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:
- Tax funding for a universal minimum level of care.
- Mandatory long-term care insurance to create a dedicated funding source.
- Means-tested assistance for people with lower incomes.
- Personal co-payments with annual or lifetime caps to protect against catastrophic costs.
- Strong investment in home-based and preventive care, which is generally less expensive than institutional care.
- 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.
