Funding Care for the Elderly

How we should fund care for the elderly is the question that has dogged all recent UK governments. Every government in recent times, and we have had a lot of them, has promised that it will sort this problem out once and for all. They have all looked at it and then done the big fudge. I had hopes that Keir Starmer would tackle this, but what did he do? Have yet another commission look at the issue!

I recall some fifty plus years ago Agnes, a friend of my in-laws, who was the matron of a council run nursing home said do not save for your old age. That person has money and is funding their own care, that person has none and it is free. Why bother saving?

Andy Burnham has said that this will be one of his main priorities; yet he has not been in power for more than a couple of days and I see that the Daily Mail is already screaming “Death Tax” as in the past he proposed a solution whereby the cost was taken out of one’s estate after death. Despite what the press might think, if one is going to go into a care home it has to be funded somehow. The question is what system is the most equitable?

Care home funding in the UK depends on your local council, your health needs, and where you live. Average costs range from £925 to over £2,800 per week. Your local council will arrange a free Care Needs Assessment and a Financial Means Test to decide if you pay your own way or receive state support.  

The main ways to fund care homes in the UK depend entirely on your personal situation:

 

1. Local Authority Funding (State-Funded Care)

If your savings and assets fall below certain thresholds, your local council can help pay for your care home. 

• England & Northern Ireland: If your capital is below £14,250, you qualify for maximum funding. If you have between £14,250 and £23,250, you pay a contribution.
• Wales: There is a single capital threshold of £50,000.
• Scotland: The upper savings threshold is £35,000, and the lower is £21,500.  

The Process: The council looks at your income (including pensions) and capital (like savings and the value of your property) to work out how much you must contribute

 

2. Self-Funding (Paying Privately)

If your assets are above the local threshold, you are considered a "self-funder" and must pay for all your care home fees.  

• England & Northern Ireland: Assets above £23,250.
• Wales: Assets above £50,000.
• Scotland: Assets above £27,250. 

Paying for your own care: Self-funders usually pay for their care by renting or selling their home, using pensions and savings, or purchasing a care fee annuity (an insurance product). If your savings drop below the thresholds, you can ask your local council to step in and help with funding. 

 

3. NHS Funding

If you have severe, complex health needs, your care might be fully or partially paid for by the NHS, regardless of your finances.  

• NHS Continuing Healthcare (CHC): This is for individuals with a "primary health need". The NHS fully pays for your care and accommodation.  
• NHS-Funded Nursing Care (FNC): If you don't qualify for CHC but still need to live in a care home with registered nursing, the NHS will make a flat-rate contribution toward the nursing costs. In England, the standard rate is £267.68 per week.  

4. Extra Benefits and Options

If you are funding your own care, you might still be able to claim benefits like Attendance Allowance (up to £114.60 per week) if you are over 65 and need help with personal care.  

If you own your home but don't want to sell it immediately, you can look into a Deferred Payment Agreement. This is a loan from your local council to help pay for care, using your home as security. The loan is typically repaid when you sell the property or from your estate.

 

So basically, if you have saved during your working life you pay; no money the state pays, as Agnes said all those years ago why save? There has to be a better more equitable funding model. We need to protect and support those who have not been able to save due to sickness, disability etc; but what about those who have chosen not to save and those who have been feckless?

 

Effects of Current Funding Model in the UK

 

The UK’s current adult social care model described above of splitting s healthcare (free under the NHS) and social care (means-tested), causing severe asset depletion, postcode lotteries in local council funding, unmet needs, and over-reliance on unpaid family carers. 

