Boris Johnson’s manifesto-breaking plan to reform social care will be the biggest shake-up of the sector for 60 years.
But the proposals have left many who receive care, or who have loved ones who do, confused and worried about what they will mean.
Here, Prof Catherine Needham, Professor of Public Policy at the University of Birmingham and Associate Director of the National Institute for Health Research’s School for Social Care, answers the important questions…
Q. What will happen if someone is assessed as having care needs but has assets of less than £20,000? And what about those with between £20,000 and £100,000?
A. If a local council decides that someone meets the eligibility criteria for having care needs and has assets of less than £20,000 then the state will pay for their care. For people with assets from £20,000 to £100,000 there will be a sliding scale of state contributions, but we don’t know yet exactly how this will work.
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Q. If I need care before October 2023, does that mean I won’t benefit from the reforms when they come into place?
A. These reforms will only affect people who need care after October 2023. If you are still using care services after that date then you may benefit from the reforms, but only if you have assets of less than £100,000. You will get some state contribution to your care costs if you have assets of £20,000 to £100,000 and you will not pay more than £86,000 for care.
Q. My mum has already spent over £86,000 on care from her savings. If she’s still alive in October 2023 will she get the extra back?
A. No. She will only benefit if she is still spending money on care from October 2023.
Q. My dad has been in a care home with dementia for two years and we are now deferring payment of his care costs until after he dies and we sell his home. If he dies after October 2023, does that mean he can leave his house to his children instead?
A. Not all of the detail on this is yet available. But it looks like only costs incurred after October 2023 will be part of the new arrangements. So it is likely that the house would still need to be sold.
Q. We want to put our mum in a good care home. After the £86,000 cap is reached and the local authority takes over paying her care costs, will she stay in the same home even though it’s more expensive?
A. The government says that people will be able to choose to ‘top up’ their care costs by paying the difference towards a more expensive service. Many families currently do this.
However, it is unlikely that the state will be willing to pick up the bill to enable her to stay in an expensive care home. This situation happens at the moment when people run out of money. If families can’t provide a top up, and the residential home won’t accept the local authority fee, then people have to move to a cheaper care home.
Q. We’ve already spent over £100,000 on care for my mum even while she is still at home. From October 2023, will we be expected to spend another £86,000 before the local authority takes over?
A. Yes, it looks like you will, because the spending won’t be monitored until 2023.
Q. My autistic daughter needs care but she also has a job, but doesn’t own a home. How will she be assessed and will she need to use any of her earnings to pay towards her care?
A. She will be assessed in the same way as any other user of care. Many working age disabled people do not pay for their care currently because their assets are too low. If she meets the threshold for eligibility for care (and many people with autism would not), then her assets would be calculated and she would be fully funded if her assets are below £20,000.
The state would make some contribution, on a sliding scale, if her assets are £20,000-£100,000. For care at home, the house is not part of the asset calculation. For residential care, the house is part of the calculation.
Q. The £86,000 ceiling for care costs doesn’t include accommodation. Are we expected to continue paying for accommodation at care homes, and if so, how much is it likely to cost? What happens if we can’t afford it?
A. This is a really important point, and one that is likely to create a lot of confusion and upset. For example in Scotland, where personal care is currently free, people are often surprised to find that they still have to pay for the costs of food and accommodation in residential care.
The government has not yet announced how this aspect will be dealt with and whether there will be any limit on it. It could be up to £12,000 a year.
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Q. My husband is in a care home and we are deferring payment with our home. What will happen to our home, and to me, if dies before October 2023, or after October 2023?
A. At the moment jointly owned property is not part of the financial assessment if you remain living there after your husband has moved into a care home (so long as his care needs are severe enough for him to meet the eligibility threshold). After October 2023, this will probably still be the case.
Q. If local authorities are paying for care won’t they try to cut costs, resulting in vulnerable people receiving worse care? Will families be able to pay extra for care on top of what local authorities pay to ensure their loved ones get better care?
A. Local authorities do pay a lower rate for care than people who are paying for it themselves. However there is no indication that the care is worse. Rather what happens is that self-funders subsidise the low local authority rates.
One of the new proposals is to make it easier for self-funders to purchase care through the local authority, getting a cheaper rate. But it is not clear how this would work, and what the impact would be on providers (some of which say they would struggle to survive without the higher payments from self-funders).
Q. What is the government proposing to do to keep social care workers who are leaving the sector for better paid jobs?
A. The government is providing £500 million to improve training and mental health support for staff. But there is nothing in the new proposals that looks likely to improve staff wages.
Q. My brother doesn’t need full-time care yet, but he has needed rehabilitation, equipment at home and spells of specialist care. Will the costs of such things be added to his £86,000 care bill?
A. Some of these services will be provided free by the NHS, or may be available from the local authority. However, your brother will only be able to put costs against the £86,000 if he meets the local authority eligibility threshold for care and if those services are part of the package that the local authority puts in place.
At the moment, more than half of requests for local authority help are turned down, usually because people are not yet frail enough to qualify for support.
Q. When means testing under 18s who need care, will their parents’ assets be considered?
A. The new proposals only cover adult social care so they will have no impact on under 18s who need care.