bands. This would be preferable to councils increasing council taxes as the government has greater fiscal reach. This would be unfavourable among many, but a welfare state on such a scale cannot be supported otherwise. The increased funding would also allow a cap on care costs to be introduced, lessening the financial burden for those receiving care.
Alternative options for home care include the “shared lives schemes”, where those requiring care are matched with a qualified carer who resides with the person requiring care. In addition to making it easier for care to be provided, it can reduce living costs for the carer as it is possible for them to move into the residence of the recipient as well, thus reducing home care costs to local authorities.
Another option would be to integrate health and care services, such as the system in Northern Ireland; this would be done by introducing social care trusts which would assess individuals based on need and provide care services. This transition is essential because of the shift from hospital care to community services to manage the ageing population and the presentation of long-term co-morbidities in elderly patients, requiring healthcare to shift along with the changing health landscape. Will we be able to make the changes necessary to cope with an ageing population, or will care suffer because of inaction?