Like all splendid idea’s it’s so simple and blindingly obvious! I shall certainly be recommending this idea to everyone I speak to that has a loved one in, or going into, a residential care setting.

No matter how good the records of a residents past are, seeing photographs of the younger person must serve not only to provide an insight into that person but also as a reminder that, if blessed with long life, we too shall be a young person in an older body!

Andrew Dilnot (pictured right), the eminent Oxford economist was charged over a year ago to look into the way the elderly fund their care and on 4th July 2011 the Commission he chaired delivered their Report – A fairer funding system for adult social care. 

“The day after the report came out I had the opportunity to listen to and question Andrew Dilnot.  It was clear that the report is only the first stage and are just recommendations.  We now enter a consultation period and this period of engagement will last until Autumn 2011.  It is hoped that a White Paper will be forthcoming in the Spring of 2012.  Mr Dilnot said at this meeting in Westminster – “the current system is nuts” and regarding the means test by Local Authorities to funding care is the “most ghastly of all the means tests in our current social security system”.

I can only agree with him on these last two points but do have my concerns whether a White Paper will be forthcoming in the Spring of 2012.  Firstly we have already had some drift on the original white paper date, originally set for the end of 2011.  Secondly, this may well be used as a reason for those to whom the legislation currently affects will take no action.  To delay will only cost money for those who need care now.  Finally, if and when the legislation does get onto the statute books there is no guarantee that those in care now will benefit.  We will have to wait and see.

I welcome the report and very much hope that it will be taken seriously by the current Government as there have been three other significant reports into our Adult Social Care system in the last 14 years; none of which have made very much difference.  Our former Prime Minister, Tony Blair, said at the Labour Party Conference in 1997 that he did not want “children growing up in a country where the elderly had to sell their homes in order to fund their long term care”.  Well, nothing has changed and it is about time it did.

Among the key recommendations in the report are:

• Should they need care an individuals’ lifetime contributions towards their social care costs – which are currently potentially unlimited – should be capped at £35,000. After the cap i  reached, individuals would be eligible for full state support.
• The £35,000 limit of lifetime personal liability is irrespective of where care is received and does not include accommodation costs. People should contribute a national standard amount to cover their general living costs, like food and accommodation, in residential care. This should be set between £7,000 and £10,000 per annum.
• The means-tested threshold, above which people are liable for their full care costs, should be increased from £23,250 to £100,000.
• National eligibility criteria and portable assessments (with an objective assessment scale whereby everyone above a ‘substantial’ care need threshold is supported) should be introduced to ensure greater consistency.
• A new social care statute should place duties on local authorities to provide information, advice and assistance services in their area, and to stimulate and shape the market for services.
• The Government should work in collaboration with the Financial Services Authority and other partners to develop greater support for those seeking information on financial planning for older age.

Paying particular attention to the recommendations in the report, there are three points which have been commonly misunderstood:

1. The care costs should be capped at £35,000.  The Commission recommended a cap of between £25,000 and £50,000 but the £35,000 is the suggested figure.  But this is the figure for care and does not include the residential (or sometimes known as the hotel) costs.  Exactly what the care costs are for a resident of a care home charging £800 per week is currently difficult to establish.  This, if implemented, will create a sea of change.  If the care costs are deemed at £300 pw, then the proposed new cap applies to 116 weeks of care, ie 2 years and 3 months.  This is interesting to compare with the figure of the average length of stay in a care home for those who have purchased an Immediate Care Plan of 4 years*.
2. The accommodation costs should be set at a maximum of £10,000 per year.  This I believe will be very difficult to administer as there is a huge difference in price with the varying quality of homes.  There will not be enough room for all at the premium establishments and as a result those who wish to receive this service will no doubt need to pay for it themselves.
3. It is very much welcomed that the new Local Authority threshold could go up to £100,000.  However, the Local Authority will still have their maximum they will fund on a weekly basis, and if a care home is chosen which is in excess of this then the resident will still be expected to pay.

