Elderly social care is failing; young people are the answer, but do we understand the question?

Did the reaction to Theresa May’s disastrous social care policy proposal show a distinct disengagement of the younger generation with social care?

During the Tory party’s embattled election campaign they announced, and rather embarrassingly had to retract, a proposed policy on paying for (elderly) social care. The proposal broadly stated that a person’s assets, primarily their property, could be used to pay for their care in later life — posthumously if necessary. The proposal managed to simultaneously alienate their core older voters and anger the disenfranchised youth.

As this policy seemed to be universally misunderstood, or misrepresented by the press, let me try and explain it:

Firstly I should begin by defining what ‘social care’ is. It is the name given to all care provided to people in the UK other than by the NHS (usually known as ‘health care’) or private (non-NHS) health providers. By far the largest group in receipt of social care is older people (other groups include children, people with mental health problems, learning difficulties and acquired brain injury — virtually all in these groups are publicly funded).

Now to the proposed policy — it stated that anyone with over £100,000 in assets would be due to pay for their own care until they fell below that threshold, when they would receive governmental support. That set of assets would include a person’s home which, it was said, could be sold after death to pay for the care fees that had built up. This is not dissimilar to the current model where a person is entitled to governmental support if they have less than £23,250 worth of assets (this only includes a person’s home if they go in to a care home). The government’s thought process here is that older people are potentially sitting on illiquid wealth and assets, built up over a lifetime, which could be used to pay for the care they might require in later life. Unfortunately for the incumbent government, every generation had an allergic reaction to the proposal. Older generations were incensed that they were to be taxed, seemingly yet again, on earnings that they had saved up over a lifetime of hard work. The reaction from the younger generations was equally vitriolic, lashing out at a perceived punitive tax against vulnerable elderly people, coined: a “Dementia tax”.

The reaction from the older generations seemed, on the face of it, more reasoned. To be “taxed” yet again on your wealth seems unfair — yet herein lies a major misunderstanding: care organisations are private entities and require payment for their services. The proposal was in actual fact a state-backed equity release scheme that allows someone to pay for services in their lifetime without having to sell their assets until after death. On the flip-side, people could justifiably argue that they are being penalised for saving up over their lifetimes — with those who spend instead of save, getting state support.

The reaction from my generation (so called ‘millennials’) was equally interesting. This age group seems to complain about the widening wealth gap and struggles getting on the property ladder, and yet vociferously goes up in arms against a policy that seemingly tried to help them, which is a strange dichotomy. But why this reaction?

I recently carried out a survey* to try and garner some clear insight into people’s understanding of social care. The overriding outcome was one of confusion, not ignorance or foolishness, just confusion. Many people who work in and around the sector forget how convoluted it can seem from the outside. For example 43% of those surveyed thought that social care organisations were public sector bodies. Social care is currently delivered by private organisations and must be paid for by someone — whether that be from state funds raised by taxes on earnings, purchases, etc. or one’s own private wealth. Like it or not, this policy was intended to push more of the burden of the cost of care onto the older generations with assets and savings. A complex funding scheme makes this system even harder to understand — with a myriad of funding options — ranging from personal, to the Local Authority, to the NHS; only 24% of people correctly identified all the main sources of funding.

Whatever your view on this policy, Theresa May is certainly right about one thing: there is no “Magic Money Tree”. Social care is expensive and delivered by private organisations which means that someone has to pay for it. If people want the state to pick up more of the bill, then guess where that money is going to come from? You got it — more taxes.

Interestingly the reactions and responses of those asked about how the social care funding gap should be covered were mixed — maybe not surprisingly due to the complexity of the system. 48% of those surveyed thought raising taxes was the correct solution, with 24% replying that those with assets should bear the cost. The final 28% offered an interesting array of alternative solutions from community support, to insurance, to innovations in the cost base. It is not an easy question, and the solution is not straightforward which highlights the shortcomings of blanket government policy making.

To give an idea of the scale, in 2013, Skills for Care estimated the total spend on social care to be circa £20bn per year. In England the total number of providers was 9,300 (residential care) and 12,800 (non residential — domiciliary, day care etc.), and 40% or 50% of care for older people in care homes is self pay.

Social care is an emotive subject, but a beleaguered care system which is beginning to creek requires an objective and reasoned solution — I surmise, beyond the realms of party politics. The overall cost of social care is going up and needs to be paid for somehow, however, where that money comes from shouldn’t matter, as long as the cost of care is effectively regulated to stop needless profiteering from people at their most vulnerable. But one thing is abundantly clear — make things simpler and more transparent. If you are going to ask people to vote on a course of action, let them do it with open eyes. It won’t be easy but starting by educating the next generation should be the first step we must take. Follow this blog to join me on a journey as I try to demystify the complex world of elderly social care.

*Survey of 46 people conducted in July 2017 using Typeform. For full results please get in touch @ joshbrook@gmail.com.