Money Box Live: Affording Care

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BBC Sounds. Music, radio, podcasts. Hello. A new government has taken office. So what might that mean for the financial issues you've told us you care about? Over the next few weeks, the Moneybox Live podcast is going to take a look. And there was one issue that loads of you emailed about in the run up to the election. It was the cost of care in older age. The sums of money are absolutely... eye-watering and this year we're just in the black but there's not much in it

Your particular bugbear was the question of who should pay. Because unlike NHS services, social care is not free at the point of use. And a place in residential care costs around £60,000 a year. But the cost goes up enormously. anyone who needs extra support. In just a few years residential care can drain away a lifetime's worth of savings. I've worked all of my life and not gone to bingo not gone out drinking smoking. saved my money for my home and my child won't benefit from it.

Today, we'll break down those costs. We'll look at the rules around who pays what and ask what a new government could do to act on this extremely thorny issue. So first of all, how much does it cost? Let's check back in with Tony. He appeared on one of our election...

Moneybox programmes, to talk about the cost of care for his mum, who has dementia. Now, just to remind you of his story, the family has gone through her savings, they've sold her home and her possessions, and they're down to her last £15,000. When she moved into the care home, the costs were about 5,500 a month, which now raised to about 6,000 a month, so 72,000 a year.

It's like trying to fill a draining bath because money's going out faster than you can refill it. So you know there's a day when the money's going to run out. You just don't know when it ends. If you knew what had happened, she'd probably say, I wish I weren't still living, which is an awful thing to say, but it is what it is.

Because, Tony, when you were on Moneybox before the election, you were wanting... the future government to to take this challenge seriously to address it there's a new government now and the department of health and social care has told us we know that hundreds of thousands of people are suffering without the care they need and they said we are going to grip

the social care crisis we will also take steps to create a national care service does that give you confidence well the devil as usual is in the detail there's a point where you could manage with a social care service at home to a point but then there's a point where you have to move into a care home and no one's really talking about how to cover those costs.

Well, Tony there talking about how much his mum has paid for her care. And listening to Tony are today's Moneybox Live experts. I'm joined by Nadra Ahmed, Executive Chairman of the National Care Association, which represents care homes, and also Simon Bottery, who's... Senior Fellow in Social Care at the King's Fund, which is an independent think tank specialising in health. Good afternoon. Thank you for joining us.

Hello. Good afternoon. Hello. Simon, Tony's story is going to resonate with a lot of our listeners. Stephen Kinnock is the new Minister for Social Care. Now, we'll get into the detail later, but briefly, what's going to be at the top of his entry?

I think there are three immediate issues that are going to be facing him. One of those is something that actually would affect Tony. So that's charging reform. So the previous government had... put on hold but still intended to introduce in October next year, plans that would set a cap.

on the lifetime costs of care for an individual. And one of the first things that Stephen Kinnock will have to do is to decide whether the new Labour government is going to go ahead and implement that cap as planned. things, the government is going to have to decide how much money it's going to give to local authorities to spend on just keeping the current social care system.

afloat. They'll have to decide that by the end of this year. And then the third thing is workforce. Labour in opposition and in their manifesto promised reform. The problem is better pay for care workers and they'll have to decide exactly how they're going to do that over the next few months. OK, well, on that care cap, the previous government had said they would introduce the care cap in October next year.

No one would pay more than £86,000 for their care. And after that, the state would pay the rest. We did ask, Simon, the new Labour government if they were going to go ahead with that. And they told us they'd provide more detail in due course. Do you have a hunch? I think I'd like to give the government the opportunity to do what they said they were going to do in the campaign, which was that their intention was to proceed with the cap. I think it's a good reform.

no means the only thing that social care needs, but it's a good reform. There have been several false attempts to get it underway. So I think they've said that they would let the cap go ahead. I think let's see and let's hope that they actually do as they said they would. Yes, a number of governments have tried to get to grips with this in the last few decades. Nadra, we heard Tony's mum is paying over £70,000 a year for her care with additional costs needed for her dementia.

