Joe Public's guide to Social Care Funding

18 months or so after Andrew Dilnot produced his groundbreaking report on how to pay for the cost of care, the coalition government have announced their plans to create ‘a new era of support’.

Jeremy Hunt’s announcement stopped short of following all of the Dilnot recommendations, but he has taken heed of some of the core principles and applied them as loosely as possible.

Unfortunately, the outcome for the vast majority of people is going to be negligible. And the scandal that people must sell their homes to pay for their care will continue inexorably.

I was mightily impressed with the way Mr Hunt MP managed to drop in the ‘caring’ and ‘fair’ references during his keynote speech. Clearly the party think-tank has managed to find enough strands to send this policy announcement spinning into fanciful coalition rebranding. However, there is very little that is either ‘fair’ or ‘caring’ in the depth of these proposals. Approximately 10% of people in care may benefit and, in truth, many more may end up paying into bespoke insurance and pension plans, but will never come close to recouping their ‘investments’.

To the government’s credit they have, at most, made everyone turn and look in the direction of our social care funding crisis, but have fallen short of taking a significant step in the right direction.

The basic numbers are summarised below:

To be implemented in April 2017	Current	Dilnot	Actual
Cap on care costs	-	£35,000	£75,000
Cap on food and accommodation costs	-	£7-10,000 pa	£12,000pa
Upper Capital Limit (means tested)	£23,250	£100,000	£123,000

To illustrate how the figures released on Monday will affect the average person we will look at Mr Joe Public who is average in every respect.

How long does it take for Mr Public to reach the £75,000 cap?

87 year old Mr Public is admitted into a residential care home in April 2017 (just after the reforms take effect).

He has total assets of £250,000 (including the value of his home) and has a pension and benefits income of £250 per week.

He is charged £650 per week for his place at the Wishful Thinking Care Home (an average amount for an average care home). Therefore, after his benefits income he has to pay £400 per week from his assets.

However, the local authority have a ‘benchmark’ cost (the amount that they are prepared to pay for the weekly cost of residential care) of £550 per week.  That means in the eyes of the local authority Mr Public only pays £300 towards his care every week, not the £400 he actually stumps up. In this ‘metered’ system Joe will tick over at £300 per week for his care costs until he reaches the cap of £75,000. This works out at 250 weeks in total, close to 5 years.

On his 92^nd birthday Mr Public has a party because he no longer has to pay all of his care costs.

Now the local authority begins to pay £300 per week as a contribution towards his care, £250 is still paid from his income. Unfortunately that leaves a shortfall of £100 per week still to be paid from his assets.  Poor Joe will have to continue to pay £5,200 per year for the rest of the time he lives at Wishful Thinking Care Home.

Don’t forget he also has to contribute up to £12,000 per year for his food and accommodation costs. This could work out at a further £230 per week.

Care costs if you live in your own home are also covered under the proposals, but don't hold your breath waiting for the cap to kick in.

If Mrs Josephine Public receives 1 hour of care at home a day for 7 days a week at the cost of £20 per hour it will take about 10 years for her to reach the £75000 cap. The cost of her care is £7280 per annum. It is very rare for an older person to receive home care services for that length of time. 

So what about the means- testing (the Upper Capital Limit)?

Let us say that Mr Joe Public has total assets, including the sale of his home, of £100,000. He still has his £250 income, but is below the £123,000 threshold.

His local authority is able to charge £1 for every £250 of assets that Mr Public has. That works out at £400 plus his income of £250 making a total of £650 per week. That is the amount of money Mr Public pays for his place at Wishful Thinking Care Home. Therefore the local authority does not need to make any contribution to his care.

Consequently, our friend, Joe Public will not benefit from Mr Hunt’s proposals and I’m afraid to say many other people will be in the same boat. The figures will be wildly different for every person, but in essence, the principle is flawed.

Average length of stay

All research conducted by organisations such as BUPA and Age UK state that the average length of stay in a care home is 1-2 years. Sadly, it is highly likely that Joe or Josephine will have passed away long before they get anywhere close to cap and upper capital limits. If they had had the foresight to take out one of the new insurance policies created in response to the social care funding proposals then they may well have passed away before the policy comes to fruition. 

