Care home charges for the elderly are becoming increasingly contentious. Health correspondent Audrey Barton speaks to healthcare experts about the current system and how it could be changed.
A LEADING healthcare professor from the region yesterday spoke out against what she described as “outrageous” care home fees for the elderly.
Jan Reed, professor in healthcare for older people at Northumbria University, said the current system – where people who have more than £21,500 in assets must pay for care – forces vulnerable elderly people to chose between themselves and their families.
“If your house goes against your fees for a home it is a difficult choice between doing what is best for you now, or what is best for your family in keeping your home for them to inherit,” she said.
“Asking people to pay for care when they have worked so hard for this country is outrageous, for older people and everyone in society, as we all think we are living in a place where no one will look after us when we grow old.”
The current means testing system was brought in in 1999 after a major review of care services.
John Bond, professor social gerontology and health services research for Newcastle University said: “At the beginning of the eighties when the Thatcher government came in, it reviewed long term care.
“The majority of the population would be cared for in local authority residential homes or specialist homes for people who were mentally ill with conditions like dementia.
“You paid some money out of your pension for living arrangements such as the rent but not the full economic cost. There was no specific means testing as today.”
Nursing care would be provided free by the NHS in long term psychiatric or a geriatric hospitals before they closed to make way for independent nursing homes.
“There was a lot of criticism of that quality of care at the time. There was a quality drive to find better care,” said Prof Bond.
The Thatcher government encouraged the independent sector to become the provider and long stay hospitals closed with council-run care homes dwindling.
The Right to Buy scheme also came in under the Conservatives enabling people to buy their homes from the council at reduced prices which would later be taken from them as they reach old age.
Prof Bond explained: “The majority of these people stayed in their homes until their partners died and they were left with it. It is treated as an asset which takes people over the £21,500 threshold so they must contribute to their care.”
The current Labour government has said it will review the care system and hinted at a consensus for a new funding settlement between the state, the family and the individual.
Both Prof Reed and Prof Bond are in agreement that the Scottish system of free care would be the most fair and empower care home residents.
“The system in Scotland is fairer as you pay rent out of your income but you are not expected to pay fees for your care,” said Prof Bond.
Prof Reed explained: “It lays out what you get for your money in very clear terms. As you pay your accommodation separately it gives you status of a tenant and all the legal rights that entails.”
Some hope has come in the form of Continuing Health Care, a system introduced around five years ago whereby if a person’s primary need for long-term care is health, whether in a nursing home, care home or the person’s home, the NHS pays.
The Health Ombudsman ruled in 2005 it was being withheld from too many and new criteria were introduced. But the line between social care, which includes personal care such as bathing and feeding, and healthcare, such as nursing, is difficult to define.
Prof Reed believes the divide is simply bureaucracy. “If you have a holistic idea of health which we are certainly moving towards then that would incorporate social care as well,” she said. “The division between personal care and nursing care has had its time.”
How the system works...
Where a person needs support either in their own home or in a care home, this support may be paid for by the NHS or local authority.
The Department of Health has said that whenever a care package is being planned, NHS funding responsibilities should be looked at before local authority responsibilities are considered.
When the NHS is responsible for meeting all costs of the care package, this is called Continuing Health Care (CHC).
The key test of whether someone is entitled to CHC is called the Primary Health Need test. This means whether a person's primary need is for health care rather than for accommodation and support.
Until the National Framework for Continuing Care came into force on October 1 2007, every Strategic Health Authority had its own CHC criteria and every PCT used its own assessments.
If a person is not entitled to CHC, they should be referred on for their local authority to carry out a Community Care Assessment.
How is it funded?
a) If a person is entitled to CHC, the NHS pays for all of their care needs. If the person is in a care home, the NHS also pays the accommodation costs.
b) If a person is not entitled to CHC but their local authority agrees they need a care home place or support in their home, the local authority may pay for this but the individual may have to pay a contribution.
c) If a person is not entitled to CHC but is in a care home and has nursing needs, the NHS pays towards the cost of the nursing care. Until last month, there were three bands of payment depending upon need. Now there is a single rate of £101 per week. Even where a person is funding the rest of the care home package themselves they can still be entitled to NHS Funded Nursing Care if they have nursing needs.
Daughter fighting battle over deferred charges
A WOMAN living with incurable bone cancer is fighting for a refund of care home fees she believes her mother should not had have to pay.
Elizabeth Ramshaw, 59, had to defer her mother’s care home fees as the family could not afford to pay the monthly £1,400 charge.
Her mother Lilian Stubbs, 85, who has Alzheimer’s Disease and has been in residential care for the last three years, pays £740 per month pension towards the cost of care but the rest will have to be paid after she dies.
The former post woman was subjected to means testing and as she lived alone, her home in South Hetton, County Durham was taken into account, forcing her to pay for care.
But as the home is in joint names with her daughter Elizabeth, and Mrs Stubbs did not contribute financially to the purchase, the family believe the home should not have been included.
Now they have taken up the issue with Durham County Council and want other people who are forced to sell their homes to know there is hope.
"I want people to see there is hope, they can fight to have their fees refunded for a number of reasons," said Mrs Ramshaw.
"We were faced with losing the family home of 50 years to fund my mother’s care which is why we deferred our payments."
Mrs Ramshaw, of Fife Avenue, Scotch Estate, Jarrow, is calling for a change in the means-testing system.
A spokeswoman for Durham County Council said the council was aware of the matter but could not comment.