Care Home Fees - Who Pays?

EdInvestor

Techno wrote:

I suppose my point agrees with you in that if the individual made best use of everything available to them (including benefits and immediate needs annuities) then as you rightly say, they wouldn't need the council at all - but many are not aware of this and no-one is telling them! (except you of course)

Techno

Shouldn't the council be telling them? Or is it just easier to bully and intimidate these old unwell people and their families into selling their home and handing over the money?I'm sorry if that sounds a bit hard on council employees who may feel it is "'not their job", but what are social workers for?

Ideally, you don't really want council officials involved in this area at all - except to help the very poor, and in areas like inspection of homes to make sure they meet appropriate standards.

I can understand it may have developed this way because most elderly people who need long-term care in the past were probably older women, who traditionally have been right at the bottom of the poverty scale with no pensions or house of their own.Hence issues like taking the house wouldn't be relevant.

Now they are. The whole area needs a rethink, IMHO.

Why are people not being properly informed? Is it because it applies to so few families? Only 4% of the over 65s last time I looked.

margaretclare

Why are people not being properly informed? Is it because it applies to so few families? Only 4% of the over 65s last time I looked.

And of those, it's mainly the over-80s who are affected.

However, although it applies to few families, it's a very widespread fear, and a large number of people put it into very simplistic terms no doubt fuelled by 'Daily Mail' headlines and TV programmes like a recent 'Panorama'. So, to inform people properly as you suggest, whoever was trying to give the information would have to conquer all those misapprehensions and mis-information first. Not as easy as trying to put over a completely new idea! In addition, when I worked as a temp admin assistant a few years ago, a lot of the social workers were foreigners - there were a lot from South Africa, for example. It's very difficult to grasp all the nuances of our 'welfare' system, the need to have a background of the history of how it all developed, what many older people were told and firmly believed, that 'they'll look after us from cradle to grave, after all we fought for this country...'

Another complication is the idea of 'inheritance' as a right, as one hears in statements like 'Mum/dad/granny/grandad have left their house to us in their will, now it will be "grabbed" to pay for their care'. The idea of grabbing, theft etc is very widespread.

Going back to Ed's point about immediate needs annuities, I don't need to worry about this for a while yet, but it does seem to give back-up to my instinct to continue saving while I can. People ask 'but what are you saving FOR, what can you possibly need at your age?' I hadn't thought of saying that either I or DH may need an immediate needs annuity, but I'd like the possibility to be there if and in case we do need it - although we would obviously prefer to be looked after in our own home for as long as possible, and that's why we've spent time, money and effort on making the place as easy-care as possible. We don't mind paying for help coming in - we already pay for a gardener from time to time. Some people, however, think they shouldn't have to pay for anything themselves, and the idea of using their own pension income as a starting-point, as you suggest, is anathema to them. It's 'What can I claim, what am I entitled to?' and you see this all the time on these boards.

BTW I have worked in some of these care homes/nursing homes and they do vary a lot in atmosphere, facilities, quality. I did a few shifts in one which is right out in the countryside near where I live - south-east Essex, Thames Estuary near where it joins the North Sea. Beautiful open countryside, ploughed fields stretching miles....but mainly the people who were there had lived all their lives in the East End of London, and were used to streets and buses rather than ploughed fields! Why were they so far from home, far from anything and anyone they knew? Well, it was much cheaper for the London boroughs who were funding their care, that's why. Grrrr.....

Margaret

EdInvestor

Some people, however, think they shouldn't have to pay for anything themselves, and the idea of using their own pension income as a starting-point, as you suggest, is anathema to them.

It's a lot easier to grasp the point I think if people look at a residential care home as more akin to a hotel than a hospital - as the best ones are.

The better off you are, the nicer the hotel you can afford to stay in, with better food, a nicer room and bath, better services ( personal and medical) from more highly qualified, better paid (and perhaps more charming) staff, nicer maintenance and decor of the building, a prettier garden....

Just because you can't quite manage to look after yourself totally doesn't mean you're sick, semi comatose, totally out of it, or not desirous of a decent quality of life, does it?

