Opinion: Caring for our elderly - part 2

Assessment of disability requires judgement and two claim assessors with the same information may arrive at different decisions. Also, some people may pursue a claim for one but not the other form of support, perhaps because they are only aware of one of them. So access to support is a bit like a lottery - there is only a probability, not a certainty, of a needy person receiving it. If this is so, then a “one-stop shop” is riskier for the disabled person than a dual system, just as it’s riskier to stake all your money on one horse, rather than two. A unified system may increase the number of people who get no support at all.

And then there’s the question of who pays for all this. At present, local authority care is means-tested in most of the UK but (almost) free in Scotland. Means-testing for residential care is contentious and, in England, offers support only to people with less than £23,250 in assets, including the value of their house. It then ‘confiscates’ the whole of that person’s income, except for £22.30 a week for personal expenses.

The asset test has led to complaints that people lose their homes as a result of moving into care. But let’s be hard-headed about this. Most stays in care homes are rather short (around two years on average) and end with the death of the person receiving care. They generally occur because disability becomes too severe for it to be safe to continue living at home - so it’s the need for continuous care, not the means test, that robs people of their homes. Selling the house is a sensible step - it generates a capital fund and releases property for the next generation of home owners to buy.

If a pensioner on the basic state pension with a house worth £150,000 moves into a care home costing £500 per week, then this self-funded care home stay will typically deplete the value of the asset to around £114,000 at death. Only 15 per cent of the cost of the care home is met by the care-receiver from income, the other 85 per cent by his or her adult children who will receive a bequest £36,000 less than they would under a system of free social care.

A key role of the means-test is to act as insurance against running out of money if the stay in residential care turns out to be unusually long. What it doesn’t do is to test the means of the people who eventually pay for care - the children of the cared-for person. The adult children of home-owners tend to have higher-than-average incomes, so it’s people who are already relatively well-off who gain most from Scottish-style free social care.

So, perhaps we don’t need a revolutionary change in the system of public support for disabled older people. The combination of universal disability benefit and separately-assessed residential care funded from assets where they exist doesn’t seem so bad as a structure. Perhaps we should concentrate on making the system work better and more simply, rather than overthrowing it.

From the ESRC magazine Britain in 2011

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