It is a huge amount of money, isn't it? What does it actually cover? It is. It's a huge amount of money. And what we have to think through is that this is for 24-hour care. But, of course, the choice of where you place your loved one is yours. And the average that we know about is between 700 and... 1200 pounds um a week a week and and that's where we are you know that that's where it sits so

If we then look at what does that buy, that buys quite extensive care now because the people we're looking after have very complex healthcare needs. It covers the training. and education of our staff it doesn't fully cover what they deserve to be paid and that's where the fair pay issue is really important but it also then covers all the kind of costs of of living in a service as you would in your own home that's all the utility costs the food

the laundry, that 24-hour care. So it does cover everything. And actually, if you look at the sort of 700 pounds a week. kind of figure, we're talking about £4.16 an hour. If you then look at the £1,200 a week, then you're looking at £171. A week. A week. From £100 a week at £700 and £171. Which is £7.

An hour, just over. Yes, I mean, we can break, and absolutely, it's interesting hearing sort of the sums at your end, but it's still breathtaking amounts of cash for people to find, isn't it? Simon, there is help in place, isn't there? There's a structure in place. So people who can't afford it get the help. Can you tell us what the rules are and how they vary across the UK?

Yeah, so as you said, social care is means tested, unlike the NHS. So essentially, if you want to get publicly funded social care, you've got to prove two things, really. You've got to show that your needs are high enough. And so you've got to show that you really do need. publicly funded support and then you've got to show that your assets are low enough and what that means in practice is that if you in england if you've got assets over 23 250 pounds then you'll be

almost certainly required to fund your own care. You won't get state-funded support. The rules differ slightly in the other nations. England tends to be less generous than other places. So what that means in practice is that lot of people will be required to fund their own

care and then others will get some help with their care costs. Yes and it is a devolved issue so in Wales you can have capital of up to £50,000 and get care home support. In Scotland the threshold for paying for care home accommodation is £35,000.

you need to have capital below 21,500 to get the maximum support available. Najra, briefly, Tony's mum's care has now burnt through almost all her money. She's fortunate. She can stay in the home that they chose through the... council funding, do some older people have to change accommodation when their own money runs out? Sadly, it does. I think this is where it's really important for people to know when to kind of start to think about this. But local authorities will say that they will not.

fund it at the level that the private fund has been applied. And that's when it becomes really, really tricky and people will start to be moved by the local authority, which will be the paying authority at that point.

Thank you. Right. Now, one of the reasons this is such a tough issue for governments to solve is that people just can't agree who should pay the bill. I went to Lim, which is a very, very pretty and affluent village in Cheshire. And I asked people there if they were worried. the possible cost of social care. I think it's terrible when you've worked all your life and then all you've got is your property.

All my worth is in my property, that's all, which is an apartment, a retirement apartment. But I'd hate to think... If I go in care, that money is going to all go to look after me when I've paid all the way through insurance and everything. I worked until I was 75, paid off my mortgage, moved here to Lim. to an apartment overlooking the canal. Beautiful for me.

um end of years if you like for my winter of life golden years that's true yeah they are golden years and um my son if i have to go into long-term care may not get anything out of my apartment. Do you ever think about the cost of care perhaps in your older age? Definitely, we're getting close to it ourselves. I do think a lot of these private places are very over... I think that the social care should be...

more even distributed amongst the general taxpayers. How would you feel if it was a sort of balance, so there was a cap so that you would pay up to a certain amount for your care and then after that the taxpayer would take over?

I could go along with that, as long as it's a reasonable amount, as long as it didn't involve selling the house. Well, Simon, there is a very strong sense, isn't there, from people that they've contributed through their working lives, they shouldn't have to spend all their money.

on this care. But we've had an email from John who says the system isn't designed to protect children from losing their inheritances because their parents had to fund their own care costs. So that's the two sides, Simon. There are no easy or maybe no palatable answers here. Well, in fact, there's quite a lot of research on this. And, you know, I've spoken to I can't remember how many people about this subject.