I don't think so.:rolleyes:

Speaking about getting care at home - has anyone considered the idea of having a live in au pair - as mothers do to help with young kids - but one with training in helping the elderly?

Why would you not be willing to pay for such a person to provide care (and/or company) for an older person, in the same way as you would pay for childcare? What is the difference?

lisyloo

Why would you not be willing to pay for such a person to provide care (and/or company) for an older person, in the same way as you would pay for childcare? What is the difference?

The government do have a policy now of trying to help people in their own homes as this is cheaper and often better for the individual.

Sometimes people cannot be cared for in their own home for the following reasons.
a) If they have medical needs their medication may need to be administered by a nurse.
b) They may need 24 hour care which is very expensive on an individual basis but cheaper to provide in a home for lots of people at the same time.
c) If they need lifting then this can be impossible for one person to do.

It really depends on what your needs are.
My parents are starting to get to the stage where they might need 1 hours help a week with cleaning.
This is different to someone that needs full continence care, bathing and lifting i.e. everything doing for them.
It is prohibitively expensive to provide a team of people (at least 3 over 24 hours) for yourself. Unless you are loaded this just isn't an option.

In a home they can have a couple of people monitoring many as they won't all need care at the same time (or will have to wait their turn).

Of course many people don't need 24 hour care and this is why these days the government (local authorities) do use sevices like "meals on wheels" to keep people in their own homes.

It a question of the levl of care that you need really.

margaretclare

EdInvestor wrote:

It's a lot easier to grasp the point I think if people look at a residential care home as more akin to a hotel than a hospital - as the best ones are.

The better off you are, the nicer the hotel you can afford to stay in, with better food, a nicer room and bath, better services ( personal and medical) from more highly qualified, better paid (and perhaps more charming) staff, nicer maintenance and decor of the building, a prettier garden....

Just because you can't quite manage to look after yourself totally doesn't mean you're sick, semi comatose, totally out of it, or not desirous of a decent quality of life, does it?

Ah no. And so often it seems to be the case that 'Dad's savings have been put into an account in this son's name because they're meant for his kids and not to be "stolen" to pay for his care'. This therefore implies that Dad can put up with any cr*ppy place and Social Services can pay for the bare minimum (as in the example I gave of urban people living 40 miles away from where they'd lived all their lives) because after all Dad won't know the difference, will he, and his descendants will enjoy all that he worked and saved for without having to work and save themselves'. There's another thread on Martin's site where Dad having £100K in savings is mentioned, and 'it's for his kids'.

The idea of using pensions income first with attendance allowance, then topping that up, sounds a good one, but it's not the way that most people think. Most people seem to be of the opinion that residential care should be completely free, and any attempt to get the person to pay out of their own resources is met with great indignation and cries of 'theft'. I've read many posts where the possibility is not even on the horizon, people in their 50s - 60s still hale and active, are spending time and energy on 'making sure my assets can't be grabbed by the State in case I need care in the future'.

I looked at it from my point of view as an example. If I'm still getting AA if/when I ever need this (never, please God, but just in case...) I could afford £200 a week because that's my normal pensions income. If DH is so inconsiderate as to die before me then I inherit all his SERPS, another £80 a week. What would £280 a week buy me in terms of residential care - preferably one of the Methodist Homes?

Anything more than that and I'd take on the idea of the immediate needs annuity.

Speaking about getting care at home - has anyone considered the idea of having a live in au pair - as mothers do to help with young kids - but one with training in helping the elderly?

Why would you not be willing to pay for such a person to provide care (and/or company) for an older person, in the same way as you would pay for childcare? What is the difference?

I used to do this type of work in the early 1990s, and there are agencies that specialise in recruiting staff to do it. Basically, one person works for 2 weeks, then replaced by someone else, and they alternate that way. I did it only to keep the roof above my head in the years after I was widowed, was made redundant and still had a mortgage, 1992 - 1997.

Margaret

EdInvestor

margaretclare wrote:

This therefore implies that Dad can put up with any cr*ppy place and Social Services can pay for the bare minimum (as in the example I gave of urban people living 40 miles away from where they'd lived all their lives) because after all Dad won't know the difference...

