Care Home Fees Conundrum

GunJack

Terry_Towelling wrote: »

It's all very well to say that those who choose university shouldn't expect the rest of us to pay for it and those who get ill should sort themselves out but we don't live in that sort of society; we live in a welfare society and, sooner or later, we are going to have to pay for it collectively through increased taxation.

I'd have to disagree on the Uni point, unless the numbers were reduced to something more realistic like 10-15% of 6th-formers going, not the 50%-ish currently.

As for healthcare, I've never seen a breakdown of care home fees, so don't get how they can justify £1k a week for a place - maybe the answer is to look at that before deciding how to finance it. I would have no problem in paying an extra couple of % in income tax IF it was for a sensible solution...

lisyloo

so don't get how they can justify £1k a week for a place

I have experience of these homes (as my MIL & FIL) were in one so have a better idea of how they justify it.
Firstly £1K is quite high.
We pay £825/£850 for nursing care.
This is for 24/7 care where there are nurses on-site and almost all the residents need hoisting.
I can see that there are high staff costs for the ratios needed and the anti-social hours as well as the insurance/bereaucracy costs.
This also includes activities (one memeber of staff) and a minibus to take people out (high staff ratio when wheelchair are involved).



£1K per week is indeed quite high unless your are in London/SE but there is a very wide variety in standards, some place are half that in the Bristol are.


Personally I don't think it's a money spinner, but if you do the answer is clear - run one, or invest in them.

Terry_Towelling

GunJack wrote: »

I'd have to disagree on the Uni point, unless the numbers were reduced to something more realistic like 10-15% of 6th-formers going, not the 50%-ish currently.

As for healthcare, I've never seen a breakdown of care home fees, so don't get how they can justify £1k a week for a place - maybe the answer is to look at that before deciding how to finance it. I would have no problem in paying an extra couple of % in income tax IF it was for a sensible solution...

I wasn't promoting taxation to pay for higher education; I was demonstrating a parallel between calls for state-funded higher education and state-funded dementia/illness care. I'm not saying either viewpoint is right or wrong.

lisyloo wrote: »

You have made the suggestion that we all pay more to expand long term care. Not everyone may agree with you.

I don't expect everyone to agree with me but people do have to understand there is a link between state-funded benefits and taxation - and not just connected with health-care.

lisyloo wrote: »

So why should everyone else pay for your long term care when you have your own assets??

No one else will be paying for my wife's care - she and I will be paying for it, until the money runs out. I hope to keep her at home with me anyway.

And why should our payments for care be used to subsidise others who are getting state-funding? For that matter, why should we subsidise others who chose to spend instead of saving for their future needs?

There are so many angles to the issue.

lisyloo wrote: »

So what you then have is some rich old people payihng nothing and younger people and just about manging families facing a bigger tax burden?

I suspect most young people and just about managing people/families won't agree with you simply to preseve the wealth of people who can't benefit from it and the inheritance of others.

Like I said, I don't ask for agreement, just acknowledgement that what we all face here is a growing problem whereby we are all expecting more and more from less and less - it's not sustainable.

And, don't forget to look into the future of those struggling young families you mention. If they have no wealth when comes the time for care, they will be drawing on the state to pay too. I'll say it again, it's just not a sustainable situation.

On the subject of fees, in our area they range from £750 per week to upwards of £1500 per week - and it doesn't matter how they justify those fees because they don't have to. That's what they ask and that's what you pay. £1K per week is around the average in this area.

lisyloo

but people do have to understand there is a link between state-funded benefits and taxation - and not just connected with health-care

I am very pro-honestly.
If we want a good NHS then we need to be prepared to pay for it.
The rich subsidies the poor (how can it be any other way?) and 60% are net takers. The wealthy should be proud to support the vulnerable not see taxation as a burden (easy to say if you're not wealthy of course).

No one else will be paying for my wife's care

Sorry I thought you were suggesting otherswise.
It's not totally clear what you are arguing for.

And why should our payments for care be used to subsidise others who are getting state-funding?

I completely agree with you on that (assuming you mean the cross-subsidy). Loal authorities don't have enough to pay their way and because they are a wholesale buyer they have pushed down their price at the expense of others. I wholehertedly agree this is unfair.

For that matter, why should we subsidise others who chose to spend instead of saving for their future needs?

I agree with you, but what do you suggest we do with them? put them on the street when they need care? of course we can't do that.
The only 2 ways I can think of to solve that are higher taxation on everyone (perhaps biased otwards spending like VAT - that won't be popular) OR we force people to save for long term care like we do with pensions (that won't be popular). Forcing people what to do will be unpopular but I do agree it's unfair.

just acknowledgement that what we all face here is a growing problem whereby we are all expecting more and more from less and less - it's not sustainable.

You have it from me.

and it doesn't matter how they justify those fees because they don't have to

I don't think that's true. I think there is cost pressure.
But if you've been to the ones with a high ratio of staff to clients you will see why.

£1K per week is around the average in this area.

It sounds like you live somewhere pricey.

Have you considered moving or is that out of the question?


BTW - I do think my MIL should pay for her own care (she doesn't need her house any longer) and I think the £825 she pays is pretty good value considering it's 24/7 nursing and includes an activities co-ordinator.

