Huge !0% increase to care home fees

NedS

Clueless56 said:

NedS said:

Clueless56 said:

Even when the cap comes in, it will only cap the total amount paid out for care in the person's lifetime and will not cover the hotel costs, which are a large chunk of fees paid to residential and nursing homes.

Exactly, the proposed cap only covers 'care costs', and the vast majority of the OP's £70,000/year fees will not be for medical care, but for residential care which would not be covered. So anyone self funding is still going to end up selling the house to pay for it.

I don't really understand this line of argument.  If you're permanently in a care home, you don't need your house any more to live in so it reverts to an asset (unless a partner or dependent still lives in the house, in which case it can't be sold).  What are people saving for if not a rainy day?  Why should the taxpayer safeguard inheritance?

I wasn't making an argument, it was merely a statement of fact. The inference being that many thought/assumed the proposed cap would safeguard at least some inheritance whereas in reality that is unlikely to be the case.

gm0

None of the inheritance envy discussion makes the current allocation of cost for OTHERS to those who happen to die slowly rather than quickly any fairer and who happen to need care longer term.  Which you cannot control as an individual absent assisted suicide legalisation.

It is wrong. Even mildly offensive to bat away the self funder cross subsidy issue as being about inheritance.  It's not about paying your own way - which is ENTIRELY fair.  And unobjectionable.  Life thows different challenges at different people.
You need it or you don't. Lucky you if you don't. The unfairness is then paying for OTHERS as well. Being SINGLED OUT to do so.  Because you happen to need residential care services - you now pay part of the bill for others while the rest of the population bimbles along happily unaware.

Clearly you could locate an all self funding home to seek to avoid this cross charge for underfunding of LA funded cases. 
A nice little poverty apartheid incentive there. Which is an odious idea on its face and a stress too far at what is a crisis point in many a family.  Not that some of this wealth based class segmentation of provision doesn't go on.  It clearly does. Via price signals to families.  In a region with a variety of provision you might well find a nicer environment for the same fee to you now that you are not subsidising the people down the hall.  Sorry about the lack of solidarity. But the nice walls don't matter.  Or the branding or that it's LA run vs private. Irrelevant. The staff do - it doesn't correlate with nicer vs faded buildings but with good on site management, good shift lead nurses and hiring practices to keep it running well.  And not too much churn of agency staff.

Anyone who falls into this care space (with assets) contributes (part pays) for their care visits at home and later for their lodging and care - bar any NHS contribution and also net of any benefits they receive as their eligibility dictates.  A melange of AA/PIP/Carers/CTAX relief at different stages etc.  If they can contribute they should.  And do.

Children with aspirations for inheritance just have to deal with that luck of the draw and call on assets to pay for it. It is what it is.  The lifetime contribution cap is an interesting idea to try to deal with the long stay tail risk.   If someone can't pay or they run out of money in situ the state steps in - as opposed to leaving them in a ditch or off to Soylent Green. Welfare state safety net.  Most agree that is sensible.  A lower "cap" than the longest stay residents pay is for a small population.  But expect the cap to be oversold based on leger de main on lodging vs nursing and carefully picking the point on the long tail.

But critics citing an inheritance motive as a complete explanation - politely - have not thought this through.

Why should that unfortunate person who falls into the residential care system be SINGLED OUT to pay for OTHERS in the same situation who cannot self fund - over and above the taxpaying public with assets and income feeding taxation in general via the LA. Genuinely curious what the justification for that idea would be - to select them to pick up (part of) the tab for their next door neighbours over time in the home because of the particular version of illness and speed to death they have

This is what happens today. 

The average care home stay is short - thankfully - an average of few years only. These are not places most of us want to spend time in.  For a few there is no easy alternative and for their health conditions (not very terminal) and personal safety the stay is much longer. Even decades. Fewer in number offset by a number of very short stays for terminally ill patients in care setting as hospice. But very much present in the system.  As with investing. The individual path as experienced may not be the median path across the data set.  A lot of stays of weeks to low months averaging out with a smaller tail of 10-20+ year cases. Don't assume a normal distribution

The cross subsidy shell game works like this:

LAs don't pay enough per person to cover full rates or even costs (depending where in the country) at their standard rate.
So while an LA patient is better than an empty bed (some revenue vs none).  You don't want too many.  Loss making.
Solution: Cross subsidised from prices charged to self funders by racking up their weekly rate widening the gap to the LA rate.
Manage occupancy + mix via applicant flow as people die off. And rooms open up.  Careful who you admit.
Make it to the end of the year.  Rinse and repeat

But then - unsubsidised energy cost shoots up 2x/3x or more in a building that needs to be kept warm 24x7 for 90 year olds who don't move much.  The CQC will deeply disapprove if you refrigerate them. 
Higher inflation and a need to raise low pay to keep staff adds more cost
Rack rates go up to self funders.  LA rates still lag.
Crisis deepens
Some (more) homes close - with particular energy woes and lack of self funders because they are in a poorer on average region
Care capacity drops further and differently around the country

Now can't discharge from acute beds in some hospital as nowhere to go
Ambulances can't unload at the front door of hospital until an acute bed is found to move the person on from triage who needs admission who is blocking A&E
You die at the scene of your car crash, fall or heart attack - for want of an ambulance turning up for hours because it is queuing to unload the last patient.  An excellent use of paramedics and the ambulance because of lack of social care provision I am sure you will agree.

