Age UK highlights the different approaches to long-term care across a group of countries in the developed world, and how they compare to the system in England. The Incisive Health report ‘An international comparison of long-term care funding and outcomes: insights for the social care green paper’ set out to explore key characteristics and outcomes of the social care systems operating in some other advanced nations, with a view to seeing what lessons could be learned and potentially applied here in England. The other countries were Italy, Spain, France, Germany and Japan.
Challenges to the social care system The findings suggest that creating a sustainable social care system fit for a rapidly ageing population is a challenge in every one of these countries, which none has completely overcome. However, most of the countries featured in the report have grasped the nettle and implemented significant reforms during the last 25 years. For example, Germany began to modify its system in 1995 and Japan in 2000. Over the same period, despite two Government consultations, two official Commissions, five Green or White Papers and one Act of Parliament, England’s system of means tested care funding is broadly unchanged.
Means Testing It is notable that England has a stricter means test than the other countries examined in the report. England has a fixed means test limit for all long-term care services, meaning anyone with savings or assets above £23,250 has to pay all the costs of their long-term care (with tapered means tested support available to those with savings and assets between £23,250 and £14,250). Even those with savings and assets below the £14,250 threshold will still be expected to pay a contribution towards the costs of their care through a deduction from their State Pension. Other countries have more progressive systems, either providing a non-means tested basic level of support (Germany), capping the level of co-payment for all (at 10% in Japan), or using a more generous and gradual means test (France). Furthermore, in recent years England’s harsh means test has become increasingly less generous:
Capital thresholds (£14,250 to £23,250) have not changed in nearly a decade: if the value of the means test had merely risen in line with inflation the upper level would be £25,559 today. This is effectively a 9 per cent stealth cut over the last ten years.
Charges for care have increased as local authorities have come under growing financial pressure. In 2010/11 the average charge was £2016.49 a year. By 2013/14 (the last comparable year) this had risen by over £500 to £2563.90 (2015/16 prices).
Since 2010 the Personal Expenses Allowance in a care home (i.e. the amount someone can keep out of their income for themselves) has risen by a miserly £2.60 to £24.30 a week.