The specific localized and systemic effects include:

• Catastrophic Asset Depletion: Social care in England is subject to a strict means test. Individuals with assets over £23,250 must fully self-fund their care. With average care home fees running at £951 a week (much greater in London) for those over 65, many middle-class families are forced to liquidate their homes and life savings, often leaving no inheritance. 
• Local Authority "Postcode Lottery": Councils administer care locally under the Care Act 2014, but severe underfunding has led to increasingly tight eligibility tests. Across the UK, local budgets are buckling, leading to longer waiting lists, reduced care packages, and complete lack of support for vulnerable older adults. 
• Cross-Subsidies and Market Instability: Because local authorities pay lower rates to care providers than the actual cost of care, providers are heavily reliant on overcharging self-funders to stay afloat. This makes the market highly volatile, with many care homes relying on international recruitment to fill staff shortages amid rising National Living Wage costs. 
• Hospital "Bed Blocking" (Delayed Discharges): When older people are ready to leave local hospitals like those under the NHS trusts (e.g., King's College Hospital or Bromley Healthcare), the lack of local authority-funded social care packages delays their discharge, severely impacting NHS bed capacity and patient flow.  
• Burnout of Unpaid Carers: Because of the prohibitive costs and lack of state-funded social care, millions of unpaid carers—often spouses or adult children—provide over 50 hours of care per week. This frequently forces them to leave the workforce, compromising their own financial security and physical and mental health. 

The unsustainability of this model is widely acknowledged, with expert bodies like The Kings Fund and the Nuffield Trust continually publishing data on the decline of publicly funded care and the resulting crisis for older people.  

 

The Way Forward

Rather than try and invent something from scratch it seems to me that we should use a model that is successful in other countries and work on that. Models often considered successful

Japan

Japan introduced mandatory long-term care insurance in 2000. Everyone aged 40 and over contributes through premiums, with government funding covering a significant share of costs.

Strengths:

• Universal eligibility based on care needs rather than income.
• Professional assessment of care requirements.
• Wide range of home and residential services.
• Reduced burden on family caregivers.

Challenges:

• Rising costs due to rapid population ageing.
• Increasing premiums and government spending.

Germany

Germany operates a mandatory long-term care insurance system funded primarily through payroll contributions.

Strengths:

• Dedicated funding stream.
• People can choose cash benefits for family care or professional services.
• High public support.

Challenges:

• Benefits often do not cover the full cost of intensive residential care.

Netherlands

The Netherlands has one of the world's most comprehensive publicly funded long-term care systems.

Strengths:

• Extensive coverage for severe care needs.
• Strong community and home care services.
• High quality standards.

Challenges:

• Among the most expensive systems globally.

What many experts recommend

A hybrid model is often viewed as the most sustainable, combining:

1. Tax funding for a universal minimum level of care.
2. Mandatory long-term care insurance to create a dedicated funding source.
3. Means-tested assistance for people with lower incomes.
4. Personal co-payments with annual or lifetime caps to protect against catastrophic costs.
5. Strong investment in home-based and preventive care, which is generally less expensive than institutional care.
6. Support for family caregivers through respite services, training, and financial recognition.

 

This will cost! Long term it will cost more than we pay today (allowing for inflation). But in the short- term there will be a large financial hit, the question is do we muddle along as we are today with hundreds of thousands of people not be cared for properly and some selling homes and losing all their assets or move forward to an equitable system? I hope that the major parties agree on a way forward for the benefit of all.

 

 

Ann Widdecombe

 A few years ago, in the early 2010's Julia and I were on holiday in Devon and went to the local Catholic Church in Okehampton summer Garden Fete. It was held in the grounds of one of the parishioners house in a nearby village. We parked the car and were walking to the house when we saw this lady carrying a couple of bags going the same way. I helped her with the bags and we started chatting. It was only when we got to the house and they thought that we were "part of her team' that Julia and I realised that the lady was Ann Widdecombe.

She had brought some of her books with her, proceeds going to the charity that the Fete was supporting. We had a cup of tea with her and an enjoyable chat. She had no "airs and graces" strong views certainly and a wicked sense of humour, someone whose company we enjoyed.

It is so sad that she has had her life brutally cut short. What makes it worse is that some are saying such vile things about her and others trying to make political capital. We live in strange times.

Julia and I will pray for her.

