Community Care

I’ve written a couple of versions of this post, about a subject that’s quite personal for me at the moment. Let’s just say that it concerns social care and the cost of it. In summary, if you’re unlucky enough to be affected by dementia or Alzheimer’s, have amassed some savings in your lifetime and haven’t acted to “protect” them from the State, then the State is going to come after you to pay for your care. They will demand to see bank statements, investments, divestments, savings and anything else that they see fit to request. If they feel that you have knowingly tried to move money in order to avoid paying for a relative’s care, you could end up in jail. It’s serious stuff.

I know from reading forums that plenty of people feel that this is fair enough – if, in your dotage, you have the cash to fund a plush care home, what better way to spend it? Especially if you don’t have kids, or likeable relatives, or a favourite charity, to leave a financial legacy for. Choose somewhere you’d like to live and pay for it.

The costs are quite breathtaking when you face the reality of them. For a standard, council care home, you’ll be looking at finding between £700 and £800 a week to stay there, of which the State will pitch in around £200 for as long as you have financial assets to cover the difference. If this is the case, then the remainder of the bills will be funded by you, until you’re down to your last £16,000, when the State will step in to pick up the charge. From your pension, investments, savings, sale of your house, whatever, you’ll be finding and funding around £500 a week.  And you’ve pretty much no idea how long that is going to go on for. One year, five years, ten years, more? The way medicine is going, they’re able to keep YOU going, whether you want to or not, for a long time.

If you want to scare yourself witless about a potential future, take a stroll around the nearest dementia ward local to you and ask yourself how, in God’s name, the country is going to be able to afford to look after the legions of poor souls who’ll require round the clock care in the near future? Yes, the big idea is to keep people at home for as long as possible while pumping in community care teams to “look after” their needs. It wouldn’t surprise me, however, if this is even more expensive than caring for someone in a home. The cost of it all is mind-boggling.

When you consider the amount of people who have no pension other than that which the State will provide; when you consider the average amount of savings people have in the bank; when you consider – if you can – the cost of looking after a person twenty four hours a day, seven days a week, plus their medicine, plus their emergency call-outs, their wheelchairs, zimmers, adapted homes for living, the medical teams required for support, the falls team, the social workers, the ambulance service, the heating bills, the solicitors, the GP’s, the administration….look down your street. How many people in their houses are going to need care at the end of their lives, One, two, ten? Then multiply your street up to imagine your village, town, city and country. 

I don’t know about you, but I’d be prepared to pitch in a couple of pence more on income tax if it would guarantee secure care for our elderly. As a community this is surely the right thing to do. My only reservation is that the money would soon be squandered and wasted hand over fist, but what’s the alternative? We’ve got to do something.

Of course, maybe because of my recent personal experience I’m worrying about a potential future of my own that I don’t particularly want to fund out of my own savings if I can help it. And maybe there’s a truth to that, and maybe I feel a bit guilty about it because I was brought up to not break the financial rules, nor even bend them. You paid your way, fairly and squarely, that was how a caring community was built. Everyone contributed what they could, or at least that was the ideal.

The way the health service is going, it’s obvious that the money it will require is way more than a small number of individuals can shoulder. We’re all going to have to contribute more, as a massive public insurance against an uncertain future. There may be a myriad of ways to approach this, politically, economically and socially, but fund it we must as we venture – a lot more slowly – toward the dying of the light.

 

29 thoughts on “Community Care

  1. I know friends who have been battling the NHS to get their parents’ dementia considered an illness so the NHS will pay for care. Its certainly an illness as far as I’m concerned, and should be covered, but there is a huge grey area as it starts, and how we handle mere frailty for the elderly.

    I live with my 88yo Mum, and one reason I FIREd was my niche career would be very hard to follow living here. I’m more companion, shopper and handyman than carer, but I’m reducing the burden on the state, and benefit as she pays all the bills. I accept that all her money should be used for care (and then mine), but equally I’d not want 100% IHT to pay for others’ care, as that level of tax would outweigh all other tax I’ve ever paid in my life.

    In a resource scarce system like the NHS, money should be spent to increase quality life years, but we end up spending too much on poor quality dotage.

