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By Debbie le Quesne

Posts Tagged ‘Dilnot

Care cost capping will help only a few

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According to a report by the Institute and Faculty of Actuaries (IFoA) the cap of care costs will help just a few.

It makes a pledge by Secretary of State for Health Jeremy Hunt that capping represented a “watershed moment for our country” now sound a bit hollow.

I recall a speech or some kind of news item where he spoke of successive governments failing to address the cost of caring which led to people selling their homes and losing nearly everything they’ve worked for to pay for their care.

Thomas Kenny, one of the authors of the IFoA report, said in the Press last week: “Recent research data shows that one in three women and one in four men aged 65 today is likely to need care.

“Yet the average disposable income for retired households was £18,700 in 2011-12, which is below the level required to fund the average long-term care costs before reaching the cap.

“Anyone who is expecting that the cap will pay for care is in for a shock. The cap is there to protect against catastrophic care costs and we estimate that few people entering care aged 85 years will reach it.”

It’s another blow for the Coalition as sit attempts to reform care. What’s more, the IFoA research found that there was not really a single product in the marketplace that help to meet the foreseeable costs of caring.

Reading this stuff just makes me feel depressed. I wonder what the care industry is like in Cyprus . . . now that’s a

Highs and lows of the passing year

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I have been thinking (dangerous I know) of what to blog on New Year’s Eve. There has been so much miserable news over the last 12 months that has both shaped and scarred the care industry.

But there have been some incredible triumphs and opportunities too where as an association we have been able to bring influence to the movers and shakers.

In recent months we have been able to respond to the Telegraph article on ‘the scandal of secret mark-ups’ and correct the over-generous figure of £486 a week quoted for the average care bed price paid by local authorities for a realistic £384.99. And we have argued also that self-funders are indeed to the difference between many home closure and survival in these difficult financial times.

Let’s take a look at the care sector highlights over the last year . . .

  • In January we had the so-called revelations on the Dilnot report where the long-awaited capping of care costs for individuals was set at a far higher £75,000 than the recommendation of £25,000 t0 £50,000. We were hoping for clarity and certainty and we got neither.
  • Domiciliary care agencies had been saying it for years, and in January the NHS Confederation adding to the chorus: GP and community services should receive a higher proportion of NHS spend to enable more care to be carried outside hospital, said the Confederation chief. Mike Farrar said in his New Year message that he would like to see ‘more investment in primary, community, mental health and social care services as a proportion of the total spend’. And wouldn’t we all?
  •  We also saw our MPs in confessional mode on dealing with mental illness – a brave and laudable move and one that could only help the funding issues around this care specialism.
  • In February the Lords Committee investigation into the growth of the section of society above retirement age tabled some scary facts, prompting calls for a proper plan to cope with the dramatic increase in those aged over 65.
  • The Care Quality Commission (CQC) and the Patients’ Association also joined forces in a move to speed up action on concerns over poor elderly care.
  • And there was a groundbreaking social media project, which aimed to trigger past memories in people with dementia, is to be piloted in Scotland. The Memory Box Network is a charity which aims to use online reminiscence therapy to increase the quality of life of those who live with dementia, which affects around 84,000 people in Scotland. The team developed a website where users can view and upload content to act as a talking point between the person with dementia their carers and loved ones.
  • In March the Joseph Rowntree Foundation encouraged care homes not fall victim of negative stereotypes. Critically, in conclusion, the report says: “With greater levels of staffing and investment, care homes will be better placed to understand and act upon the wishes and aspiration of older people.” So much of this report was based on the need for extra money and more staff and at the sharp end of care and still we need both like never before.
  • I loved the newsbreak on the care home where charity Magic Me was holding cocktail nights specifically aimed at bringing in new faces to residential care settings and establishing a larger friends network. Sadly, I never did receive my invitation.
  • The chancellor also announced that a modified version of proposals laid out in Dilnot report would be brought forward by a year to . . . wait for it, 2016.
  • April gave us Good Care Week Good Care Week, a national platform to be show off excellence in care and a fantastic initiative.
  • Also in April was the announcement that the Care Quality Commission (CQC) would be introducing bigger, more expert inspection teams to police the industry.
  • May’s centre stage event was work by pupils in Sandwell who created visuals to help understand dementia. It was a real privilege to be part of The Sandwell Dementia Friendly Event.
  • June came with a new buzzword – integration where NHS and social care funding pots combine. Hmm . . . My abiding concern in the ‘real world’ of caring is that there are huge divides still between social care and the NHS – not an easy fix; inadequate funding – CCGs are being asked to give two per cent of their budgeting to this cause and already cash is tight; there’s the political issue of who gets priority; and frankly, I don’t believe the initiative will fix the billions of pounds shortfall politicians are speaking of.
  • July – When you don’t know the way ahead, ask a care worker on the frontline. Well, at least that seemed exactly what the government was doing. Care minister Norman Lamb called for everyone in the care mix – service users, carers, managers and directors to submit ideas on how to make the home care system work.
  • August came with more agendas on the Care Bill, this time with a Prevention Matters initiative where investment into first-line social care was being sought as a way of saving NHS treatment costs.
  • Author Sir Terry Pratchet was in the news in September after going public with an update about his particular dementia condition and a memory lane street created at care home near Bristol. Great if you can afford this kind of therapy.
  • October saw headlines stating there was a RGN crisis in nursing homes. Burt there was joy for the National Care Homes Open Day with 2,500 care providers taking part.
  • Also in this month Health Secretary Jeremy Hunt found the solution to an ageing population and poor funding: Adopt the Asian culture in caring. The British way was deeply flawed, he maintained, so we must look overseas for sustainable answers. Hmmm . . . I’ve been privileged to travel a lot and what has struck me most in these cultures is the poverty, sickness, neglect and chronic conditions.
  • November saw The Work Foundation suggest that social care apprenticeships could “strengthen the pipeline for future talent.” The flouting of the minimum wage law was also highlighted this month with investigations by Her Majesty’s Revenue and Customs finding that of the completed 183 investigations, 48 per cent of employers had paid workers below the national minimum wage, set at £6.31 for adults. And so to December: It’s still Bah, humbug! Over funding from government but good will to the elderly from the young all over the country was in evidence. One very good piece of news in this month was Mr Cameron calling for an international summit to address the global problems of Alzheimer’s disease.