Moving forward over the next few months, those who are immediately in need of care and are going to have to pay for their own care costs, are going to have to carefully consider the following:

• The changes are probably not going to be effective until the end of this Parliament (May 2015)
• Most care home costs will mean that individuals will still have to make some contribution 
• Not to delay in seeking financial advice in this specific area

One part of the Report which I strongly advocate is the recognition of ‘wide access to high quality information and advice which people can trust’.  At The Wealth Care Partnership (TWCP) our Care Fees Specialists are Independent and are Society of Later Life Adviser (SOLLA) accredited, or are currently working towards their accreditation.  Our Specialists understand the issues facing the elderly and have been providing crucial advice to these people or to their Attorneys for many years.  TWCP advisers offer comprehensive advice in a clear and concise manner when addressing long term care funding, pension, investment and inheritance tax planning issues.”

* Source – Partnership

The views expressed here are those of Tim Anstee and do not necessarily reflect those of The Wealth Care Partnership.

I feel strongly that the opinions of the care providers are massively important to the implementation of the outcomes of the now anticipated white paper. Without care providers we would have no care system to fund and the events at Southern Cross cannot fail to bring home the implications of funding constraints on care providers whatever business model they follow.

I have asked Roger Wharton, Executive Officer of our local Somerset ‘Registered Care Providers Association’ for some feedback. Roger attended the launch of the Dilnot Report at the Central Hall Westminster and has put some of his thoughts together for me. I would like to share them with you.

Dilnot.

“I met with Tim (Anstee) and loads of people from Partnership, cornered Dame Jo[i] from CQC, Peter Hay Chairman ADASS[ii] and others during the course of the day with some useful feedback from all of them. Of course any conversations were as a representative of care providers.

To summarise what was a long day with a variety of speakers, all with a leaning towards the theme of the day – Independence – I would say that the general consensus amongst and between all of the high level speakers was that there is a strong case for change and support for the recommendations that have come out of the Dilnot report. Several attempts have been made in the past to grasp the nettle of funding for Adult Social Care but for a variety of political reasons there has not been sufficient appetite to follow through.

This is a ‘final’ opportunity to grasp the nettle and there seems to be general cross party appetite to do so. The Shadow Social Service Minister, Emily Thornbury certainly made this clear, as did the Chair of the Health Select committee, Stephen Dorrell. The terms of the report are now well known so I won’t go into them here. Suffice it to say that the general principle is almost universally accepted but there will inevitably be elements contained in this that will be essential to success in delivering it.

One major concern is the possibly unintended consequence of effectively taking the 60% self funders into the state funded system once they have used up their allowance of £35000 plus hotel costs. As a self funder they are at liberty to choose their care whether at home or in residential care. Once their allowance is spent, will the Local Authority then say they will have to change their carers or move between residential homes to a cheaper option or pay the higher charges that the  service user was already paying? The latter is unlikely but with this increasing exposure to providers of a lower income then, inevitably, they will go out of business. It is therefore crucial that the self funders should be allowed to personally top up the state fee to the self funder fee to forestall a change of care home or carer at home. Under current legislation only third party top ups are allowed.

Secondly, timing. If the momentum is allowed to slip, this issue will be at risk of losing its way again. It is crucial that Government openly undertakes to set this into legislation (whether primary or secondary) in a given timescale. The thought at the conference is that this is achievable by next summer.

Thirdly, the strength of the personalisation agenda is such that if this continues there is danger of creating the mindset that residential care is no longer a solution. Commissioners will begin to avoid this as an option even for people with high needs. Care homes will suffer by default and capacity will reduce. The reality is that demographics alone will increase demand for care home beds, especially for dementia sufferers where overnight attention is necessary. Safety must be an integral ingredient in the assessment process, not cost.

And finally, a common and transferrable assessment process must be delivered which obviates subjectivity. Eligibility must not vary across the country.

Putting all this into context. The £2bn bill represents a quarter of 1% of public spending and 3% of the NHS budget.

Roger Wharton is the Executive Officer of the Registered Care Providers Association (RCPA) in Somerset, a retired RAF Officer, he ran his own nursing home in Yeovil until 2006 and in his RCPA role looks after the interests, views and concerns of care providers in the county.

There is much heartache for us as well, when we speak to a family too late for us to help, knowing that, had we been involved at the earliest possible stage of the care process, we could have guaranteed the care fees for life and possibly ring fenced some of the remaining money for a ‘rainy day’.