In general, what people agree, I think, is that it's right that they feel that if they've got the money, they should contribute something towards their care costs. They're not expecting to get everything for free. What they do think, though, is that it's really unfair if they have very high care costs they should be required to foot all of those care costs themselves and you know in reality you know none of us knows what care costs what care we'll need in in later

None of us knows whether we're going to get dementia and perhaps need to go into a care home. One in seven people will face care costs of over 100,000. in their lifetime. And it does seem to me incredibly unfair that those people may well have to foot that whole bill themselves. It would be much better to have some way of sharing the cost across all of us.

Thank you for giving us a flavour of the debate. Naldra, we've had an email from Lindsay who says her mother was diagnosed with Alzheimer's disease and went into specialist care in 2015. And that was at a cost per week of just under £12.

She says almost exactly nine years later, my mother is still in the home and the current cost is £2,040 a week. That's more than a 70% increase. Can that be justified? Well, I think it depends on the levels of care, but the... Care costs have been going up. They've had to go up because as we see the cost of living go up. So we've got gaps now of investment in social care, which are being picked up by the private funders.

And I think that is an enormous challenge. So just this year, we had a 10% increase on the national living wage, which means all the kind of rates of pay go up by that much across. the board of that service so that's before you look at food costs or any energy costs or anything else so those costs are rising and they've got to be passed on and I think that's an enormous challenge because otherwise the

provider can't operate. Well, we had an email from John who says, will self-funders still have to subsidise those funded by social services? Having to self-fund is one thing, but subsidise, presumably he thinks that's quite something else. I mean, in a word nudge.

Is that what's going on? Well, I would disagree with that because the subsidy is coming from the provider who agrees to take that funding from the local authority. That's lower than they need. Okay, thank you. I want to bring in Alison here, who I also met in LIM. I actually had to give up work to look after my mum and dad because the state clearly wasn't going to.

Unfortunately after my dad died then my mum had to go into a care home because she had dementia and I couldn't give her 24-7 care. We had to pay for everything but it wasn't. It wasn't a glorious place she was in. It could have done with being a little bit nicer, but the people were nice. One of the things that struck me about it was you paid your fees, your monthly fees, and they were.

pretty high but there was all these extras that you had to pay as well you had to pay for a chiropodist had come in once a month and you had to pay extra for that and and so on and so forth it's surprising what isn't included in social care and once you they know that you're paying they seem to just keep throwing more at you and then you also find out that you're actually paying more than people who are being paid for by the state

So now, Jerome, you were just referencing that. Alison's clearly pretty frustrated that so-called self-funders do pay more than councils pay for the same service. Why does that happen? Well, I think this is to do with the commissioning process because, you know, local authorities commission the individual's care and they have a cap on what they will pay. And some providers are taking that.

More and more providers are now saying that we cannot operate on that level of fee and are just going for the private funders. But those that are, are making that positive choice to take people from the local authorities. OK, well, the local government association, which represents councils in England and Wales, told us that the adult social care sector remains in a precarious position with overstretched budgets, significant unmet and undermet need and remaining instability.

And it's calling for immediate investment. I'm sure that will chime with a lot of people listening. Alison there, she gave up her job to care for her mum until her mum went into residential care. And that made Alison one of the nation's six million unpaid. So I asked her if that had had an impact on her own finances. It did have for a couple of years, but when my mum died, I inherited the house. I kept the house there and that's alleviated that. finishing work in my mid-50s.

I've lost touch with people. I feel a bit isolated now. And I was planning to go back to work. And it was like, I'll get through the winter and then get to Easter and then I'll start looking. And of course, that was 2020. And now I'm over 60 and I don't feel like... I can go and get a job now. Been away from the workplace too long. Thank you to Alison for talking to me about her situation.

Alison illustrates a whole other financial issue, doesn't she? The cost of leaving work to provide that care to a loved one. And that could even stop many people saving more money for their own old age care. Yeah, I mean, unpaid carers are really the bedrock of the care system. They provide far more care than paid carers. And as you say, with Alison, you know, people do have to give up work. in order to care for loved ones.

