Eligibility criteria for social care services

Is it right or fair to sell granny’s house to pay for her care home and other care fees?

MORE than one million homes have been sold by pensioners to pay for the soaring cost of care, a study has found. And another two million elderly people have had to use their savings to pay care costs.

Elderly care costs an average £3,000 a month for a nursing home and £2,000 for residential care. The bills devour savings and assets, leaving nothing from a lifetime of hard work to pass on to children and grandchildren.

In all, 1,163,200 elderly people have been forced to sell their house or flat over the past five years to pay care bills, according to the report by investment group NFU Mutual.

It means three in four Britons with parents in care will lose their inheritance, jeopardising their own retirement plans. Since 1999, one in 10 adults has had a parent go into care. Of those, 28 per cent have been forced to sell the family home and 48 per cent have used ­savings to meet the charges.

While 15 per cent of children of pensioners in care still hope to inherit a property or money from their parents, 77 per cent said fees had eaten up “most” of their parents’ wealth.

(Daily Express 4/9/2013)

Uncle Sam says

The Health and Social Care and the social care support system in the United Kingdom is complex and can be confusing, with many organisations involved in assessment, arrangement and provision of care. The rules on how you pay for old age care and support can also be difficult to understand and it is important to know what your elderly service users are entitled to in order to at least save some of them the much-dreaded consequence of selling their homes in order to pay for their care.

In the UK there are basically three systems of public funding of care provision for the elderly:

  1. Care provision funded by local Social Services fully or in part, means-tested, and can be:
  2. Directly-funded care—that is receiving care service that is directly-funded and arranged by the local authority, or
  3. By Direct-payments system—which means that you can ask for cash payments from your local authority so that you can arrange your own care.
  4. Care provision funded by the National Health Service’s Continuing Healthcare (NHS—CHC) which is free and not means-tested, and
  5. NHS-funded nursing care. This is simply a financial contribution to nursing care in a nursing home through the local Care Commissioning Group (CCG).

Which system applies depend to a large extent on the patient or service user himself and the specific needs of that patient or service user.  Therefore a decision by a local authority or the NHS to fund a patient’s or service user’s care costs is always preceded by an assessment of their care needs.

What Social Service care provision is available for the elderly in England and who pays?

The type of social services available to help with care and support needs in England can include:

  • Local authority provision of equipment and adaptations to help make an elderly person’s home more suitable to meet their needs in an amount which does not normally exceed £1,000;
  • Help at home with shopping, laundry and cleaning;
  • Intensive home care (also called domiciliary care) such as washing, dressing, preparing a meal, administering medicines;
  • Twenty-four-seven care in a care home with Nursing; or in a care home without nursing; or in a housing-with-care scheme, (also known as sheltered accommodation).

Social Service funding—‘Eligibility criteria pre-2014:

Following a formal assessment, if a patient or service user’s care needs qualify for Social Services funding, we say that ‘they are eligible for funding’ and the term ‘Eligibility Criteria’ is used to describe the official measures used by Social Service authorities to determine who qualifies for funding.

Before 2014 Social Service Departments of various local authorities in the United Kingdom used the ‘Fair Access to Care Services (FACS)’ policy to determine which patients or service users qualified for Social Services funding of their assessed care needs. Under FACS procedure, the assessed needs of a patient or elderly service user were categorised from highest to lowest into the following:

  • Critical,
  • Substantial,
  • Moderate and
  • Low

Under FACS most local authorities funded social care of people whose assessed needs fell into the categories of ‘Critical’ and ‘Substantial’. Those assessed as having ‘Moderate’ and ‘Low’ care needs were not funded. Although a patient or service user with ‘Moderate’ and ‘Low’ care needs was not funded by Councils, he could still find services locally, but had to pay for these from his own income or using his own savings.

Social Service funding—‘Eligibility criteria post-2014:

The Care Act 2014 introduced a new focus of individual ‘wellbeing’ into Health and Social Care services and simultaneously adopted and / or consolidated previous legislation governing Needs Assessment and Eligibility to public funded care including: the National Assistance Act 1948, the Chronically Sick and Disabled Persons Act 1970, the Disabled Persons Act 1986 and the NHS Community Care Act 1990.

The Care Act 2014 came into effect in April 2015. It is divided into five parts with the theoretical basis of individual ‘wellbeing’ at its heart and as its driving force.

In preparation for determining eligibility the Care Act 2014 prescribes assessing the needs of not only the elderly patient or service user but also those of any carer(s). Under the Care Act 2014 there is a national threshold and adults with care and support needs will meet the eligibility threshold if:

  1. They have needs connected with any kind of disability or illness, and
  2. Those needs prevent them achieving two or more outcomes in the list below, and
  3. That results in a significant impact on their wellbeing.

The List of Outcomes in the Regulations include:

  • Managing and maintaining nutrition;
  • Maintaining personal hygiene;
  • Managing toilet needs;
  • Being appropriately clothed including being able to get dressed.
  • Being able to make use of the adult’s home safely;
  • Maintaining a habitable home environment;
  • Developing and maintaining family or other personal relationships;
  • Accessing and engaging in work, training, education or volunteering;
  • Making use of necessary facilities or services in the local community including public transport and recreational facilities or services; and
  • Carrying out any responsibilities the adult has for a child.