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  2. It’s great that you are able to care for your mum. That’s the ideal for many people (and the worst nightmare for many more!) Putting your folks into a “Care home” has a real stigma to it, but sometimes there isn’t really an alternative. You hope it will never happen and then Nature intervenes.

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  3. In your post on taxing issues on 28 January you whined about having to pay taxes and now today you want other (presumably working) people to write you an insurance policy for dementia and alzeheimers. Just another brexit Boomer wanted it both ways….

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    • Definition: Doublethink
      Doublethink is the act of simultaneously accepting two mutually contradictory beliefs as correct, often in distinct social contexts. Doublethink is related to, but differs from, hypocrisy and neutrality. Also related is cognitive dissonance, in which contradictory beliefs cause conflict in one’s mind. Doublethink is notable due to a lack of cognitive dissonance—thus the person is completely unaware of any conflict or contradiction. First expressed in George Orwell’s novel 1984

      https://en.wikipedia.org/wiki/Doublethink

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      • We are all guilty of DoubleThink. We want social justice, but don’t give all our money to cure blindness in Africa, the best social and economic bang we could get for our buck. We are more prepared to pay time and money to provide care for those close to us than give it to the state for them to spend on others.If you accept that private wealth is a good idea, you have to expect inequality.

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  4. Good post which raises a lot of important questions. There is better liaison/coordination between the NHS and Social Services in Scotland so they carry out more care in people’s homes. From what I’ve seen, this is the better way to go in the early stages of dementia since the patient gets to stay in their familiar surroundings which is better for them. Also a cost effective solution as, in our case, the carers only come in twice a day so are free to see other people the rest of the time. It is also equitable as the person pays for the upkeep of their now home. However, I do agree with the point that we are sleepwalking into a future situation where the burden on society becomes very great as the demographic trends take over. In this case (as with others – especially diabetes), the cost will fall on the taxpayers of the future. By under-funding at this stage we are creating an inter-generational crisis. It seems to me that the only fair solution is an increase in general taxation now. Of course this has it’s own problems as, in general, governments don’t “save” money for the future because they work on a pay as you go basis. This means that the additional income would have to be spent now but in a way so as to be equitable to future generations (investment e.g. in infrastructure or housing?), a complex challenge. Anyway, thank you for an interesting and thought provoking post and I wish you well in your own personal dilemma.

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    • Thanks Nick, my mum is in Scotland. She’d carers coming in four times a day. My dad, suffering from Parkinsons, was on 22 tablets a day. My local hospital bill for prescribed paracetamol last year was over £500k when you can buy a packet in Tesco for about 15p. Who can’t afford 15p? It’s great not to worry about the cost of healthcare on a personal basis because the NHS picks up the tab, but you can’t help but wonder how long it can go on that way? It just can’t.

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      • It can go on indefinitely but have to pay more tax for it personally obviously

        Top marginal income tax rates across much of Europe are up to 40% higher than in the UK. A few countries like Holland and France have annual wealth tax levies as well

        its not really surprising these countries have way better healthcare services than the UK

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      • There is a prescription charge of £8.60 already in England, so no GP would prescribe paracetamol on that basis, certainly no patient in their right mind would take that prescription to a pharmacy. Note if you’re after elastic hosiery the charge jumps to £17.20 (ouch)

        I’ve thought for a while that GPs should follow the same approach as NHS dentists and apply an appointment fee of say £20ish.

        That could be an effective nudge, and sometimes nudges can have dramatic effects. Think of the 5p charge on plastic bags, usage has fallen off the edge of a cliff!

        Obviously, those currently qualifying for free dental would be entitled to free GP appointments

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  5. I’m worrying about a potential future of my own that I don’t particularly want to fund out of my own savings if I can help it.

    You can’t take it with you 😉 Seriously, though, AgeUK say there are about 15% of the elderly in care homes, so the odds of going that way aren’t overwhelming. There are also insurance products than can help with the risk of outliving your savings in a care home, though you tend to need a SOLLA financial adviser to make that happen. And enough money to start with…

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    • I maybe can’t take it with me, but I feel that I don’t want any more to be taken off me. I admit that opens me up to the Neverland criticism of wanting to have my cake and eat it, but I feel I’ve already give quite a bit of my cake as it is! What I have left I’d like to divide out myself – who knows, that might include my local hospice or hospital because I think I trust myself more than Jeremy Hunt.

