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Elderly care: a frail step forward Elderly care: a frail step forward
(7 months later)
Inadequate, impersonal and complex, many things are wrong with elderly care in England. Harsh rules about footing the huge bills that follow the move into a home are only one aspect, and not the worst. The outright lack of provision in many councils for individuals who are in desperate need but not technically "critical" is one bigger failing, as arguably is the culture of callous indifference which some so-called "care providers" display.Inadequate, impersonal and complex, many things are wrong with elderly care in England. Harsh rules about footing the huge bills that follow the move into a home are only one aspect, and not the worst. The outright lack of provision in many councils for individuals who are in desperate need but not technically "critical" is one bigger failing, as arguably is the culture of callous indifference which some so-called "care providers" display.
But losing everything built up over a lifetime during a final few years passed in a costly care home is, undoubtedly, a fear that sends a shiver down the spine of an ageing country. In his review of care finance for the coalition, Andrew Dilnot homed in laser-like on this. As a social security expert, he immediately identified one of those catastrophic risks of life that communities ought to pool – after all, nobody can know in advance whether they will be the one in four or five citizens who incur truly crippling costs, and so it makes sense to set up a system where everybody contributes, and nobody has to be ruined. Catastrophic risks ranging from costly cancer drugs to house fires are pooled via social or private insurance, and Mr Dilnot proposed that the best way to cover lifetime care costs would be for the Treasury to fund anything an individual might require over and above a cap of about £35,000.But losing everything built up over a lifetime during a final few years passed in a costly care home is, undoubtedly, a fear that sends a shiver down the spine of an ageing country. In his review of care finance for the coalition, Andrew Dilnot homed in laser-like on this. As a social security expert, he immediately identified one of those catastrophic risks of life that communities ought to pool – after all, nobody can know in advance whether they will be the one in four or five citizens who incur truly crippling costs, and so it makes sense to set up a system where everybody contributes, and nobody has to be ruined. Catastrophic risks ranging from costly cancer drugs to house fires are pooled via social or private insurance, and Mr Dilnot proposed that the best way to cover lifetime care costs would be for the Treasury to fund anything an individual might require over and above a cap of about £35,000.
On Monday, the coalition committed to implement the Dilnot principle in cut-price fashion, with a higher cap of £75,000. In practice, the gap between the Dilnot and the coalition plans are not as large as the difference in headline caps implies, not least because the government has committed to follow Mr Dilnot's advice about smoothing the cliff edge of the means test, the most punitive bit of the current system that bites on families of modest means. There are legion practical questions about, for example, whether the insurance industry will – as hoped – step forward to cover that first £75,000 of costs without the exorbitant mark-ups for which it is so often known. But Labour's objection – that most care home residents would gain nothing – entirely misses the point of a scheme whose purpose is to shelter the unluckiest minority.On Monday, the coalition committed to implement the Dilnot principle in cut-price fashion, with a higher cap of £75,000. In practice, the gap between the Dilnot and the coalition plans are not as large as the difference in headline caps implies, not least because the government has committed to follow Mr Dilnot's advice about smoothing the cliff edge of the means test, the most punitive bit of the current system that bites on families of modest means. There are legion practical questions about, for example, whether the insurance industry will – as hoped – step forward to cover that first £75,000 of costs without the exorbitant mark-ups for which it is so often known. But Labour's objection – that most care home residents would gain nothing – entirely misses the point of a scheme whose purpose is to shelter the unluckiest minority.
A more serious potential objection is that at a time when the poor are being savagely punished by benefits cuts, keeping middle-class homes safe for inheritance is the wrong priority. Rather neatly, however, the scheme is being partly financed by frozen inheritance tax thresholds, so that recipients of inherited wealth as a whole will contribute towards the new protection for estates that would otherwise be entirely eaten up by nursing home bills. Elderly care will remain more of a bad than a good news story through the ageing years ahead, but it would be churlish not acknowledge Monday's progress.A more serious potential objection is that at a time when the poor are being savagely punished by benefits cuts, keeping middle-class homes safe for inheritance is the wrong priority. Rather neatly, however, the scheme is being partly financed by frozen inheritance tax thresholds, so that recipients of inherited wealth as a whole will contribute towards the new protection for estates that would otherwise be entirely eaten up by nursing home bills. Elderly care will remain more of a bad than a good news story through the ageing years ahead, but it would be churlish not acknowledge Monday's progress.
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