The regulations go on to say that an individual will be treated as unable to achieve an outcome if:

  1. Unable to achieve it without assistance;
  2. Able to achieve it without assistance but doing so causes significant pain, distress or anxiety;
  3. Able to achieve it without assistance but doing so endangers or is likely to endanger their health or safety or of others;
  4. Able to achieve it without assistance but take significantly longer than would normally be expected.

The Funding Decision

Unlike Scotland where elderly care is free because it is paid for by the Scottish government, in England eligibility for elderly care and nursing services provided and /or paid for by the local Social Services are means-tested. This means that the service user will pay the full cost of care if they have more than £23,250 in savings.

Therefore in England if an elderly patient or service user owned their own home and no one else was living in it when such elderly patient or service was moved into a care home, the Council is able to take into account the value of the property and use it to pay their care home fees. The repayment to the Council could be deferred but the home is ultimately sold when the elderly patient or service user dies and the Council then recoups its money spent, leaving any remainder to the lawful beneficiaries of the deceased.

In this way ‘an average of about 3,000 elderly people in England have lost their homes annually and another two million elderly people have had to use their savings to pay care costs.’

As a result of an austerity programme in which extensive cuts were made to public spending which negatively affected the UK Health and Social care sectors, and as a result of significant consultation, the UK Lib-Con coalition government of David Cameron considered raising the threshold for funding social care by 2016-17.

From 2016, the proposed reforms were meant to deliver a new cap of £72,000 on eligible care costs, additional financial help for people of modest wealth with less than £118,000 in assets including their home and, from 2015, a scheme to prevent anyone having to sell their home in their lifetime. According to Norman Lamb, the Lib-Con Secretary of State for Department of Health:

‘These reforms bring reassurance to millions of people by ending the existing unfair system

so no one need face unlimited care costs or the prospect of selling their home in their lifetime.’

The foregoing social care reforms proposed by the Lib-Con coalition government transformed into a 2017 Conservative Party General Election Manifesto item under Theresa May as Prime Minister.

“The manifesto promised a ‘floor’ of £100,000 on social care contributions, meaning pensioners could pass on that amount to their children but faced otherwise unlimited contributions towards residential or domiciliary care. It contained no mention of a cap, dropping a 2015 manifesto commitment to limit contributions to £72,000.”

There was considerable political backlash against the Conservative Party when these manifesto promises were announced by Prime Minister Theresa May in the run up to the 2017 UK general elections.  As a result the government resolved to deal with this matter after further consultations in future,

Question: Is it right or fair to sell granny’s house to pay for her care home and other care fees?

This is a moral and ethical question because in itself it raises a number of other very emotive and moral sub-questions, the answers to which, determine our ultimate answer to the original question.

The premise to this question is that:

  • Government at any time raises the needed capital for funding Health and Social Care mainly by taxing the existing lot of current tax payers.

Therefore it could be argued:

  1. That after working hard and contributing a lifetime of service to their country in various working or professional capacities; and after saving wisely and acquiring their properties or wealth generally (when others destitute in their old age now may not have done the same), is it right or fair on the part of government to spend or compel the spending of the assets of the rich to provide for their social care in old age while providing the same social care services to poor elderly people free of cost?
  2. That if government at any time raises the needed capital for funding Health and Social Care mainly by taxing the existing lot of current tax payers, why should the current generation of taxpayers (most of whom are poor themselves) fund the old age social care of elderly people who are already rich and who will only die in the end to bequeath all their riches and property to succeeding generations of their own? Would that not foster the idea and practice of ‘old money inheritance’ and further exacerbate economic inequality in society in the future?
  3. The cost of elderly care is much reduced if older people are partly cared for and / or supported by their families and relatives, especially in domiciliary care settings, thereby reducing the possibility of dissipating elderly people’s savings or selling their properties to pay for expensive care homes as part of their old age social care. People in poorer communities are renowned for this kind of community support to their elderly until the rendering of such support becomes practically impossible in most cases.

Therefore why should the children, relatives and potential successors or inheritors of the wealth of rich elderly people not care for their own parents or predecessors and thereafter succeed or inherit their wealth but rather expect the government to tax existing taxpayers (who are mostly poor themselves) to pay for the social care of rich elderly people?

The answer to this conundrum, which depends to a large extent always on the financial capacity of central government, also seems to lie somewhere between the polarised arguments above:

  • Depending on the availability of financial resources, central government to fund social care of the elderly irrespective of whether they are rich or poor or can afford to pay or not
  • Without the funds to pay for social care independently, central government to tax the rich elderly people extra in order to pay for their social care but introducing a reasonable financial cap beyond which no one pays anything for their social care in old age.
  • Central government to establish and maintain an Old Age Social Care Fund into which all people of working age pay specific amounts of money gradually into retirement and from which the cost of the old age social care of every elderly person is deducted irrespective of whether they are personally rich or poor.

By Samuel B. Jonjo

(Registered Manager, PTMS Care Solutions and Recruitment LTD)


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