GDB2222

Quote:
For that matter, why should we subsidise others who chose to spend instead of saving for their future needs?

---

I agree with you, but what do you suggest we do with them? put them on the street when they need care? of course we can't do that.

Whilst I agree with you entirely, there have been societies (very successful ones at that) that took a very draconian approach to social welfare. The Spartans, for example.

billy2shots

As well as the regular costs of running and staffing a business including taxes, staff pension etc, Here's a few things to consider why care can be expensive.

-24 hour 365 days a year needs to be staffed by a decent ratio of workers to service users (including bank holidays, nights, weekends where pay may need to be increased.

-Managers, clerical, and maintenance staff on top of nurses/caters/activity coordinators

-Accountants and banking fees

-Mortgages, food, Gas, electric, water etc etc just like a normal home but multiplied by 4, 8,10,20 depending on the size of the home.

-Fees to CQC

- High public liability insurance due to the level of risk of the industry

- constant repairs and renewals of furnishings and specialist equipment

- maintenance and up keep of vehicles

-numerous staff training courses (first aid, moving and handling, infection control, H&S, risk assessment, food hygiene, diet and nutrition, dysphasia, epilepsy, dementia awareness,aggression in the workplace, safeguarding , fire awareness, I could literally go on and on) that's before you get on to specific training

-the above need doing at various intervals, quarterly,3 times a year, yearly, every 3 years.

- holiday pay that must be factored in for all staff. Yes every business is the same but in an office you may run a person short, in care you can't do it's a double whammy, holiday pay and replacing those hours. The same with maternity

lisyloo

24 hour 365 days a year needs to be staffed by a decent ratio of workers to service users

The nursing home my MIL is in has no-one that can get to the toilet unaided.
In most cases they need 2 members of staff to hoist the client into a wheelchair, hoist them out at the other end, clean/pad as necessary, hoist them off toilet to wheelchair and then from wheelchair to chair and of course they need massive bathroom (large bedroom size) to get the hoist, wheelchair and 3 people in there.

I think £825 is quite good value for money for a decent home with an activities co-ordinator and mini-bus.


When my FIL was dying there, they took notes of every meal/refusal.
Presumably this is party for medical reasons but also to cover their own liability i.e. each time he refused food, his response was recorded, so I think there is a fair amount of beauraucracy as well.


But if anyone thinks it's a money-spinner - then get into the business.

billy2shots

Record keeping is a massive part of the job. I will not talk about care and cleaning records because that would take up pages but food was mentioned.

-Menu planning to make sure of a well balanced nutritional intake. Taking into account allergies, religious requirements and choice for each service user.

-Temperatures taken of any meat prepared (most meals)

-every meal a resident eats is recorded

-the amount of food eaten is often recorded so its easy to see if someone's appetite is changing.

-fluid charts are often used, both drinks taken and fluid out.

- fridge and freezer temps need to be checked twice a day and recorded.

- service user weight should be recorded monthly if no concerns. More regular weight should be taken for anyone at risk of malnutrition.

-malnutrition paperwork needs doing with scoring taken to determine someone's malnutrition risk

There is equally as much paperwork involved in care that you don't see as there is to physical care happening that you do see.

Terry_Towelling

This thread has shifted from a case of 'deprivation of assets' to 'justification of care home fees'. Billy2shots is obviously well-versed in the subject and it is good to see that some of what has to be done is very similar to what I have to do caring here at home - only without the bureaucracy, costs or revenue. That said, I do also keep records of certain things and that enables me to identify patterns and progressions so that I can modify the regime to keep things on an even keel - ha ha I wish.

@lisyloo, I'm not arguing for anything in particular - I don't have the energy - I'm simply responding to points raised and raising a few of my own.

The sustainability argument is key though. Whilst it is not always appropriate to assume that a trend will continue at the same rate indefinitely, I have no reason to believe that ill health (dementia in particular) will not carry on increasing in later life.

We are often told that today's generation cannot afford to buy their own home and are deeply in debt. If this is true, they are going to reach a stage in life where care may be needed and they will have no asset-base or wealth behind them to pay for it. The state will have to fork out. That's fine, but the state cannot afford to pay for it - just look at the increasing number of councils falling into financial difficulty partly due to the 'social-care' cost burden.

I don't have a solution, but whatever it is, it will involve more of us paying more in taxation.

AnotherJoe

GunJack wrote: »

As for healthcare, I've never seen a breakdown of care home fees, so don't get how they can justify £1k a week for a place - maybe the answer is to look at that before deciding how to finance it. I would have no problem in paying an extra couple of % in income tax IF it was for a sensible solution...

Since these places and the companies that run them are shutting down / going bust at a rate of knots, that speaks to the "justification" of £1k a week. (where i live, the two homes I know of are charging £1400 and £1500 a week which makes £1k look like a real bargain)



Basically its down to people costs, and what else could be done with that money. If you are restricted to very low prices by councils not paying what it costs, once you've run out of privately funded people to subsidise the low paying council tenants, you are likely going to knock the care home down, sack everyone and build flats instead.