When are the proposals due to take effect?

If you are receiving care now, or are in a position to be considering impending care options, these proposals will not affect you. Not until 2017 anyway.

Mr Hunt did announce that people will be able to defer payments in 2015, but it is not fully clear how this will work.

What should I do now?

At the present time there are some very limited insurance products on the market to help pay for care costs, but the uptake of these is very low. Over the coming 6 months-1 year more insurance and pension alternatives are bound to be launched, but paying for social care has low rewards for the insurance industry. In other words there is not a lot of scope for them to make a lot of money. It is likely that the new products, wistfully alluded to by Mr Hunt and Mr Cameron, will be relatively expensive. Also, bearing in mind the low likelihood that the insurance policy will ever kick in then it is not looking like the most attractive option, unless, of course you have a very good salary and can afford to pay for peace of mind.

Conclusion

The Dilnot Report had the potential to hail a revolution in the way we fund care and in the way health and social services work together for the good of the individual. Jeremy Hunt’s proposals announced on Monday fell pitifully short of both objectives.

I’m afraid the government has managed to pay enough lip service to Dilnot’s recommendations to garner a few positive headlines in Wednesday’s fish and chip paper. The plain fact is that unless you are part of a small percentage of the ageing population it will have absolutely no effect on you. The most likely beneficiaries may well be those in the insurance and pension industries.

Today we have witnessed a casual doff of the Conservative cap to dealing with social care costs. I am quite certain that before we get close to 2017 we will have had to take real action for our age-related crisis and Mr Hunt’s proposals will be long forgotten.

No one said that this was going to be easy!

Who should carry the can for neglect?

Paul Burstow MP, the former care services minister in the Brown government, is calling for company directors, chief executives and senior managers to be held to account for poor and failing care homes in their organisations.

There is an increasing spotlight on abuse in health and social care. The Care Quality Commission are under-pressure to show their teeth; the media are constantly on the hunt for a new salacious story. The government need to show that they are doing something about it.

The difference this time is that there is a semblance of cross-party support for this move. Last week Norman Lamb MP, the current incumbent of the Care Services office made similar overtures towards increasing accountability for those at the top.

I have personal experience of life under the stewardship of a venture capitalist-owned care company as a compliance manager. My job took me around over 60 care homes on a regular basis across the south-east. I can tell you that a frighteningly high proportion of those services were not fit for purpose with poor care and were poorly/understaffed. I witnessed abusive practices in homes and attitudes from senior managers citing that if the contract price was right then the placement was right. Home managers earned bonuses for saving money rather than quality outcomes for service users. In one instance I visited a recently purchased, large supported living group, without doubt one of the poorest services I have ever been to. I tore the service to shreds in the internal quality and compliance report and put together a clear action plan for improvement.
I was threatened by a senior manager with disciplinary action, the report findings were ignored despite a show of concerned hand rubbing. Worryingly, CQC visited not a month later and gave the service a completely clean bill of health. Nothing was done. I returned to the service 6 months later and literally nothing had been done. The service had worsened if anything. CQC visited again a matter of days after my inspection and this time placed warning notices on the service.For at least 6 months, but probably a lot longer, vulnerable adults with learning disabilities were subject to abusive practices.The service had been subject to a local social services embargo on admissions and safeguarding alerts for over a year, but again nothing had been done. It seemed that there was a absolute lack of will from the company and social care professionals to make the changes the service users needed.

This is one example of a clear case where there was corporate neglect. True, some of the staff should never have been working in care in the first place, but staff were poorly paid, working up to 70 hours a week with highly challenging clients in a service without any effective day-to-day management. The problems were not just localised to that service, but there were significant systemic failings. My reports were shared with the service manager, the regional manager, the operations director, the head of the specialist services division and the board of one of Europe's largest health and social care provider. Nothing was done.

