Money: We're paying the price of living longer

With 70,000 people a year selling their home to meet care costs, Esther Shaw asks how the state intends to avert a crisis
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Anyone with an elderly parent knows that deciding to move him or her into a care home is one of the toughest decisions they will ever make. And financial worries may well add to the stress, for most families in this situation will have to face the question of how their relative's care is to be paid for.

Under current rules, people with capital of more than pounds 20,000 - including the value of their home - must pay the full cost of their own long-term care. This is no easy feat, given that residential or nursing home places currently cost on average around pounds 25,000 a year.

Research from Help the Aged's Care Fees Advice Service shows that 70,000 older people are forced to sell their homes each year to raise the necessary cash. It's the only option left for one in five pensioners who need to go into care, the charity's report says.

Not only that, but the number of elderly homeowners affected will increase over the coming decades, as nursing costs soar and life expectancy rises.

Meanwhile, people who do qualify for financial help are in a dwindling minority. National guidelines on eligibility criteria - typically based on income and benefits - and the range of services funded by the National Health Service have not been updated since 2001.

And interpretation of these guidelines lies in the hands of cash-strapped local health authorities - turning long-term care into a lottery.

Costs will fall into one of two categories: accommodation charges for staying in a residential home, or fees paid for medical care in a nursing home. The latter should be covered at least in part by the NHS, but in reality, the boundaries have become blurred.

In February 2003, the Department of Health ordered a review of the system after the Health Service Ombudsman accused some health authorities of "misinterpreting" the rules and wrongly charging people for nursing care they were entitled to for free on the NHS. Since then, the Ombudsman has received 4,000 complaints from the public on the matter.

Campaigners have long been calling on the Government to implement new, clear-cut national criteria for funding.

"The Ombudsman's figures only begin to reveal how many older people and their families are victims of the shambolic care-funding system," says Gordon Lishman, director general of Age Concern. "Some have received a pittance towards the cost of their care when they should not have paid a penny."

In December last year, the junior health minister, Stephen Ladyman, commissioned a new national framework for the assessment of fully funded NHS continuing care, and announced the publication of an independent

report on the matter. No date has yet been set for the framework's introduction

While Help the Aged spokes- man Jonathan Ellis says it will be a "vast improvement" on the existing system, Philip Spiers, director of the Nursing Home Fees Agency (NHFA), is reserving judgement until details are announced. "Funding for long-term care has been a grey area for far too long," he says.

Anyone who believes they are wrongly paying for care should contact their local Primary Care Trust to ask for a review. If they are unhappy with its decision, they can then appeal to the Health Service Ombudsman.

Mr Spiers says the NHFA saw a rise in calls to its helplines last month. Many people complained of inappropriate or delayed assessment of care needs, and information not being provided by social services on time.

"Most of the problems we encounter at this time of year are money-led," he adds.

The good news for those who have to pay for their own care is that there are a number of state-funded benefits and schemes for which they may qualify. For example, if their capital excluding their home is less than pounds 20,000, the local authority must disregard the value of the property and assist with fees for the first 12 weeks of residential care.

After this, the local authority can lend the money to finance care through a "deferred payment agreement", to be recovered when the property is finally sold.

Check, too, for eligibility for what is called attendance allowance. Those who end up funding themselves can qualify for a non-means-tested, non-taxable pounds 39.95 benefit paid weekly for care by day or night - or pounds 58.50 if both are needed.

If one spouse is still living at home, this property should not have to be sold or be included in care-fee calculations. Many elderly people may also be able to claim income support or pension credit, depending on their capital and income.

In any event, professional financial advice will allow you to consider all your options.

Contacts: Age Concern, 0800 009966 or www.ageconcern. org.uk; Help the Aged Care Fees Advice Service, 0500 767476 or www.helptheaged.org.uk/ carefees; NHFA, 0800 998833 or www.nhfa.co.uk

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