I think this value illustrates something that, you know, we talk an awful lot about the cost of social care and having to pay for carers. But there's a real value to having good social care as well. And, you know, that value would include if we had a better. system, it would mean that people like Alison didn't have to give up work. I still hear about people who are nurses in the NHS who end up having to give up their jobs in order to care for a family member.

There's a real value to having a good formal system of social care where people can get access to decent, high quality, but relatively low cost or subsidised or free funding, free care from the state. Well, we've had an email, Simon, from Roy.

who says, why should I not have to sell my house to pay for the care I need? If my family are concerned, why don't they take care of me? So a few different issues in Roy's email, but it just won't be possible for everyone, will it, to take care of their relatives? There's that long-term... financial impact and care needs can become really complex if people have conditions like dementia.

Yeah. And, you know, as we were saying, I mean, the reality is, is that families already provide a massive amount of care. They are the bedrock of the system. And many would want to do more, but they. But they can't. I mean, one of the things that's happened is that people don't necessarily always live in the same geographical neighbourhood as their parents anymore. We've got more older people who are growing up without children who aren't able to provide that care.

So it's right that we should support people, family members who want to and can provide unpaid care. But actually, we've got to have a good state funded care system that provides a decent quality. of support for people that need it when they need it and which gives unpaid carers at least a break when they need it or a baseline of support.

Thank you. Nadra, in Scotland, there's free personal and nursing care up to a set amount. Can you just explain what personal care is and how much it costs in the rest of the UK? Well, I think personal care is that... support that is given in order to make sure that a person's dignity, their privacy is all in place and they can live a life that they would wish to live.

All of what is delivered in a care setting will be personal care. That will include... personal occupational therapies all of those sorts of things I think the other bit of it the reason they call it personal care is to you know that's about the individual's well-being the other bit of it is the bit that's to do with the choice of rooms and accommodation.

Thank you. But of course, personal care in the home, we've had emails coming in from people who are paying up to £25 an hour for that kind of care. So it can be exceptionally expensive, even without going into a care home. Let's hear from Phil next. spoke to him before we came on air and he told me about choosing a care home for his mum after his father passed away. Because there was no one at home for her to look after her.

Fortunately, she had been in a couple of homes before just for short stay while dad had been previously ill. So I kind of knew. We've done the recce because I always think it's really important to check out the different care homes that you've got in your area because it's not as straightforward as choosing the most expensive ones. They seem to offer the most, the most expensive ones.

But you have to cut your cloth accordingly, and obviously you have to kind of target your relatives, your loved ones' needs. I mean, there's no point in paying a load of money for a place which has a hairdresser and a nail bar. if your loved one's never going to use those facilities. So we chose one that's relatively good value in comparison with some of the others in the area. How much is it?

It's just under a thousand a week. And to be honest, the initial reaction is just complete relief because you know that they're being cared for and you're not going to be... on 24-hour call. When you go and see her, she recognises us and she'll smile and you do get things back from her. I enjoy visiting her. Your mum's self-funding, can she afford it? At the moment, just.

She obviously gets a state pension. She was a teacher, so my parents were both teachers. They didn't have lots and lots of money, but they came from a generation, I think, that saved. But the trouble is that the care home every year put up their costs. This year...

We're just in the black, but there's not much in it. Next year, I don't think we will be. Do you find...

yourself having to do some really bleak maths, trying to work out how long the money will last and how long your mum, who you love, will go on. You get into a horrible sort of situation of... of thinking almost willing them to die and it's an it's an awful thing because you you you do you do do the maths in your head and it makes you consider things you don't want to consider and it makes you think about things in a way you shouldn't

Phil there, grappling with some thoughts that I'm sure a lot of people listening will also be thinking about. Nadra, we were talking there about the bleak maths that come into play. How long is a typical stay in a home? Do you have any data on that? Well, I think we...

