Most people get depressed when talking about long-term care, but there are some positive developments which could have a huge impact on the quality of life of frail elderly people.
In April Age Concern Financial Partnerships (ACFP) changed the terms of its long-term care insurance policies to make it easier for people to claim while living at home. Claimants used to have to fail two ADLs - "activities of daily living" (such as dressing themselves or bathing unaided) - before they could claim for assistance, and even then any assistance had to be used on that particular ADL. Now claimants can get help after failing one ADL and can spend the money freely.
Peter Gatenby, director of ACFP, says "as technology advances, it is becoming easier for people to stay on at home". About three out of four claims made on the policies are from people living independently - even though some of them are so disabled they fail three ADLs.
About 5% of over-65s are in an institution, according to medical researchers Laing & Buisson - about the same as in other European countries. But there is an increasing feeling that institutionalisation is happening unnecessarily. The government is making significant efforts to promote independence: around 5,000 extra "intermediate care beds" are due over the next five years, to help people discharged from hospital become rehabilitated.
The government also estimates that by 2004 it will be helping 70,000 people "who might otherwise go to hospital" to live safely at home.
But many people are going into homes without really needing to. "Wherever possible, couples usually prefer to stay in their own home," says Peter Fisher of independent financial adviser Nursing Home Fees Agency. But people who are reliant on the state for long-term care will often find they are pushed into a home. Social services carry out physical and financial assessments of older people at the same time - and often appear to let financial pressures dictate. It will frequently be cheaper for social services to encourage someone into an institution - not least because the value of that person's home can often be used to pay for care. "These sorts of decisions are never fully explained," says Fisher.
Getting some care early can make a big difference. "By getting some money and assistance, it is quite likely that they will stay healthy longer and be able to stay on in their own home longer," says Gatenby. Research from the Nursing Homes Fees Agency suggests the typical age for going into a home is 87 but that the need for homecare assistance starts at 79. So a 79-year-old should be able to stay at home for another eight years.
But you need to scrutinise closely all decisions made by social services. "He who shouts the loudest gets heard," says Fisher. The support of your GP can prove crucial. Buying an insurance policy should give you more flexibility if you can afford one, but these typically cost £8,000 for men and £14,000 for women at 60 for a policy that pays out £10,000 index-linked a year. There are huge variations - as the Age Concern example shows - so policies need to be examined carefully.
More information
www.ageconcern.org.uk
www.nhfa.co.uk
www.nhs.uk