Frustrations with our transport systems

What is up with the transport system in the UK? Last Wednesday evening, 15th July 2026, I was driving from Bromley to Lamberhurst in Kent to see a friend installed as the vicar of the local C of E church. I was picking up a friend and it took me, at about 5:30pm over twenty minutes to drive less than two miles to pick them up. There appears to be roadworks on all the roads into/out of Bromley. Eventually we made in time and saw an interesting and joyous service. After the installation and commissioning there was a gathering with food and drink - elderflower cordial for me as I was driving.

We left about 9:30 and the church is less than a mile from the A21, the main road to take us back home. Only problem is that they had closed that part of the A21, no marked diversions, which left us and others driving around that part of Kent seeking a way home. Satnavs were not much help as the systems were not set-up for the main road being closed. We kept finding routes only to find them closed off as they led to the part of the A21 under repair. I realise that roadworks on main routes have to be done at night as they are so busy during the day. But not to put in diversions is beyond the pale.

There was one amusing episode where I took a road and found that it ended in a farmyard - only to find four other vehicles following me! Eventually we made it home safe and sound.

Then Thursday evening I was off to the Askean Association AGM and dinner. I thought that bus seemed the best option as I suspected that alcohol might be involved! We were about a mile from where I was going when the driver opened the inside door of his cab yelled something incomprehensible and shot off in the "wrong direction". Looking back I think he said diversion road closed - but no prior warning. It was not registered on any of the transport apps leaving me with a mile and a half walk to work up a thirst.

Something similar happened on the way back. The bus was diverted and the journey doubled in length. I was travelling with a friend, and we were using different bus routes as we knew that the way we used going was "up the Swanee"! Again no mention on London Transport apps.

Perhaps these are simply first world problems; but judging by pictures and reports of queues at airports, ferry ports etc it would seem that we are slowly (or should that be rapidly) grinding to a halt.

Back in the Days

Back in the days of tanners and bobs, 
When Mothers had patience and Fathers had jobs. 
When football team families wore hand me down shoes, 
And The T.V had only two channels to choose

Back in the days of three penny bits,

when schools employed nurses to search for your nits. When snowballs were harmless; ice slides were permitted

and all of your jumpers were warm and hand knitted.

Back in the days of hot ginger beers,

when children remained so for more than six years.

When children respected what older folks said,

and pot was a thing you kept under your bed.

Back in the days of Listen with Mother,

when neighbours were friendly and talked to each other.

When cars were so rare you could play in the street.

When Doctors made house calls and Police walked the beat.

Back in the days of Milligan's Goons,

when butter was butter and songs all had tunes.

It was dumplings for dinner and trifle for tea,

and your annual break was a day by the sea.

Back in the days of Dixon's Dock Green,

Crackerjack pens and Lyons ice cream.

When children could freely wear National Health glasses,

and teachers all stood at the FRONT of their classes.

Back in the days of rocking and reeling,

when mobiles were things that you hung from the ceiling. When woodwork and pottery was taught in schools,

and everyone dreamed of a win on the pools.

Back in the days when I was a lad,

I can't help but smile for the fun that I had.

Hopscotch and roller skates; snowballs to lob.

Back in the days of tanners and bobs.

A personal reflection on Pope Francis (Written 2nd March 2025)

 As I write this Pope Francis is seriously ill in hospital and the Catholic world is praying for him. During the past hundred years or so the proportion of Catholics has remained fairly steady at about 16% of the world’s population which has trebled in number. However, the centre of balance of the Church has dramatically changed. In 1910, Europe was home to about two-thirds of all Catholics, and nearly nine-in-ten lived either in Europe (65%) or Latin America (24%). By contrast in 2010, only about a quarter of all Catholics (24%) were in Europe. The largest share (39%) was in Latin America and the Caribbean. (Figures from Pew Research)

 

This change was reflected by the installation of Pope Francis, the first non-European pope for over a thousand years with his different. As the first Jesuit pope he has a charism of being grounded in love for Christ, a focus on discernment and animated by the spiritual vision of St. Ignatius of Loyola, to help others and seek God in all things. It is unsurprising that his modus operandi has come as shock to many in the west. 

