Care nightmare: can we afford to get old in Britain?

Thousands of elderly people receive a raw deal under an 'unfair and incoherent' system
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The Independent Online

Making sure our parents are cared for in their old age is a concern for many of us. Which makes it all the more worrying to hear critics of Britain's care system describe it as encumbered by a labyrinth of legislation.

With the lines of responsibility for the cost of long-term care blurred between the individual and the state, elderly people and their families have no choice but to do "battle [with] the care system", says Philip Spiers of the Nursing Home Fees Agency (NHFA).

In the course of the past month, plenty of Britons will have had their first experience of this bureaucratic nightmare.

The festive season is often the only time during the year that the whole family gets together. Not surprisingly, then, the holiday weeks saw telephone enquiries to Help The Aged's Care Fees Advice Service (Hacfas) more than double to around 1,000.

"People just don't know how to go about approaching long-term care," says Mr Spiers. "Those patients funded by the state get their hand held a lot more because the local authority is responsible - and the care tends to get delivered.

"But those who are self-funding are not given the same level of support."

This situation can only get worse: the number of people aged 80 and above is set to double in the next 30 years, according to social policy research from the Joseph Rowntree Foundation. Three months ago, it published a discussion paper condemning Britain's care system as "unfair and incoherent".

The report's author, Donald Hirsch, argues that the current system is unsustainable. He claims that it provides neither clear-cut guidelines on how much care individuals need, nor an acceptable set of rules to determine how much they should contribute based on their ability to pay.

"In the next 50 years, we'll have to spend four times as much on long-term care as we do now," says Mr Hirsch. "If we keep our present system of public funding, most of the increase will fall on individuals. We need a system that's fair and clear to users if we are to raise more public money."

But the prospect of achieving that seems remote. Last year, an Office of Fair Trading report concluded that two-thirds of elderly people in care homes are paying either "unfair" or "unclear" bills.

One particular problem is that there are different ways to pay for the type of long-term help on offer, depending on whether this is basic care in a residential home, or care involving nursing and medical treatment. In the latter case, the NHS should cover at least part of the fees regardless of the patient's income.

But when it comes to non-specialist care, older people need startlingly few assets to rule themselves out of any state assistance. Anyone with capital of more than £20,500 (including the value of their home) slips straight into the self-funding bracket.

One in five pensioners in Britain go into care. Little wonder, then, that with average care fees now in the region of £26,000 a year, some 70,000 people a year are forced to sell their homes in their old age. Fees at this level can quickly absorb the proceeds from a property sale and eat up any money that people might have been hoping to pass on to their children.

The OFT report, along with pressure from consumer groups, has prompted the Department of Health to look into the idea of a "one-stop-shop" long-term care information service. It is hoped this will lead to greater price transparency, fairer contracts for patients, and better access to complaints procedures. But no deadline has been set for its introduction.

The NHFA believes any such advice body should be independent of the Government and is now looking to put together its own information resource.

The good news for those who must pay for their own care is that they can also draw on a number of state-funded benefits and schemes.

First, even where patients own their own home, local authorities must cover the cost of the first 12 weeks of care if their other assets are below £20,500.

Individuals who need daily or night-time care may also be eligible for "attendance" allowance - a non-means-tested benefit paying at least £40.55 a week (£60.60 if both cases apply).

An NHS nursing care contribution should also be claimed towards the cost of fees, even if someone is staying for only a short respite period. Paid directly to the care home, this ranges from £40 to £129 a week.

Depending on their savings, an elderly person may also be able to claim income support or pension credit. And if their property is left empty when they move into care, it should be exempt from council tax until sold.

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