U-turn on plans to fund care: What a mess we’re in

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Writing in the Daily Mail, columnist Simon Heffer, addresses the apparent U-turn on government care policy.

He points out that Care Minister Norman Lamb announced last July that people would no longer be forced to sell their homes to pay for long-term care in old age. And it seemed to be a policy, and a promise, set in stone.

Guess what – now it appears to be nothing of the sort.

Heffer claims “there has been no great Government announcement – in fact, the U-turn has been slipped out in virtual secrecy. “

The devil, as always is in the detail, with the latest consultation proposals making provisions for means testing “that would penalise tens of thousands of hard-working, thrifty people each year.”

Heffer adds: “Essentially, it would force many members of the middle class to spend their assets on care or face having to sell their homes — as 40,000 a year do now.

“In doing so, it would make a mockery of their efforts to scrimp and save for their retirement — often at a cost to their quality of life in middle age — in the hope that financial rectitude would bring its own rewards.”

I have prided myself for years in not ever letting politics jaundice my views on care, but this coalition is something else when it comes to offering defined leadership – and not least, information – to the care sector.

Indeed, Heffer is correct when he writes the change would be “shocking breach of promise.”

To recap, Mr Lamb had pledged to ring-fence people’s homes by offering a deferred payment scheme that would allow the state to recover the cost of care (up to a capped level of £72,000) from estates after death.

Succinctly, Heffer rightly adds: “However, this may not now be so. The promise of a universal scheme of deferred payments for care, whether residential or in the elderly person’s own home, may be diluted so that homeowners with assets (excluding their house) over £23,500 would be forced to run them down to that level before qualifying for help.”

Well, Mr Cameron, where do we go from here?

Clearly there needs to be a major overhaul of care funding and the problem is not going to go away. How much worse can this all get? My care provider members are essential to the wellbeing of our elderly, frail and chronically sick. Frankly, the government’s commitment to them as they have effectively help roll out its modernisation policies is shameful. We are on the cusp of major social care crisis and we’re looking for a lead.

Things must be bad when the Mail, of all newspapers, criticises these new Government proposals, agreeing with Labour’s shadow care minister that it’s  “an attempt to ‘pull the wool over the eyes’ of the elderly.”

Heffer concludes his well-structured rant by writing: “Much as I am always loath to agree with the present Opposition, in this case they are absolutely right.”

Back to the drawing board (does anyone use that expression any more?). . .

Funding care: My worries at the latest government plan

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Last Thursday the Department of Health published yet another proposal on how to fund care for the elderly.

