Paying for care

[MrGongGong]

Can someone explain to me what is so outrageous about people using their own money to pay for things they need ?
Some folk have no money and need a lot of assistance
some folk have large assets which they seem to be against spending on things they need ?
Why is it ok to treat property as money when you are young (all the "good news" stories about house prices going up etc) and somehow it becomes NOT money when you get old ?

What is the point of having something you don't use ?

[Eine Alpensinfonie]

Can someone explain to me what is so outrageous about people using their own money to pay for things they need ?
Some folk have no money and need a lot of assistance
some folk have large assets which they seem to be against spending on things they need ?
Why is it ok to treat property as money when you are young (all the "good news" stories about house prices going up etc) and somehow it becomes NOT money when you get old ?

What is the point of having something you don't use ?

When you have malaria, you are treated for nothing by the NHS.
When you break your leg, you are treated by the NHS at no cost to yourself.
When you have a kidney transplant, it costs a huge amount of money, but you pay nothing.
When you get dementia -an utterly humiliating condition - you are expected to sell everything. This happened to my mother. Eventually, the NHS acknowledged that she was so far "gone" that she received funding. But my mother was too clever for them. The system is crazy in that it switched from her paying over £2000 per month for care home fees to having everything paid for. She made sure she lived for long enough to recoup all that she had lost.

A far better system would be to require patients to fund normal day to day costs they would have at home, with the NHS paying for the rest. All-or-nothing makes no sense.

[MrGongGong]

When you have a major illness you are treated by the NHS but you don't get paid to live, you are expected to fund that yourself.
I'm not advocating anything in particular and all circumstances are different with some gross injustices
I was simply wondering why some folk (including some of my own family) seem to find it outrageous that they would be expected to use their own considerable resources to pay for things they need ?

[Eine Alpensinfonie]

...which would be resolved by the compromise I have suggested.

[Ferretfancy]

When you have a major illness you are treated by the NHS but you don't get paid to live, you are expected to fund that yourself.
I'm not advocating anything in particular and all circumstances are different with some gross injustices
I was simply wondering why some folk (including some of my own family) seem to find it outrageous that they would be expected to use their own considerable resources to pay for things they need ?

This is certainly complicated, but our tax contribution over our lives is supposed to pay for care in hospital. However, when you have a stay in hospital you are required to inform the DWP of the fact, and deductions from benefits are made accordingly.

[rauschwerk]

One idea of the Dilnot commission was that if there is an upper limit on what people would pay towards their own care in old age, then they could buy insurance to cover the eventuality. I'd be more than happy to do that in principle. With a £75,000 cap, I worry that the insurance premium will be punishing. If my wife should need care but not me (or vice versa) what is to happen if our house has to be sold to raise the money?

[Eine Alpensinfonie]

This is certainly complicated, but our tax contribution over our lives is supposed to pay for care in hospital. However, when you have a stay in hospital you are required to inform the DWP of the fact, and deductions from benefits are made accordingly.

Yes, but although Attendance Allowance is taken away, pensions remain untouched. It would be reasonable to expect patients to pay the costs they would normally have at home, but only in so far as it did not affect others still living at home.

[teamsaint]

A cap at £75 k will hit people with fewer resource hard. The rich can cope with £75 k contributions.
It is , in fact, a regressive tax.

[MrGongGong]

One idea of the Dilnot commission was that if there is an upper limit on what people would pay towards their own care in old age, then they could buy insurance to cover the eventuality. I'd be more than happy to do that in principle. With a £75,000 cap, I worry that the insurance premium will be punishing.

Having recently had an occasion to be in hospital ,and always having been self employed
the economics of being able to pay for insurance to cover all but the most extreme events are such that
it would be almost impossible for anyone to set themselves up in business

I always thought it was me being a bit slack
but conversations with some very successful orchestral players revealed the same situation

Insurance is a gamble , look at what insurance companies do with their money (sponsor big sports events etc etc ) someone is paying for all of that......I only wish I had bought some cello bows in the 1980's , one of the few things that are actually worth more now.

[ahinton]

Of course insurance is a gamble - all insurance, even the one that is (albeit incorrectly) called "National Insurance".