 

His first encyclical  published in the year 2013 the Apostolic Exhortation “Evangelii Gaudium”, is the true ‘guiding manifesto’ of his Pontificate, in which he called for a new evangelization characterized by joy, as well as the reform of ecclesial structures and the conversion of the papacy, so that they may be more missionary and closer to the purpose intended by Jesus. For this reason, also in 2013, the Pope established a “Council of Cardinals” whose task is to study a project to revise the Apostolic Constitution “Pastor bonus” on the Roman Curia, dating back to 1988.

 

Since this beginning he has published other encyclicals dealing with the family, “Amoris Laetitia,” and the duty of care that we owe to the world, “Laudato si’ on Care of our Common Home.”

 

Like all of us Pope Francis is not without fault, but nobody can doubt his determination and zeal to carry on with the work and mission of his predecessors who have sat in the Chair of Peter to evangelise the world. His determination to carry on with his work can be seen by the start of his “Synod on Synodality” that is still evolving and transforming how the Church functions.

 

What has Pope Francis achieved? To start, the pontiff has achieved a great deal by living simply, speaking his mind, promoting frugality, and working for peace and justice. Pope Francis makes the news regularly with his reforms and proclamations. He has simplified annulment rules, threatened to shut down the Vatican Bank if it didn't embrace transparency and reform, and moved toward liberalizing the Vatican's stances on the environment, and the economy. He has also placed women in high positions within some of the Vatican departments. In the process, he's angered conservative and traditionalist Catholics around the world, who feel he's going too far, too fast. 

 

Personally, I think that Pope Francis is what the Church needs in this day of age. Sadly, I fear that his days are numbered. I hope and pray that the changes he has instituted are allowed to fully develop by his successor which I suspect will be before the year end.

Barry Mellish 2^nd March 2025

Who is responsible for the single old folk?

 I have a situation with an elderly cousin, or rather elderly widow of a cousin of mine. We are coping more less OK; but this situation is I suspect not uncommon and is part of what I feel is a major situation - care of the old and vulnerable and who is responsible for single old folk?

My cousin, we will call her "Mary", is a childless widow in her mid-nineties. She has no family members physically closer than a two hour plus drive away. Who would have been her closest relative, her sister,  has died as has one of her sister's two children. The other child is in his early eighties, suffers with Parkinson's, and is a four hour drive away! So in terms of blood relatives who could help we are down to great nieces and great nephews who are working, have their own families and are at least two hours away.

Her nephew and niece on her husband's side are in their sixties, do not have good health and are a four hour drive away. So we are left with folk like me, her husband's cousin and we are a two hour plus drive away so we cannot just "pop over". She has LPAs in place for Finance and Health & Welfare. (I am one of the two attorneys)It is easy enough to keep her finances in order using online banking and fortunately money is not an issue. But Health & Welfare LPAs do not kick in until the person has lost the capacity to make decisions and although she is in the early stages of dementia she does not cross the loss of decision making capacity threshold.

She has carers and they are very good but I cannot help feeling that her quality of life could be so much better if there was someone who could gently persuade her into doing things. Neighbours help with shopping and do the odd "handyman" job and there is a local tradesman who is trustworthy and reliable who does bigger things.

Maybe I shouldn't worry, but I do. I understand and accept that people shouldn't be bullied into doing things. Just because something is not what I would like doesn't mean it is wrong for other people. "Mary" says that things are fine, but she is slowly deteriorating and it is sad to see it happen. Talking to carers they themselves have similar issues with their own parents who live a distance away.  I guess that all we can do is let "Mary" make her decisions and we support her as best we can. At least she has us and others who visit when able and phone regularly. What about those who literally have nobody and have financial issues? 

Political and economic issues will ebb and flow. Leaders come and go and the shock waves that they cause will fade. But there will always be an ageing population who deserve our love and support.

The real existential question for 2025

 What will happen sooner; The End of the World or the completion of HS2?

Happy New Year