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  6. Rather than raise the money through income tax, how about charging a nominal fee for GP visits and prescriptions? (The latter are free in NI – I don’t think they are in England?).

    If the cost of visiting the GP is zero, then demand will, in theory, be infinite. A nominal fee of, say £5 per visit, would dramatically cut frivolous visits and raise funds at the same time.

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    • Y here in Australia you have to pay to visit the GP unless you are too poor and on benefits. If I remember correctly the total is AUD$65 for a normal consultation (it varies). Medicare refunds about $35. The benefit is that I can normally see my GP the same day. You can also go into any surgery and see any GP too.

      In relation to having all your assets eaten up by care, would it really matter when you have declined to that point? If you have substantial assets and kids then the way round it would be to dole out the money to them before you get to that stage.

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  7. What about just taking the money from the people who actually need the care if they have it? After all you can’t take it with you…
    Oh wait! We already do that…
    Then their middle class baby boomer offspring whine about not getting multiple inheritances (mainly free of IHT) they didn’t earn just because their relatives didn’t have the foresight to die in the most tax effective way.
    Really find me the world’s smallest violin…

    Liked by 1 person

  8. Firstly, sorry to hear about your family. It’s never easy dealing with that sort of thing.

    Care is something I’ve been thinking about following family hospitalisations and care at nursing homes. I struggled to believe that some of the people there confined to beds, staring vacantly at the ceiling (even when being visited by family) would want this life. And I couldn’t morally reconcile the amount of NHS money being spent to keep my elderly relative alive in hospital with the delays to urgent surgery another relative had recently had, due to a lack of resources.

    I want the option of bowing out before it gets to needing constant care. Having had 2 grandparents in care with dementia, going downhill with falls and general ill health, I wouldn’t want to live that way myself.

    Following the family death I’ve spoken to my family about writing living wills for us all with instructions on exactly what medical intervention we each would want, everyone seems agreeable.
    I listened to the following NPR Planet Money podcast, well worth a listen:
    https://www.npr.org/sections/money/2014/03/05/286126451/living-wills-are-the-talk-of-the-town-in-la-crosse-wis

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  9. This is a really important subject, yet very uncomfortable, so you do well to raise it; it’s one of several elephants crowding the room in the UK. (and aging nations generally) These are the facts:- the population is aging rapidly as the tax base supporting it is shrinking. (that is just one serious contribution to the national budget deficit) The poor can’t pay more, the rich won’t and nobody can make them, so that leaves the middle classes to be squeezed, it’s that simple, morality aside.

    The answer is a gown up political conversation the nation has to have, which is: ”What needs/wants are you the taxpayer willing to accept paying for?” Scotland as well as topographically, is looking more and more like a scandinavian country, willing to accept paying for more social justice generally, while England wont, as evidenced by the electorate repeatedly voting for parties that worship at the altar of neoliberalism. This leads to an interesting dilemma that is inescapable even for the magical thinking Cake-ists, when the middle classes can’t be shaken down any further for the demographic cost bomb of geriatric ‘care’, something has to give. You can shrink the NHS to cover less conditions, finish privatising it and let the poor ‘go’, or in keeping with the ruling ideology, now promote euthanasia as ‘the ultimate free-market choice’, hey, like any other utility provider.

    Very soon, given current trends, even confiscating all the wealth of those in the departure lounge of life will not cover the costs of the boomer population graph overhang when they make their reluctant exit. It’ll be making-up-your-minds time soon and if the ostriches wont look up, they’ll just be run over anyway, refusing to decide doesn’t make the scary scary reality go away; as Marie Antoinette found at great personal cost, the cake doesn’t really regenerate.

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    • A visit to any NHS hospital is always a sobering experience, once you get past all the smokers loitering outside the front door. I wouldn’t mind paying more for it, I just wish I knew that the money was being well-spent, although how you could ensure that I have no idea.

