April 2023 - Women in Public Life Guernsey

Summary
How long-term care works
The co-payment
Care at home
The size of the problem
What happens elsewhere
Services for older people/SLAWS
Carers action plan
Joint strategic needs assessment
Media
Reference documents

Summary

In 2001, the States agreed to create the Long-Term Care Insurance Scheme and it was implemented in 2003.

The purpose was to help prevent older people having to sell their houses to pay for long-term care and to encourage investment by private care providers. To fund the scheme, an additional 1.4% was added to social security contributions. At the time the policy paper said there was ‘…some confidence in the financial projections for the following 10 to 15 years, but thereafter the future is increasingly unknowable’.

In 2014, consultants predicted that the Long-Term Care Fund would be exhausted by 2031. At that point the amount paid in by the working population would not be sufficient to cover the costs of people needing care and reserves would also have run dry. As an interim measure, contributions were increased by 0.5% in 2017, extending the life of the fund to 2047 (recently revised to 2053).

In March 2020, the Committee for Employment and Social Security, led by Deputy Michelle Le Clerc, brought a policy paper to the States to further extend the life of the Fund. They proposed, amongst other changes, that they and P&R should undertake a report on whether people with homes or other assets valued at greater than £350k should be asked to pay the first £35k of their care, or £50k for a couple.

If beneficiaries didn’t pay the first £35k of care, additional funding for the Long Term Care Fund would need to be found as part of the Tax Review (eg from GST), or contributions would have to rise over time from 1.8% to 2.7% (or 3.1% if the scheme was extended to care in the home).

The States rejected the £35k proposal. Then, earlier this year, the States voted against GST and all four other alternatives in the Tax Review. Contribution rates have started to rise, moving up by 0.1% to 1.9% in January 2022 and to 2.0% in January 2023. They are currently scheduled to increase by a further 0.1% each year until 2025.

Relying on increased contributions means the working population of today are paying more to preserve the assets of the older generation. ESS remains concerned about this ‘inter-generational unfairness’ and are working on a new policy paper.

In more detail

How long-term care works

Islanders are eligible for long-term care benefit if they meet the residency requirements, pass a Needs Assessment, find an available bed in residential accommodation and can fund the co-payment. There is no financial assessment except where an individual cannot afford the co-payment. More detail in leaflet LTC 1.

The co-payment

Long-term care benefit alone does not cover the cost of living in a care home. The Fund pays for the care and support from staff but the person is expected to cover accommodation, food and day to day living expenses since they would be paying for these if they still lived in their own home. This additional amount is the co-payment, set by the States.

A “States rates” bed is one that costs the same as the long-term care benefit plus the co-payment. In 2003 70% of beds were States rates. In 2019 it was 36% which means that 64% of beds required payment of an extra top-up fee – not set by the States – to the care home.

If a person can’t afford to pay the co-payment, she or he can apply for income support. A home or other assets are not taken into account, just pension and other income. That means 40-45% of care home residents are claiming income support, even if they have an empty property that could be rented out.

In their March 2020 policy letter, ESS proposed including the value of the home above £350k in the calculation of income support (unless the person’s partner was still living there). They also planned to introduce a deferral scheme so that the additional cost wouldn’t have to be paid until the person died. These proposals were rejected by the States.

Care at home

One proposal that did get voted through in March 2020 was to extend the long-term care funding to care provided in the person’s own home. This would reduce the perverse financial incentive for people to take up a place in a residential or nursing home even if they’d rather remain at home. The cost would be the equivalent of a 0.4% increase in contributions. Although the States agreed to progress this, ESS don’t want to actually make the change until there is “a clear funding plan” for long-term care.

Funding for care at home would only cover the cost of professional carers, either HSC or private. Family members will continue to be entitled to claim Carer’s Allowance but only if the person they are caring for is in receipt of Severe Disability Allowance and the family member provides more than 35 hours of care a week.

Carers Guernsey say carers allowance is ‘not enough and it’s hard to claim’ (1 Aug 2022, Guernsey Press).

Professional care at home is, of course, highly dependent on staff availability. In November last year, HSC announced that they were having to scale back care at home by 25% because of staff shortages.

The size of the problem

In Guernsey and Alderney, demographic changes which had long been forecast are beginning to have increasing effect. In addition to the ageing of the post-war baby boomers, medical, societal and technological advances have contributed to the increase in life expectancy with some individuals living longer with multiple chronic conditions.

What happens elsewhere

In England, an individual is expected to use almost the entire value their assets (only £14,250 is fully protected) before local councils meet an individual’s care costs in full.

In Jersey, a scheme was introduced in 2014 which required those with significant income, a home valued at more than £419,000 or other assets in excess of £25,000, to fund up to the first £57,590 of their care costs (or £86,390 for a couple). The long-term care contribution rate is 1.5% in Jersey and the States also contributes to the Fund.

Services for older people/SLAWS

In 2013 the States formed a cross-departmental working party, led by Deputy Peter Harwood, to determine what care and support services Guernsey needs, who should provide them and how they should be paid for. After a public consultation in 2015, the Supported Living and Ageing Well Strategy was approved by the States in 2016. The strategy was intended as the beginning of ongoing, long-term change to bring about:

The last published update on the Strategy’s progress is dated 2019 (pre-Covid). It refers to:

A new reablement service to help people who have been hospitalised to relearn skills to live independently. This was piloted in 2019 and is now operational.
A carers action plan (see below).
Strategic funding of the long-term care scheme. A policy letter was debated by the States in March 2020, see Summary above.

SLAWS is included in the Government Work Plan. ‘Develop proposals on the funding options for long–term care’ is currently included in the top ten actions:

Carers action plan

The Carer’s Action Plan was published in 2019 (pre-Covid). Reports on progress are not available. There are estimated to between 2000 and 4000 people caring for family members or friends in Guernsey, saving the island an estimated £29m a year.

From some quick desk research, it seems the status is as follows (corrections welcome):

Completed:

Information for carers on Signpost.gg
Outreach workers & voice for carers from Carers.gg
Carer assessments from Community Health and Social Care
Care home regulation
Carer status included as a protected characteristic in discrimination legislation
Improved voluntary transport scheme from Health Connections
Carers allowance can be claimed alongside sickness benefit

Progress not clear:

More respite care
Carers represented on CareWatch
Improved travel grants
Include carers in discharge planning

Not happened yet:

Right to flexible working
St John’s training for carers

Joint Strategic Needs Assessment for people over 50

Also in 2019, Public Health conducted a detailed joint strategic needs assessment process for people over 50, involving the community to help identify and prioritise actions. The report covers much wider issues than SLAWS and the Carer Action Plan, looking more broadly at how people over 50 live their lives – activity levels, digital connectivity, housing needs etc. Again this was pre-Covid and no reports on progress have been published.

Media

Only ‘difficult options’ remain for long-term care (19 Aug 2020, Bailiwick Express)

Elderly couple could be forced into residential care just to be together (30 Jun 2021, Bailiwick Express)

Debate on cost of long-term care due next year (20 Oct 2022, Guernsey Press)

Care at home services have been cut by 25% (8 Nov 2002, Guernsey Press)

Guernsey’s care sector facing ‘unprecedented threats’ (4 Jan 2023, ITV Channel TV)

Care homes sector ‘likely to support equity release scheme’ (9 Jan 2023, Guernsey Press)

Reference documents

Long-term care leaflet LTC1

Supported Living and Ageing Well Strategy – 2016

Supported Living and Ageing Well Update – 2019

Carers Action Plan – 2019