Age UK fears care reforms ‘will be underfunded’

With the debate on social care intensifying as The Care Bill receives its second reading in the House of Commons later today, the underfunded system teeters on the brink of collapse.

In real terms, spending on social care has fallen by around £1.2 billion since 2010 and we have seen a steep rise in the length of time people are waiting for a care homes place, home care or adaptations over the same period.

Everyone hopes the Government's reforms will transform social care, but how much better will the new system really be?

It is not too late for the Government to act

Caroline Abrahams, Charity Director at Age UK says: ‘To understand how much the Government's proposed social care reforms will help older people and their families you have to read the small print.

‘That's what we have done at Age UK and we have produced 10 myths about the social care reforms to cut through the technicalities and give people a more realistic idea of what to expect.

‘Though it can still be improved, the Care Bill is fundamentally good legislation, but it won't make much practical difference without the funding to bring it to life.

‘At the moment we fear the reforms will be underfunded, but it is not too late for the Government to act. Ensuring older and disabled people get the care they need is what really matters.'

10 myths about changes in social care: 

1.If you need care, you will definitely receive it

Today, access to publicly funded social care is more restricted than ever and in most local authority areas it is only available if your needs are assessed as being ‘substantial' or ‘critical'.

Many older people who need help getting up in the morning, bathing, preparing meals or doing the shopping are assessed as only having ‘low' or ‘moderate' needs.

If the new national eligibility threshold for care is set at the equivalent of substantial, as has been suggested, this will mean anyone assessed as having moderate or low needs will not qualify for help, shutting all these people out of the system - until their needs become much worse.

2.Any money you spend on care will count towards the cap

Under current proposals any money that people pay out on care will only count towards the cap if spent on care that meets the local authority's eligibility criteria.

Any money paid to meet needs that would not be a local authority responsibility because they fall outside of eligibility criteria - for example ‘low' or ‘moderate' needs will not be eligible for means tested support and won't count towards the £72,000 cap.

3.All costs associated with your care are included in the cap

The cap only covers what is defined as ‘care costs' and people will still be responsible for paying other related costs even after they reach the cap.

So if you're in a care home you will still need to pay for your general living costs such as food and living accommodation, regardless of how much you've already spent on your care, even after you have reached the £72,000 cap.

The contribution to general living costs is capped separately at £12,000 a year, none of which counts towards the cap.

It also remains unclear what will be considered a ‘care cost' - e.g. attending a day centre - and what may not be - e.g. the cost of transport to get to the day centre.

4.You will have free choice and control over the care you receive

If you choose care that is more expensive than the local authority usually pays when it buys care, it might refuse to allow the full amount to count towards the cap.

Local authorities often pay below the market rate as they can purchase care more cheaply than individuals.

Even after you've reached the cap you or your family may be asked to pay a ‘top-up' fee.

Local authorities pay on average £120 a week less for a standard care home place than someone who pays for their own care.

There are 56,000 people whose care is funded by the local authority but who pay a top-up because the care they receive is more expensive than the local authority's ‘usual rate'.

5.If you meet the national eligibility criteria for care and your assets, such as your home and/or savings, are worth less than £118,000, (the upper means test limit) you will automatically receive financial support for your care needs

If you have less than £118,000 in savings and assets when you move into a care home you will not automatically receive financial help towards the cost, since both income and assets are taken into account when it is decided how much you will need to pay towards meeting the costs of your care.

The calculation is based on disregarding a minimum of £175 a week income if you are living at home and £23.90 a week if you are living in a care home.

If your income is enough to meet the cost of the care home and still leaves you with £23.90 a week you will not receive financial support. Income includes so-called ‘notional income'.

This is calculated by assuming that you have a notional income of £1 a week for every £250 worth of assets you hold above the lower means testing threshold of £17,000 - whether you are actually receiving this income or not.

6.Once you reach the cap the local authority will take over paying the full cost of your care

Many people may find they are still paying a range of charges even once the cap has been reached.

These could include part of the food and accommodation costs in a care home; ‘top-ups' for services that are more expensive than the local authority's ‘usual rate'; or the cost of additional services that don't fall within the confines of ‘care costs' or that the local authority doesn't consider necessary to meet your needs.

7.Your care package will remain the same if you move to another area

Even when your needs are assessed as substantial there is no obligation on another local council to provide the same care services as you are currently receiving.

There will be a national system for defining what your care needs are, but it will be up to the local authority to decide what budget is needed to meet these needs, and how exactly to meet them.

8.You'll be able to pass on your home to your family after your death

The Government proposals, including the new ‘deferred payment' scheme, only mean that you won't have to sell your home while you are alive if you have savings of less than £23,250.

The scheme means if you are in that position you can put off selling your home and instead the council will keep an account of what they have paid on your behalf.

This, plus interest, will be deducted from your estate when it is finally sold, whether that is within your lifetime or on your death.

9.You will be able to buy insurance in advance to cover your care costs

At the time of needing care you can buy ‘immediate needs annuities' to pay out a guaranteed amount for life, but at present there is no real market for ‘pre-funded' policies you can buy before you need them.

The Government hopes that setting a maximum limit to people's care costs will set an upper limit to possible insurance pay outs, thereby making it easier for insurers to devise policies.

However, for the reasons already explained, some people are likely to spend considerably more than the £72,000 spending cap, so insurance companies will still be worried about the risk of open ended liabilities.

For this reason experts say they do not expect new pre-funded insurance policies to be developed.

10.The system will be straightforward to understand and navigate

At the moment, local authorities have to make sure that some information and advice relating to care and support is available.

But the Care Bill requires them to ensure more is on offer, including about the choice of available care and how to access it.

This is very welcome but the social care system is complex and will remain so under these reforms.

As a result many people will still find it hard to navigate the system, especially as older people's need for care is often precipitated by a crisis; for example a fall leading to a broken hip and a hospital admission, followed by the realisation that care will be needed from now on.

People will still struggle to understand the system at such a distressing time in their lives and we do not yet know how comprehensive the new information and advice will be.

This will likely depend in large part on the available funding. At present, local authorities say they are worried that what central Government is giving them will not be enough to meet all their new responsibilities under the Bill, and to pay for the costs of moving to the new system.

For many years Age UK have been campaigning for reform of the care system - if you are interested in learning more go to http://www.ageuk.org.uk/careincrisis