There does seem to be a certain amount of this attitude about

I looked at it from my point of view as an example. If I'm still getting AA if/when I ever need this (never, please God, but just in case...) I could afford £200 a week because that's my normal pensions income. If DH is so inconsiderate as to die before me then I inherit all his SERPS, another £80 a week. What would £280 a week buy me in terms of residential care - preferably one of the Methodist Homes?

Accoding to the link above:

The cost of long term care will depend on the health of the individual. Where the individual only needs companionship as well as help with the daily activities of life such as washing, feeding and dressing, this is provided by a residential care home. Residential care may cost an average from £13,400 to £16,400 depending on the location in the UK.

So the median fee would be 286 pounds a week.This would be the type of care needed for someone with dementia, for instance.

.... nursing care could cost an average from £16,700 to £24,400 depending on the location in the UK.

You'd need this is you had a bad stroke. But part of the cost here is paid by the NHS - all the actual nursing as opposed to personal care and the actrual residential cost.So it might work out much the same.

It does actually seem to me that people on an average retirement income would be able to afford residential care on this basis without having to sell their home, providing their income,the Govt subsidies and the care fees increased by a similar amount to cover inflation over the years.An immediate needs annuity could be used to provide a higher standard of home and/or cap the cost.

However it would be nice to have more information on what you get for your money in this area.

Sharpie

OK...another thing that has not been mentioned is the fact that we should all have an Enduring Power of Attorney in place for ourselves. This enables someone that we trust to have the authority to manage our finances for us if we become mentally incapacitated and unable to do so.

If there is no EPA in place, and we become mentally incapacitated, then we would have to become a ward of the Court of Protection, which would then have control over the finances (via a designated person).

EPAs need to be sorted out whilst you are fit and mentally sound, and everyone should have one, at any age (because you could have a car accident age 30 and need care as a result) along with a Will. It costs about £80 to set one up via a solicitor.

New ones come into force next year which will alllow welfare decisions (as well as financial) to be made.

It takes a long time to set up an immediate needs annuity for a client who is a ward of the court of protection. Much quicker if an EPA exists.

Also, if a client is self funding in residential care, and needs nursing care, then they may also be entitled to RNCC (Registered Nursing Care Contribution), which is around £80-£120 per week.

Janeywaney_2

The care costs I see on this thread seem lower than in my area. My dad's care costs £332 a week in a nice residential home. Bear in mind as well as fees elderly people need to have money for clothes, hair cuts, chiropodists, gifts, spectacles and maybe even coffee out...

EdInvestor

Prices do seem to have risen a lot .According to this survey outside London a couple of years ago the price range was between 15,500 and 19,500 a year for residential care, ie 298/375 per week.

The FSA says average costs are now 19k p.a.The Norwich Union insurance company has a range of costs depending on location (outside London) of between 17,888 and 23,608 (344/454 a week)

60% are self-funding but the costs seem to be rising by more than the 5% typical of index linked pensions and annuities, while the rest will be council funded. The main difference between the two seems to be that self funders get a private room, while council funded people have to share with one other.

Not clear if there is much difference in price in not-for-profit/charity run places and those run as a business.Indeed generally there is very little info available on costs, which is something that needs to be addressed since people are actually paying - we are not talking NHS.The current lack of clarity on costs makes it very easy for homes to raise prices and others with vested interests to scare families and elderly people into buying expensive financial products or services which they may not actually need.

It's currently very difficult to 'shop around'.

BBC Moneybox has a good discussion pointing out that many people in nursing (not residential) care could be eligible to have all their costs funded by the HHS, regardless of what their assets are.

margaretclare

In response to Sharpie, there is no one who could/would take on an Enduring Power of Attorney for either of us. DH would not hear of it in any case, and I have only one daughter who happens to be 250 miles away. So, while there may be some merit in the idea, it's just not practical for us.

I would imagine that the chances of us BOTH becoming mentally incapacitated at the same time are pretty remote anyway, and our affairs are designed and set up to run with as little attention as possible.

Margaret