I confess I’ve been putting off doing this blog in the hope that I could over time understand more fully the government’s plans. Sadly that has not happened.

The original Dilnot plan – or should I say, the revised Dilnot plan, was complex enough – but this latest offering seems worse.

The Guardian noted that “relatives wishing to investigate the costs of a care home for a loved one will need expert guidance to explain how the funding will work.” Too true.

This latest initiative is essentially an insurance system for elderly care in England which promises to cap costs for one in eight poorer pensioners and cut bills for the wealthy by up to a fifth.

Postcode lotteries of how much care is delivered and for how much money will be swept away in 2016 and replaced by a national level of eligibility.

Individuals will pay into a government-backed “care account”.

We know the cost of care will be capped at the proposed £72,000. But this will only pay for someone’s care. It will not take into account the hidden “hotel costs” for bed and board, which could be another £15,000 a year.

Where is this shortfall of cash coming from?

Deferred payment has also been mentioned, so that settlement will come from the estate of the deceased. Essentially those needing care will also be able to borrow money from local councils at a nationally agreed interest rate to pay for the service but will have to pay it back when they die.

All we seem to be doing here is putting off the inevitable: The government seems to be saying the plan will stop people having to sell their homes to pay for care – but only while they’re alive. Outstanding care costs will still have to be met and I suspect for most, through the sale of property.

Given that local authorities are squeezed financially as much as the rest of us, how are they going to fund care ‘up front’?

Critics are already forecasting this system will be a field day for lawyers as disputes erupt between households and local authorities over the levels of care provided, the cost and whether someone has been properly assessed.

Tricky questions on the care capping issue

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There’s a million-dollar question that’s forever being asked about the funding of care regarding just how the new £72,000 capping level is going to be rolled out by April 2016.

It’s a gigantic job and the logistics are complex.

The principle of introducing a capped cost was outlined in the Care Bill with the aim to provide financial help for people currently facing catastrophic care costs.

The government’s intention is to assess all the self-funders already receiving care who ask to have their costs applied towards the cap.

An assessment framework is within the Bill and all eligible people will have a personal care account which will monitor their progress towards the cap.

The Guardian online, with the help of Laing & Buisson and Nick Kirwan, director of ILC-UK Care Funding Advice Network, poses the burning question of how this will be be implemented before April 2016.

It’s not a lightweight piece, but care providers will be in the vanguard of this change, so it’s well worth the read. Care managers will be the ones quizzed over the details of this self-funding ceiling, believe me.

According to Laing & Buisson, there were 175,000 people in residential care (43.4 per cent) in 2012 who paid the full cost without support from their local authority.

Issues raised in the piece include:

  • How many will apply to have their care costs accrue towards the cap and what will be the demand on local authority resources?
  • Fears that this exercise could have an adverse effect on the care sector.
  • How will the facts and the process be communicated, so that people are clear about whether or not to apply?
  • What about people who lack mental capacity?
  • What of the so-call ‘accommodation cots’ not counting towards care?
  • Self-funders should be assessed immediately before April 2016 so that they don’t miss out on any qualifying costs. Could this create a traffic jam in the system in March 2016?
  • How will the queuing system work?

Just for good measure there’s a bunch of other Pandora’s Box questions too. I’m dreading 2016 unless the government really gets its act together.

Full article: http://www.guardian.co.uk/social-care-network/2013/may/28/how-to-implement-care-bill

Oh dear, the Dilnot consensus is falling apart

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The government’s Care Bill, outlining a range of issues including how to better integrate care, tackle social care costs and how to drive up care standards, was published a few days ago.

In essence, the Bill will create a single law which replaces more than a dozen pieces of legislation.

But it came with a warning from the Alzheimer’s Society, a group not known for overplaying its hand or for barbed political ‘spinning’.

This is what it said on the day the Bill went public: “Today’s Bill has the potential to bring about important changes to prevent the highest costs, integrate care and give carers the recognition they deserve.

“However we must ensure eligibility levels are not set so high as to deny thousands of deserving people vital support.”

And here’s the crunch: ”Also, unless the huge financial hole in the social care system is addressed in the summer’s spending review, the system will never be fully fixed.”

Fast-forward less than a week . . . and today we have the Labour Party breaking rank with the cross-party consensus that the Dilnot cap of £72,000 is a fair deal.

As many of us working in the care sector suspect, the capping level to ensure older people will not have to sell their homes to fund social care, would not work.