So who should be held to account? The staff who are abusive and should be frog-marched out of care. Yes. The senior managers who knew exactly what was going on, wrung their hands and then sat on them. Yes. The local authority who were complicit and colluding with neglect. Yes. The board that institutes a culture of penny pinching and blatant disregard for the care of vulnerable people. Most definitely yes.

We have to press for a co-ordinated cross-party plan. There is far too much money being made out the frail, ill and vulnerable, which is highlighted by the fact that big business and money-makers are invading the care sector. The one thing they do know how to do is butter their own bread.

http://www.harriscareconsultancy.com

Ode to the Ronseal Deal

These are my toes
these are my feet
these are my ankles
and my knees.
These are my calves
these are my thighs
they are my hips
the pelvis is mine.
I've got my ribs
and vital organs
these are my shoulders
...up holders.
This is my face
and my neck,
this is my nose
...that grows.
My eyes, my ears
my mind, my fears
my shortfalls
my lack of balls,
my courage
my fate
my all-in-all
my state
of being.
This what you get
this is what you see
take it or leave it.
This is me!

Lance the boil

I hate Lance Armstrong. I used to love Lance Armstrong. I don't hate him so much for the whole drugs thing; it was an age when every single, sodding one of them pumped some shit into their veins whether they knew it or not.

No. What I really hate about Lance Armstrong is that he fooled me. Completely bamboozled. I cannot for the life of me believe how I watched him year after year. High cadence peddling to the top of every Col and me thinking he was really clean, despite what the detractors said.

The cancer charity philanthropist blazed across my screen like a meteorite entering the atmosphere. I watched his competitors trailing in his wake. Ulrich, Landis, Hamilton. My suspicious eye looking them up and down thinking 'surely a drugs cheat'.  But my Lance? Not a chance Lance.

The boil turns up on Opera Wonfrey this week. The man is a consummate actor having graduated from the  PD school of drama and psychopathy. He will wear his face full of regret mask and talk about how he was pressured; it was out of his control; he was depressed, bi-polar and schizophrenic with a sex, alcohol, gambling and caring addiction. How he was just a pawn in the game.

The audience will be shocked, they will shed a tear, applaud his honesty and think to themselves, 'but he has done so much good'.

And the boil will rise from his seat. Wonfrey will stroke his arm and thank him oh so sincerely. He will turn and walk, chastened from the stage. As he gives a last humble wave of acknowledgement he will hold his gaze firmly on the wings. The applause will begin to subside and he will look at his agent with the subtlest wink.

Lance will feel clean.

Volcareno Warning

The heat on the world of health and social care is turning up. Don't underestimate the tacit reference to a cap on social care costs in the lacquered mid-term review. I can feel the earth rumbling under our feet. There is a volcareno brewing.
The Health Select Committee today released a report on the Care Quality Commission (CQC) that will be missed by many because of the Con/Dems audit. They have been backed into a corner and need to change now or face extinction. I'm amazed that they have lasted this long under DC to be honest.
Amidst a catalogue of criticism is the odd sliver of acknowledgment, but really, very little for the new CQC Chair to hang on to.
So, like a trapped animal, CQC must come out bearing their teeth. They have recruited over 100 locum inspectors in an effort to meet inspection targets. Don't be fooled by the spin that this is to promote better quality. It is driven merely by spreadsheets.
An actual positive is the widening of the Specialist Advisor role. Compliance Inspectors are jacks of all trades. The breadth of caseloads cover 2-bed care homes to NHS Trusts. It is impossible for one person to have knowledge that spreads that widely.
Dilnot is also looming large giving every social care provider kittens. Unlike CQC, care homes generally just have to roll over and play dead when they are faced with a mortal threat. Care home providers and services work in their own little bubbles and there is no sense of organisation to carry any sort of fight to the regulators. DC, Jeremy the Hunt and Normal Lamb have yet to reveal what watered down version of the Dilnot report they plan to follow, but for the people it is potentially an election issue. The big care home providers are still making a pretty penny out of care, but I fear the consequences will have the effect that big business has had on the high street. Soon you will only be able to choose from Tesco or Sainsbury's care homes and all the little independents will be boarded up.