We're clear that it's around about two years in a nursing setting. It depends because people coming into our care settings now have very, very complex healthcare needs and they were looked after in long-stage geriatric wards not that long ago. So what we have is that...

that they're coming in with very complex healthcare needs. But once they are stabilised, quite often if people come in at the right time into a care setting, they may go on for a lot longer because they're getting that sort of nutrition, that stimulation. that care and their medications are on time. We've seen that happen quite a lot and I saw that when I was a provider.

Now, if someone is choosing a residential home for themselves or for someone that they love, it's clearly so important they get the right place. And we were just hearing that's not necessarily going to be the most expensive home. No, it's not. And I've done this with both my parents. And it is really important to look around. It's really important to get the feel of the service and know what your loved one, what sort of life they would have.

you know liked what do they want what we often look at it's like window shopping you look at what you you think you want but just think about their environment and what they want and actually ask the right questions ask about the training of staff if you know the condition the individual know that that condition can be managed there and how are the staff trying to deal with it but also just do that math it's really important just to be aware that how long is this going to happen

And you don't want to be planning for two years. You want to be planning for longer if you can, because that's what might happen. You're talking about doing your shopping, doing your research. Nadra, BBC England's data journalism team analysed Care Quality Commission.

statistics, it found that more than two and a half thousand care homes just in England require improvement and there are 194 inadequate homes. Where can people look for information and inspection reports on the care homes that they're considering? Well, the Care Quality Commission have a website and I think it's really important if you're going to look at a home to look at that report, look at those reports. And if it is inadequate or it requires improvement, look at when that report was done.

Commission come in and visit it again because actually the service may have improved they might have done what they were told to do and that's when you need to go in and see that and make sure that you've got a good history of that service because the Care Quality Commission don't visit on a regular basis anymore. And there are, I should mention, about 17,000 care homes in the UK. So there is quite a lot of choice. Simon, the Centre for Aging Better says that just in the last...

40 years there's been a 52% increase in the number of people over 65 so that's three and a half million more people in that age group just in England. Do we actually have enough care homes to meet the eventual need? Well, I don't think it's just about care homes. We certainly need care homes and nursing homes for people who are at that stage, that that's the best place for them to be cared for. And the general trend actually has been a small reduction.

in both nursing homes and residential care homes over time. So there has been a reduction. Now, that's not a problem if actually we're increasing the amount of home care capacity that we have. because most people will say that they want to stay independent at home for as long as possible. Or that we're increasing the number of what are called extra care or retirement type villages where people can live relatively normal.

lives, but actually if they need care, they can get it as well. The trouble is we're not necessarily doing that. And I think that we may be storing up problems for the future. Simon, thank you. The trouble is here. That's all we've got time for in this Moneybox Live podcast. Thank you.

everybody who shared their family's stories. And thank you, of course, to our experts today. We've been hearing from Simon Bottery from the King's Fund and Najah Ahmed from the National Care Association. Now, over the next few weeks, we'll take a look at more of those big issues for the new government. Thank you. or the rest of the team here with any money story you want us to take a look at.

In this podcast, the producers were Sarah Rogers and Immy Rhodes, the studio manager Matthew Dempsey, our editor is Jess Quayle. I'm Felicity Hanna and this was a BBC News Money and Work production for BBC Sounds. For years, a witness's evidence has been locked away. I've seen the dark side. He warned a chemical is coming. It's a silent killer. And that he was a target.

forced into a witness protection programme. We're Dan Ashby and Lucy Taylor, two investigative journalists, joined by the Hollywood star, Michael Sheen. Do you think someone's going to try and kill us? From BBC Radio 4, an unsettling investigation into a chemical secret unravels. They don't have any record of him. What? Listen now to Bury, The Last Witness, on BBC Sounds.

Make money predicting football. Now you can. Now in Texas with Calci. Calci is the only platform that lets you legally trade on real world events in all 50 states from football to Bitcoin, the Oscars, and even politics. If it matters, you can trade on. Trade on who wins each game, props, spread, and more. Legally, now in Texas. Don't miss your shot. Download the Kalshi app or go to K-A-L-S-H-I dot com. Use code PODCAST and get $10 when you trade on.

This is an investment that carries risk. CalSheet.com.