I recall blogging about its implications – one being the possible rash of insurance policies emerging for funding, but so far even this potential has not been stimulated by the Dilnot rule.

Liz Kendall, Labour’s care spokeswoman who sits in the shadow cabinet, said that after the opposition had analysed the new arrangements it was “plainly obvious families will face losing even more of their homes than they do now”.

I don’t understand the mathematics of such analytical work, but she adds “most elderly people in care homes will die long before they ever reach the cap” and that I clearly do understand.

At the heart of the policy, said Kendall, was that the cap only applied to payments for care at council rates.

The Guardian online states today: “By 2016, when the cap takes effect, local authorities will pay about £500 a week for residential care and “hotel costs” (essentially food and accommodation). Hotel costs are limited to £12,500 a year or £240 a week, leaving £260 for care costs.

“At that rate it would take about five years to reach the £72,000 cap, at which point the government will step in and pay the £260 a week as a care subsidy.

“However, that is about twice as long as the average stay in a care home. And anyone paying more than the local authority rate will have to pay the extra themselves, before and after the cap is reached – which won’t count towards the £72,000.”

This is all so messy, embroiled in politicking, and I dislike getting involved in this debate because it has always been such a political arena.

Isn’t it time for the politics to cease? We need a care funding solution and under this parliamentary watch there’s doesn’t seem to be one emerging. It has to be a cross-party resolve that will stand scrutiny and critically, any solution will need to be driven by addressing care demands rather than squeezing those increasing social needs into a predetermined budget.

The government summer spending review is on the horizon and I can only hope that a political will emerges in hard cash to help us deliver the care ministers demand, but will not presently fund.

Date brought forward for care reforms

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It’s rare I get chance to read the weekend papers, but I’m grateful for the enlightenment that the government is to introduce reforms to the funding of long-term care for elderly people a year early.

Our friend George Osborne had made the announcement, no doubt in an attempt to show that the government is responding to the challenge of an ageing population.

The chancellor announced that a modified version of proposals laid out in Dilnot report would be brought forward by a year to . . . wait for it, 2016.

The government will also cap the maximum amount anyone will have to pay at £72,000, rather than the £75,000 proposed by the health secretary, Jeremy Hunt, in a statement to parliament last month.

Economist Andrew Dilnot had proposed a cap of around £35,000.

According to the Press, the chancellor made the announcement on BBC 1 Andrew Marr Show in a preamble to the budget on Wednesday. No doubt that will bring with it fresh gloom.

Osborne said: “We have to go on in this budget confronting the very difficult economic problems Britain has – difficult problems in a difficult world situation . . .

“We have got to change a lot of things. It is painstaking work. It is difficult work. There is no easy answer to Britain’s problems. There is no miracle cure because of course if there was a miracle cure it would have been deployed. It is just a lot of hard work dealing with Britain’s debts, helping businesses create jobs and helping families who work hard and want to get on.”

All deep joy stuff. But it gets worse with forecasts on growth likely to be downgraded by the Office for Budget Responsibility.

Mr Osborne added: “ . . .we will bring the Dilnot cap forward to 2016 and indeed reduce the cap to £72,000. In other words you will have to pay £72,000 of care costs but after that, for the rest of your life, those care costs will be covered by the state.”

I cannot understand why there is so much inertia in responding to a need to radically restructure care services and its funding. . . 2016! Why so long to wait?

What is deeply worrying is the ‘set course’ response we hear over and over again from the coalition. No matter how bad it’s getting in the care sector, no matter how budgets are tightened, no matter what the personal cost, we don’t seem to be able to adapt to emerging need, or deepening crisis.

I am not an economist, but some things leave me puzzled. I read recently in The Independent newspaper that the HS2 rail project to link the north and south with a super fast service is about to break out of its £33bn budget because of rising costs. So far the government has spent £250m on the plan.

No wonder a coalition of campaigners and MPs has questioned the financing in a time of supposed austerity.

Can someone explain why this project must go ahead now when we can no longer afford to care for the elderly, chronically sick, disabled and mentally ill?

The West Midlands Care Association does not have a political mandate, but it does have a responsibility to try to uphold standards of care in whatever way it can. And if that means adding pressure to this government, or indeed standing against it, the association will do so.

As the economy founders, businesses sink and care budgets are slashed, we are as ever, left to pick up the pieces at the sharp end. Just once, it would be lovely to start the week with some better news about the issues of caring.

Written by debbielq

March 18, 2013 at 10:16 am