Adult social care and its funding

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What should be the role of the state in providing and funding adult social care for older people?

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Social care for older people is in crisis. Almost a million people aged 65+ do not have their care needs met. We are an ageing population, so more of us will need social care. Yet many people do not know how social care and its funding works.

Explore the topic and read the views of ordinary citizens who took part in a Citizens Assembly commissioned by parliament and in workshops run by Ipsos MORI, both in 2018. Then have your say.

What follows describes the situation in England. Wales and Scotland have different systems

We are grateful to the Royal Society of Arts for a Catalyst Award to fund the development of this topic.

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Researched and written by Perry Walker, with advice from many experts, especially Lillie Wenzel and Richard Humphries, both of the Kings Fund.

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  • Provide free personal care, as in Scotlandmore

    Free personal care has been offered in Scotland since 2002. It is provided to anyone aged over 65 based solely on need and not their ability to pay. It includes personal hygiene, continence, diet, mobility, counselling, simple treatments and personal assistance.

    This does not cover accommodation costs for those in care homes. These are means-tested – whether you have to pay depends on your income and your assets.

  • Stick with the current system of funding
  • Prevent anyone having to pay very high care costs more

    1 in 10 people may face ‘catastrophic’ care costs of over £100,000. This could be prevented if there was a limit on the total care costs that anyone would have to pay. This is known as a cap.

    At present there are no insurance products that allow people to protect against such costs.

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What is adult social care?

Adult social care provides help, care and protection from harm for adults with learning disabilities, physical disabilities and people with mental health problems.

Many people who receive social care are older people who are frail and/or living with long term health conditions, such as dementia or arthritis.

What is the aim of adult social care?

To help people be as independent as possible, retain their dignity and achieve a better quality of life.

Where does adult social care happen?

In people’s own homes.

In a residential care or nursing home.

What does it involve?

Personal help with things like washing, eating and getting dressed

Domestic help with things like shopping and cooking

It might also include less traditional services, such as giving people money to employ a personal assistant

The current funding system

Adult social care is not part of the NHS. Whereas the NHS is mostly free at the point of use, social care is not.

Local councils are responsible for social care for people who meet two criteria:

1. They must have high care needs

2. They must declare their income and assets. This is the asset test:

Local councils’ funding is mainly from: council tax, business rates, charges to service users, the NHS and government grants.

Demand is growing

One study found that older people with unmet needs were not generally going hungry or cold or unsafe. But:

  • Carrying out the basic activities of daily living could take a lot of time and lead to pain and exhaustion
  • They were often unable to participate in hobbies and interests and unable to get out of the house, leading to loneliness and isolation

The number of people in the age ranges likely to need social care is growing:

Public spending has been falling


Finding out more

The report of the Citizens Assembly on Social Care is at

https://publications.parliament.uk/pa/cm201719/cms...

The report on the workshops run by Ipsos MORI can be downloaded from this page:

https://www.ipsos.com/ipsos-mori/en-uk/understandi...

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