But that's OK - well - you had it coming for not scraping yourself up and transporting yourself to A&E. You didn't die on the NHS's time so it doesn't really count.  And at least you won't need residential social care later.  So there is that.

Or do you have a private ambulance on speed dial to take you to a private hospital instead ?  And you are alright Jack
The uber rich would solve it that way.  But for the rest of us with an interest in UK as a society - a solution needs to be found for NHS and Social care alignment. Which may as well tidy up this associated horizontal unfairness of charging users for more than their own care along the way

LA's can't and don't raise the rate because the government LA block grant is too small to keep up with costs and they are limited on local tax rises.  And there are other statutory duties and competing priorities. So from where they sit.  It is what it is.

Russia in Ukraine has just lobbed a hand grenade of energy costs into a barely functioning system prior where they were just bouncing back from the occupancy vs death roulette of pre-vaccination infection getting into care homes via hospital discharge of untested patients, via staff and families, or via visitors (prior to visitor ban).  An empty care home is an insolvent care home.  An entirely full care home is no use to the NHS this weekend with a stuck bed.  Shut homes and full homes. Not enough home visit capacity.

Result 13% blocking of dischargable (treatment finished) acute beds at present and a queue out the door.

Suggest you don't have an accident

Are you bothered about social care funding languishing unsolved for 12 years since Dilnot yet ? 

Malthusian

Clueless56 said:

I don't really understand this line of argument.  If you're permanently in a care home, you don't need your house any more to live in so it reverts to an asset (unless a partner or dependent still lives in the house, in which case it can't be sold).  What are people saving for if not a rainy day?  Why should the taxpayer safeguard inheritance?

(dollar sign eye emojis) (flying banknote emojis)
My favourite example of this kind of skitehawkery came from a BBC article a couple of years ago (12:38), featuring a man complaining that his council wouldn't dump his own sister in Overmydeadbody Grove in order to halve her care fees, which in turn would allow he and his relatives to keep using her empty house as a free hotel.
The really eye-opening thing about this nonsense was that the BBC reported on him as a victim of the system without a trace of critical thinking.
People base their morality system on what they want, not the other way around.
I suspect it may also have something to do with denial of the reality of death. "Dementia is an illness! They don't make you sell your house if you've got tonsilitis! Mum's coming back some day!" (The last part is always unstated but it is implied by the idea that her previous home is anything other than an empty house.)

AlanP_2

Care Home fees are a confusing and fairly opaque thing normally.

I used to work at a County Council and worked on many IT projects with the care teams.

I remember a conversation with one of the Assistant Directors about care homes me pricing. He said if you go in your new Merc / Jag etc. on a scoping visit you will be quoted a higher price than if you go in an old banger.

They are private businesses and charge what the market will support, and, would rather not have council funded people at all if possible.

Pollycat

AlanP_2 said:

I remember a conversation with one of the Assistant Directors about care homes me pricing. He said if you go in your new Merc / Jag etc. on a scoping visit you will be quoted a higher price than if you go in an old banger.

I'm not sure I believe this.

AlanP_2

Pollycat said:

AlanP_2 said:

I remember a conversation with one of the Assistant Directors about care homes me pricing. He said if you go in your new Merc / Jag etc. on a scoping visit you will be quoted a higher price than if you go in an old banger.

I'm not sure I believe this.

Why not? It's anecdotal, I can't give you evidence but it was definitely said and I have no reason to disbelieve him. 

I do know of people in the same home paying different private rates so seems like it could be possible.

I also know a couple of tradespeople who fine tune their quotes based on what they feel the potential customer might be happy to pay / can afford. Size of property, type of cars on drive etc. are part of their calculation process.

NedS

AlanP_2 said:

Pollycat said:

AlanP_2 said:

I remember a conversation with one of the Assistant Directors about care homes me pricing. He said if you go in your new Merc / Jag etc. on a scoping visit you will be quoted a higher price than if you go in an old banger.

I'm not sure I believe this.

Why not? It's anecdotal, I can't give you evidence but it was definitely said and I have no reason to disbelieve him. 

I do know of people in the same home paying different private rates so seems like it could be possible.

I also know a couple of tradespeople who fine tune their quotes based on what they feel the potential customer might be happy to pay / can afford. Size of property, type of cars on drive etc. are part of their calculation process.

Quite possible for small privately run care homes maybe, but less likely for larger national operators who will more likely have set pricing structures.

blue_eyes

The ONS J3J6 series does attempt to track retirement home costs within
"CPIH ANNUAL RATE 12.4.0.2 Retirement homes for elderly persons and residences for disabled"
https://www.ons.gov.uk/economy/inflationandpriceindices/timeseries/j3j6/mm23

So this might give OP an indication of how costs/prices are trending.
Over 2.5 years, assuming the annual increment was in December (selected only because that's the latest figure available)
that would be 3.5%(dec20) ->4.5%(dec21) ->7.5%(dec22)
would be approx 16.5% increase from the mid 2020 price if my maths is sound.

In practice this might be more "lumpy" in rounder £ numbers.