I would be so grateful if Liz and her fellow journalists would start to focus on the solutions to the dilemma’s currently faced by so many families. Whilst the present system is not satisfactory, with three government reviews in the last 13 years and no significant changes, you surely aren’t expecting your articles to speed up changes, are you?

So, how about it Liz? Lets really help those facing a care funding need now, get in touch and come spend a couple of hours with specialist advisers and let us take you through the options that, had Phyllis Knight and her family been acquainted with, could have avoided the very real and very heartbreaking situation
they now face. That really would be helping people.

While solutions for the future remain as Jeremy Vine put it “ a thorn in the side of many governments to come”, attention must surely focus on what is available now and the needs of those currently going through the process of arranging care. “Death, Taxes and Care Fees Planning! There’s never a convenient time for any of them” Margaret Mitchell put it so well in her novel Gone With the Wind (although was of course referring to Death, Taxes and Childbirth!) the sentiment, however, seems appropriate.

Those entering this ‘arena’ will experience a bewildering number of agencies frequently working at odds with each other. Indeed obtaining accurate information is in itself a challenge. I would clarify that the Asset Means Test Threshold for England is £23,250 and not £23,000 as stated in this evenings programme. It may also help to clarify what is meant by the reference to FREE personal care in Scotland, this is a reference to the payment of both a ‘Nursing Care Allowance’ and a ‘Personal Care Allowance’ and does not mean that ALL care in Scotland is ‘Free’.

We believe the first step to empowerment is knowledge and through our ‘Guide to Care Fees Planning’ we provide a truly comprehensive overview of the system you are entering.

We are also tremendously proud of our recently launched ‘Care 2 Plan’ tool, this enables those wanting information specific to their own situation to create an ‘Options Report’ based entirely on their own individual circumstances. Simply go online to www.carefeesplus.co.uk/care2plan .

I would love to hear of your experiences, both good and bad, of the care system if you have or are in the process of arranging care. This helps us model our services to the public need and to lobby government and the financial providers to find solutions for tomorrow, today. Email me please on rene@twcp.co.uk.

So the subject of social care for the elderly is now ‘sexy’ in the journalistic and political sense, anyone would think there was a general election on the cards! Having waited 2 years for the Green Paper on Adult Social Care we now see all main parties using this document, and the debate that followed, as a political football with a view to scoring points rather than achieving effective change, changes it will take years to put in place.

The frustration of those working with families and individuals involved in arranged long term care continues and worry is fuelled by inaccurate and emotive cherry picking of the facts by both politicians and the the media alike. Importantly those in need of care cannot put their needs on hold to await the outcome of the current debate.

As care fees specialists, our advice line continues to answer calls from those concerned by the prospect of being forced to sell their home to fund care as it is this topic that is wheeled out as the focus of the debate whenever the need arises. Let’s be clear, the option to selling a property once the owner has taken up permanent residence in a care home is in the vast majority of cases the most practical and financially viable solution.

In this age of extended and independent families, sons and daughters have their own family homes, often in another area of the country to their loved one in need of care. There is no practical need to keep the property going once their relative has gone into the care home. In the event that a spouse or dependent relative will continue to reside at the property, there is no issue; they will not be forced to sell their property.

Let’s consider the alternative to selling, that of letting, to let the property will change the tax status and the taxable income from the property rarely covers the shortfall in care fees. This option will also incur legal and maintenance costs which will further reduce the income for the letting.

The ideal situation for anyone facing the need to fund their own care fees is undeniably to cap the cost of care and to ‘ring fence’ any residual capital for their future desires or for beneficiaries. Financial products do exist that are specifically designed to achieve this and to ensure no one need worry about ‘outliving’ their capital or have concerns that they may need to change facilities should that happen.

My own great dismay is the reluctance of the public sector to engage with specialist financial professionals and encourage families to explore the financial alternatives that could mean care fees would be guaranteed for life. This would benefit both parties as the care recipient need have no fears about covering the cost of care and the local authority will not be required to fund care when an individual’s money has run out thus preserving funds for those for whom local authority funding is the only option.

The Wealth Care Partnership continues to work towards raising awareness of financial solutions available for those facing the need to fund care NOW whilst engaging in the debate about future funding at every level. We encourage everyone to lobby their MP’s and write to local and national press on the issue’s of current and future funding options, and to continue to do so until a workable solution is found.  Lets have the agenda driven by the electorate for a change.