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  10. The NHS while being undeniably sabotaged by privatisation, equally has drifted via mission creep to something it was never intended to be – why should you be able to waste your gp’s time repeatedly with no repercussions [missing appointments] …..as opposed to punitive measures for wasting police time? Responsibility cuts both ways, so people shouldn’t be able to abuse the service – why do people get stuff like paracetamol free off it when that’s 17p a pack in Lidl?

    Then there are many arbitrary issues that have a fortune spent on them that are not basic, essential needs – certain cases involve individual’s flights paid for to go to distant specialist centres in the UK (England to Scotland for example) where there are clinics for things related to self-esteem. If you think that’s Ok, fair enough, pay more taxes & don’t complain, otherwise have the honesty to admit you don’t.

    There are still many snowflake conditions indulged on the NHS that were not conceived of at inception & in anyone’s language couldn’t be described as essential/life threatening vs marginally improving. This is such a contentious area it’s easy to be accused of hypocrisy, so to give a concrete example I’d be personally fine with a legally-approved, safe euthanasia pill.

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    • I’d be in favour of paying for GP appointments too and I often wonder if all the money pumped into private health by individuals and companies went into the NHS, then how much would that be? Would it help? It seems to me that for the rest of my life the NHS will be there, in pretty much the same state as it is now, but consuming billions and billions more than it currently does. That money will have to come from somewhere…

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      • Actually, I wasn’t saying we should have to pay for the appointment, but maybe for proven negligently missed appointments – you lead onto another interesting & important point with your reply there though – value for money. Studies have shown Americans for example with their brutal, dysfunctional healthcare system pay more than us for a significantly worse service in general, mostly due to corporate capture.

        This makes me think that private vs public administration/control is largely a red herring, it’s actually more about intelligence-led efficiency & dedication, so apolitically what would get the average person on the street the best deal? As far as I can see, corporate control is too open to abuse & govt. control has to be better only with the huge caveat of truely independent regulatory oversight, so as to avoid political interference via the evading of toothless watchdogs.

        Certainly choice is always a good thing & individuals in a civilised democracy should be able to hedge their options by having private & state cover if that is their wish, both of which should be strictly regulated to eradicate as far as is humanly possible, corruption & ineptitude.

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    • Guessing whether the wealthy would let a bit fall through the cracks between their fingers to ease systemic injustice, as opposed to letting even their own off-spring take the hit – if that’s the only other option – well, …….if 2 wolves & a sheep vote on the menu, it was always going to be the lamb wasn’t it?

      Archaeological studies show that civilization after civilization returned to dust because their elites preferred death to sharing …..& for the most part, people never really change; that suicidal greed is such a hardwired evolutionary survival urge.

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      • Currently working my way through ‘The Origins of Virtue’ by Ridley. One of the theories presented there is it is precisely because we learnt to share that we managed to be so successful on the savannah and go forward to dominate the world. Its all to do with big-game hunting and sex (its a great book!) The assertion is that our hardwired evolutionary urge is to share and reciprocate rather than some tendency toward suicidal greed.

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  11. The country is effectively bankrupt. Our national debt is increasing whilst schools, hospitals, emergency services, local councils and infrastructure are being underfunded. Just look at the potholes everywhere. We as a nation are in a dire situation.

    Our debt is servicable as long as we join the Americans in their wars. I like Corbyn and how he has reframed the debate, but let’s face it, were he to win power it would create further carnage. When he resists following the US into its next war, the international debt community will turn its back on us. We are then the next Argentina.

    When he suggested printing money to build council houses we were told about magic money trees. It’s ok to print queesy money for the banks, print money to bomb Baghdad back into the stone age, print money to refurbish the world’s largest council house, or buy votes off the DUP, but spend it on the people. F(%cling no chance.

    So the issue of an aging population losing their minds…….these are people who can’t pay taxes, contribute to the economy or fight wars. They will eventually be abandoned by the state despite the fact that they have worked a full life, paid taxes and maybe even fought in a war.

    We live in an era of political individualism. I fully expect there to be no state pension when i retire. You’ve got to look after yourself – don’t expect any help off the state. Maggie, Tony and Call Me Dave took us to the point of no return.

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