Yes, there's nothing inherently "wrong" with the notion that people could be expected to fund those things that they want, but healthcare is rather different to a better car, more expensive vacations, a second home and the rest because it's something that everyone "needs" as well as merely "wants".

The problem is that most people - i.e. all other than the very wealthy (and, although some of those may yet be becoming wealthier still, I'm less certain that they're increasing in number these days) - simply cannot afford to fund long term care any more than they can fund major surgery and aftercare, of which the latter at least has the advantage of a more predictable one-off cost whereas the former is an open-ended requirement until death - a bottomless pit, in other words - and there's no predicting when death might occur.

It's clear that the Government cannot afford to fund this kind of thing for more and more people in the sure and certain knowledge that the costs will always increase month on month; as it's also clear that most people cannot afford to fund it themselves either (especially now that, for one thing, personal debt is now far higher than it once was and is increasing and, for another, selling one's home won't fund as much as once it did, as many residential property prices are no longer keeping pace with the increased cost of long term healthcare), it's hard to see what the solution can be. Insurance won't help if the premiums are too high for most people to afford. I fear that it might not be possible to develop a solution that will work even for the majority, let alone everyone.

[ahinton]

This is certainly complicated, but our tax contribution over our lives is supposed to pay for care in hospital. However, when you have a stay in hospital you are required to inform the DWP of the fact, and deductions from benefits are made accordingly.

Whatever it might be supposed (though by quite whom I'm uncertain) to do, it doesn't actually do anything of the kind; no taxes, including NICs, get invested for use in the future, be in in healthcare for the old or in state retirement pensions and other benefits that are supposed to be drawn down later in life, because they're all shelled out almost immediately on national debt repayments, state benefits and all the other expense that Government is pressed to make immediately.

[ahinton]

Yes, but although Attendance Allowance is taken away, pensions remain untouched. It would be reasonable to expect patients to pay the costs they would normally have at home, but only in so far as it did not affect others still living at home.

Fair comment as far as it goes, but what will be the result when far more people have far less pension income that they've enjoyed to date?

[Resurrection Man]

.... If my wife should need care but not me (or vice versa) what is to happen if our house has to be sold to raise the money?

My understanding was that if you or your wife were still living when the other needed care then you would not be forced to sell your house to pay for that care. Otherwise where would you be expected to live? I think that that is reasonable.

[ahinton]

My understanding was that if you or your wife were still living when the other needed care then you would not be forced to sell your house to pay for that care. Otherwise where would you be expected to live? I think that that is reasonable.

That may be the case, but increasingly there will be people who need care in the later part of their lives who do not have houses to sell in any case or have houses that are still heavily mortgaged so that their net equity following mortgage redemption upon sale won't go far towards funding long-term care; there will also be far more people whose pension income from all sources is considerably less than it would be now. Effectively, then, long-term care funding is not so much a time bomb as an explosive on a long fuse, with the problem constantly increasing and the solutions looking ever more impractical. This fact is hardly helped any by the fact that long-term care insurance is far less easily available and at far less advantageous rates than was once the case, whereas PMI (private medical insurance) remains a much more competitive and thriving market.

Whatever happens, if anyone wants to fund long-term care (the cost of which is not merely for the care itself but also for the living accommodation, food and other services that go with it for all those receiving care other than those who can have it in their own homes), someone somewhere has to save adequately for it over a period of time, just as retirement income has to be saved for over time; if most people do not have the kinds of income during their working lives from which such savings for retirement and long-term care can be made and if the Government of the day does not have the funding resources for it, the eventual outcome will not be difficult to see. How many of us could realistically expect to be able to save (without insurance) from the ages of, say, 23 and 68 for an income to last from, say, age 68 to age 98 as well as to cover the cost of long-term care from the age of, say, 88 to age 98? Very few indeed, I imagine!

[Resurrection Man]

It's not helped by modern medicine. With life-expectancy increasing due to improved healthcare in terms of taking pills to 'fix' things that in days gone by would have brought about an earlier demise, those illnesses and infirmities that come with increasing old-age will manifest themselves more and more. In days gone by, they would not have done so as we would have been dead.