]]> http://thewealthcarepartnership.co.uk/blog/?feed=rss2&p=37 http://thewealthcarepartnership.co.uk/blog/?p=35 http://thewealthcarepartnership.co.uk/blog/?p=35#comments Tue, 08 Sep 2009 12:56:02 +0000 Rene http://thewealthcarepartnership.co.uk/blog/?p=35 Arranging and funding care is an issue gradually working it’s way up the national consciousness, however, for those of us that settle down on a Sunday morning with The Archers for a little escapism, it is at the forefront of a continuing storyline.

In recent months the Archers and the Aldridges have had to cope with Jack Wooley’s declining health since his diagnosis with Alzeimers Disease and wife Peggy’s insistence that he must stay at home and that a care home is out of the question.

As a care fees specialist, advising those in just this position, I congratulate the script writers with the gradual way the storyline has developed. I know from experience that Peggy’s reaction is a common one and the stroke she recently suffered is one way in which the strain of coping with a loved one’s illness can manifest itself. The family’s uncertainty of how to achieve a solution to satisfy ‘mum’s concern for Jack’s well being, whilst ensuring that she is relieved of the role of primary carer leaves them feeling at a loss as to how to help and not knowing where to turn.

Then comes the awareness that Peggy is making economies and has developed a certain ‘carefulness’ with money despite being financially ‘comfortable’. Daughters Jennifer and Lillian finally pluck up courage to address the matter of money with mum, and the floodgates open, that the drop in income over the last year has resulted in her worrying about paying for Jack’s care and her own needs, that she has felt unable to cope but not wanting to be a burden to her very busy family. Well, Brian has now reviewed Peggy and Jacks investments and has agreed to set up a meeting with his financial adviser who is ‘an excellent chap’.

It’s how the story is developed from here that interests me, with only 150 advisers in the UK specialising in care fees funding, I wait to see if Brian’s ‘excellent chap’ is one of those and if not, if he will refer Peggy to such an adviser. I hope he does as an experienced specialist will not only be able to advise on exclusive options for funding care but would also be able to provide guidance and valuable points of contact for sourcing possible care solutions. If such an adviser had been consulted early on, not only Peggy, but the whole family, would have had a point of continuing guidance in all matters relating to Jack’s care and Peggy’s finances.

As Peggy herself observed this week ‘who knows what the future holds’, well in her case the script writers do! For family’s in similar circumstances, however, there is no script writer and so they are on their own, until, that is, they talk to a care fee specialist!

Of greatest concern, however, are the anecdotal references to individuals being forced to sell their property, during a declining market, to fund care fees. This is a highly contentious issue likely to cause a great deal of concern and distress to those arranging care and whilst it is an option, it is not a ‘fait accompli’.

Often the only realistic way to fund Care fees is to sell, or release equity from, the family home, the proceeds may be used to purchase an Immediate Care Plan (ICP) or invested in the hope that the money will fund the care home fees for as long as care is required. Equity release and home reversion schemes may be considered where a spouse continues to live in the property, however, this is not possible where a property will be left empty once someone has made the move into a care home.

Through consultation with specialist advisers such as The Wealth Care Partnership, plan providers continue to improve their products to suit the changing demands of the market.

One such example comes in the form of an innovative way to pay care fees, without the need to sell the family home. Essentially, it is a loan, secured against the property, which is then used to purchase an Immediate Care Plan. Interest is payable on the loan but is ‘rolled up’ and does not become payable until the property is sold, or upon death when the loan and all accrued interest becomes payable. The loan can be repaid either partially or in full at any time without penalty.

What sets this aside is that the loan is available on empty and let properties giving the family the option to await optimum market conditions before selling. The Care Plan Payment Option typically means that the funding of Care fees can start as soon as the need is identified without having to wait for the property to be sold.

Equity Release providers also continue to improve the flexibility of their offerings making scheme’s less restrictive and a more attractive financial planning tool. Indeed Safe Home Income Plans (SHIP) is launching a debate involving regulators, Government and consumer organisations on how these products may continue to evolve to help with the huge pressures of retirement and care funding faced by older people.

