At present, over 7% of the population is aged 75 or over. By 2031 this figure is predicted to reach ...
At present, over 7% of the population is aged 75 or over. By 2031 this figure is predicted to reach 10.5%.* One in four women are likely to need some form of long term care.** How can we ensure that the resources are there to provide it and to the highest possible standard?
There is no doubt that the Government faces a thorny dilemma when it comes to long term care. It cannot ignore the problem given the number of elderly people who will require care can only grow. But it cannot offer a politically popular solution either - the money is simply not there to provide free care for everyone who will need it without raising revenue through general taxation.
So when it does finally come up with a policy on funding and provision - and it cannot delay forever - it is unlikely to win votes. In fact it could well lose them, particularly from the 27% of the electorate who are aged over 65 and for whom the possibility of requiring long term care is looming on the horizon.
It is now well over a year since the Royal Commission published its report on long term care, a period that has been filled by intense inactivity. The time has now come for the Government to act - but realistically we should not expect anything too decisive just yet. The summer spending review and the White Paper expected soon afterwards should create some direction on the way forward.
However, in the interest of keeping votes, any concrete solution is not likely to materialise until the Government is safely installed for a second term. Long term care is unlikely to take Treasury cash away from the other, even more pressing and politically-sensitive, issues of the health service, education and transport.
Because the cash is not there, in reality the Government has little option but to look to improve the partnership it already has through the means test between the public and private sectors. This is the only certain way care can be provided for everyone who needs it over the short, medium and long term.
Public mind-set
The popularity of this solution with the public is another issue. The generation currently facing the spectre of long term care has been brought up to believe in 'cradle to grave' State care. While this ideal is being eroded - and certainly members of the younger generation realise that they have to make provision for their own pensions and possibly their own and their families' healthcare and even education - older people have never expected to have to make such plans.
Paying for care in old age is expensive and most people hope it will be something they never need, whereas we all hope to draw our pension one day. To ask people to set aside tens of thousands of pounds 'just in case' is therefore unlikely to be well received.
A further key issue faced by the Government is how to ensure that consistently high quality care is provided across the country. At the moment, care is a lottery based on postcode. There is currently no clear line drawn between where NHS-funded hospital care stops and means-tested social services begins. This is simply not good enough as a way to determine the lives of the country's elderly and infirm.
Complex issues
While the Royal Commission attempts to clarify the difference, it merely serves to underline the complexity of this issue. Under its recommendations, food and drink would be free but individuals would have to pay for its preparation. Clarity is therefore key to the successful provision of long term care in the future. The public needs to know what the State will provide and what they must contribute themselves, and they need to be sure that the care they receive will be appropriate and of good quality.
The promise to set up a National Care Commission by April 2002, coupled with a partnership approach with individuals taking out insurance to cover, say, the first four years of their care, requires not only clarity but quality. The provision of consistent, high quality care can only be delivered by establishing a single standard care assessment system.
Minimum data set
This is where an assessment tool known as minimum data set (MDS) comes in. It can ensure the delivery of consistent care within the State and private sectors, with individuals being provided with tailored programmes of care. It is a tool that allows people's personal and social care needs to be assessed accurately.
MDS has been used successfully abroad for some years, particularly in the US and Germany, and was established in the UK in 1998 by Norwich Union, the Joseph Rowntree Foundation and two fellows of InterRAI (the charity that owns the license to MDS) from the universities of Manchester and Canterbury. InterRAI UK was set up specifically to achieve the adoption of MDS as a nationally-approved care assessment system.
It is used to assess the needs of elderly people requiring long term care, either at home or in a nursing home, and works on three related levels.
Firstly, it enables effective care plans of a consistently high standard to be put in place for individuals by evaluating their needs, both mental and physical, in detail. It also allows for the results to be assessed and reviewed regularly.
Secondly, it allows nursing and residential homes to manage their staff and financial resources more effectively because they know in advance the level of care they need to provide for each individual and its cost.
Finally, MDS can provide data on the morbidity and mortality of the elderly that would help the Government to allocate resources to the public sector across the country according to requirements, and to assess the performance of both public and private facilities. In addition, but equally importantly, MDS provides a way to evaluate and regulate care homes.
The benefits of this system are huge. It offers a consistent basis on which to admit claims, is a fair way to deliver care under long term care policies and allows more accurate monitoring and management of claims.
MDS is already being used in a number of locations in the UK and is being piloted by various public and private providers, but there is still a long way to go.
Strain on resources
Putting the right assessment system in place now is essential, not only for the individuals receiving care today and in the future, but to ensure effective resource management. Whether they come from the State or via insurance products, these resources will inevitably come under increasing strain.
Market feedback suggests that many nursing homes are already feeling the pressure on their resources. The introduction of the EC Working Time Directive and the minimum wage, plus the restricted levels of local authority reimbursement, are forcing nursing homes into taking cost-cutting measures. MDS can provide information that will help them to plan effectively by comparing their current resources against requirements in pre-defined areas.
By using MDS everyone wins - the individual, the long term care provider, the local authority and the State. Once the Government has grasped the nettle and announced that long term care provision will be made through a partnership between the private and the public sectors - as it is most likely to - MDS is the only way to ensure both equality of care provision and good management.
Martin Chapman is marketing manager for long term care at Norwich Union
* Source: SwissRe
** Source: With Respect To Old Age