The need for specialist advice has never been so great, In the UK there are 45,000 financial advisers, yet of the 2,000 holding the necessary CF8 qualification, only 150 are active in care fees planning. As my foray through the world wide web this weekend has proved, there is a wealth of outdated and inaccurate information available out there. The face of financial planning in retirement is changing bringing new challenges to financial advisers and product providers in their efforts to ensure their clients may fund the lifestyle they seek in retirement from the wealth accumulated during a lifetime of work. When did you last review not your finances, but your objectives in retirement?

As Karen and Tim outline below, the consultation period runs until November, we then await the White Paper, the publication of which may well follow a general election and change of Government.

This may sound an extremely bleak proposition but then, with the Government encouraging what it calls ‘The Big Debate’ on the the reform of Adult Care and Support in England, the electorate have the opportunity to turn this to their advantage.

By engaging in the debate, individual voices may shape the future. The results of the debate will provide fuel for any party’s manifesto into the next election, the *demographics tell us that by 2014 over 65 year olds will overtake under 16 in the UK and the over 65’s are the most likely to vote.  This fact will not escape the attention of any political party.

This presents each and every concerned care recipient, their family, care providers, charities and agencies to  make their feelings known and to drive home the need to make change to the care system a top political priority.

As a Care Fee Specialists, the prevailing comment we hear from  the families and loved ones of those receiving, or about to receive care, is the lack of a single agency to guide them through the practical process, let alone the funding.

The frustrations felt by having to deal with several different agencies, none of which seem to have the ability talk to each other, often leaves relatives drained having repeated the same story 2 or 3 times.  It is hard not to blame the individuals within these agencies but they are simply working within a system over which they have no direct influence.

You may be going through this process now for someone, you may be concerned for yourself or a relative, whatever your circumstances, your opinion matters.  Make your thoughts on the proposals put forward in the Green Paper count, The Wealth Care Partnership encourages everyone to engage in the debate.

I shall be lobbying my own local MP, Jeremy Brown, with my thoughts and am tremendously interested in hearing from you with your comments, indeed I’ll be happy to pass those on for the debate if you wish, you may contact me direct on rene@twcp.co.uk.

Remember you have until 13 November to make your voice heard and to ensure you influence the future of care in the UK, PLEASE don’t miss the opportunity.

*Government Actuary Dept 2003 projections

On the 14^th July 2009, Andy Burnham, the Health Secretary announced in the House of Commons the long awaited Green Paper on Adult Social Care.  He is proposing that everyone in England will have access to a National Care Service that is “fair, simple and affordable”.

This, of course, is only the Green Paper, which sets out the Government’s proposals. Nothing becomes law until the White Paper is ratified in Parliament. Indeed, it is not expected to be effective until 2014.

There will now be a consultation process running up to mid-November and it is expected that a detailed White Paper will be published in 2010.  The General Election will have to take place before June 2010. It will be up to the new Government, perhaps a change in colour, to carry these proposals forward, or not.

Tony Blair, the former Prime Minister, told the Labour Party Conference in 1997 that he did not want children “brought up in a country where the only way pensioners can get long term care is by selling their home”.

Twelve years on, we have finally got the Government’s proposals but we have not got any real progress. Families currently dealing with long term care for their loved ones have to act now to protect their family’s capital from erosion.

Proposals

The Secretary of State for Health is proposing that everyone in England will have access to a National Care Service that is “fair, simple and affordable”.

The National Care Service is aiming to create a level playing field and end the postcode lottery of care services currently affecting those needing long term care.

 The Wealth Care Partnership fully endorses the setting up on such a service and feel it is well overdue. The current situation is totally unacceptable where families are bounced around Government agencies with no-one taking full responsibility of guiding and helping those thrust into dealing with a loved one needing care. It is our experience that the levels of service provided by Social Services and The Primary Care Trust differs widely across the country and this simply should not be the case. We do hope that the National Care Service does not turn into yet another inefficient, expensive and confusing, state-funded institution. It simply must be primarily a “Care” service.

Andy Burnham also claims that everyone in England will be guaranteed:

• Prevention services - the right support to stay independent and well for as long as possible and to delay care needs getting worse. 

Karen Rayner, Partner at The Wealth Care Partnership says “Until the Government are prepared to accept that the NHS is not helping an aging population by treating an illness once it has happened, and only then by the over use of prescription drugs and surgery, there will never be a world without long term illness. Substantial investment into educating the population about preventing illness through healthy living, from school age onwards is what is required. This is a “slow burner” and this is unlikely to happen in my lifetime let alone those currently in retirement”.

• National assessment - care needs will be assessed and paid for in the same way across the country.

“We do hope the National Care Service will remove the current Postcode Lottery affecting everyone who is facing long term care”. Ms Rayner continues, “It is to be remembered that Andy Burnham is talking about care costs and not living costs being covered by the new proposals. Living costs for those continuing to stay in their homes are likely to increase. For those moving into a care home the living costs will need to be paid for by the elderly person and may be higher than if they stayed in their own homes.”

• Joined-up services - all the services will work together smoothly.

Tim Anstee, Partner at The Wealth Care Partnership comments, “If Andy Burnham is able to pull this off, he will be seen as the next Nye Bevon, founder of the NHS in 1948.” He continues, “It is a terrific objective, but 60 years of the NHS has proved that it is totally unworkable.”

• Information and advice – the care system will be easy to understand and navigate.

Tim Anstee agrees that this is a wonderful objective. “There is a confusing maze of legislation and information depending on the levels of care and support an individual needs. People are genuinely confused about what is right for their loved one. Even those who work within Social Services or the NHS can find themselves lost in the maze and it is so difficult to know that you are doing the right thing for the elderly person concerned.”

• Personalised care and support - services will be based on personal circumstances and need.

Is this not something that should already be in place?

• Fair funding - money will be spent wisely and everyone will get some help meeting the high cost of care.

Again, these are wise words and make a good political soundbite. However, the reality is that whatever is paid to the care providers it will not be enough to give a high level of care to all. The Government are proposing they will pay towards the cost of care for all, but care costs vary from provider to provider and the support being offered will not be about everybody getting the same. Many care homes now insist on “third party top up” arrangements whereby family members must fund some of the care fees charged because the homes simply cannot provide the high levels of care their residents deserve, on Government payments alone. We cannot see the proposals changing this position.

It is interesting to note that the Government has been running a scheme in Scotland, whereby the person requiring care is able to receive Personal Care at £153 per week. If a person qualifies for Personal Care they are no longer eligible to receive Attendance Allowance (a form of tax free disability benefit worth up to £70.35 per week regardless of capital and income levels).

The Wealth Care Partnership believes that it is likely that this system will be adopted in England and many will not be able to claim this very valuable state benefit in the future if these proposals are adopted.

The Options

The Green Paper has proposed three options to be consulted on:-

The first option would be a Partnership Service, where the State would offer a proportion, possibly a quarter or a third of the cost of elderly care and the individual would fund the rest privately.

The second would be a voluntary Insurance Scheme, where people invest into a scheme before they have to be taken into care with the State part funding the programme. The Government says around 20 per cent of people could take up this option.

The third option would be a compulsory Comprehensive model, where all those over the age of 65 contribute to a national scheme that would, if necessary, offer everyone full state funded health care.

The Green Paper also states that both a fully state funded scheme and fully privatised programme would not be recommended.

Andy Burnham says the Government has calculated that the Partnership Scheme would cost an individual around £22,000. The insurance scheme could cost between £20,000 and £25,000 as a lump sum and he says the comprehensive scheme will cost around £17,000 to £20,000. He also says these proposals will not result in an increase to National Insurance and says the White Paper will include details for those currently in need of care.

The Wealth Care Partnership’s Tim Anstee states, “Each of the proposals are suggesting a cost of around £20,000, paid either during our working lives or towards the end of it. We would question the quality of care that this would provide. In certain parts of England a typical care home costs in the order of £35,000 to £40,000 per annum (including living costs) and we believe the Government has seriously underestimated the ongoing costs of care. People are living longer and spending many more years in a care environment.  It is also not clear whether social care is included, which is particularly important for the growing numbers of people suffering from dementia, who require no nursing care but cannot live on their own.”

Mr Anstee concludes, “The result of the debate will be released with a White Paper which is forecast to become effective in 2014. It is crucial that those in care now or about to go into care seek advice on the best way to plan for the costs involved. It is my belief that whatever option is chosen, although the Government are proposing to provide some support to all, we are still going to be paying for our care.”