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Long-term care funding in England: an analysis of the costs and distributional effects of potential reforms
- Authors:
- HANCOCK Ruth, et al
- Publisher:
- University of Kent. Personal Social Services Research Unit
- Publication year:
- 2013
- Pagination:
- 13
- Place of publication:
- Canterbury
This paper examines projected costs and distributional effects of Government plans to reform the systems that determine how much the state contributes to people's long-term care costs compared with the current system. It also contrasts these costs and distributional effects with the central recommendation of the Commission on the Funding of Care and Support (Dilnot Commission) which was set up by the Government and reported in 2011. Two variants on the Government’s plans which would give additional help to recipients of residential care with capital below the proposed higher capital threshold are also considered. (Edited publisher abstract)
Housing wealth, income and financial wealth of older people in Britain
- Author:
- HANCOCK Ruth
- Journal article citation:
- Ageing and Society, 18(1), January 1998, pp.5-33.
- Publisher:
- Cambridge University Press
Explores the housing wealth of older people in Britain in relation to their incomes and financial wealth. Uses the Family Expenditure Survey data for 1992/3 to 1993/4 to assess the extent to which housing wealth could alleviate income poverty in old age. Analysis suggests that although housing wealth increases with both income and financial wealth, there are non-negligible portions of low income older people who could generate small supplements to their incomes by converting the wealth tied up in their homes into an income stream. However, asks whether this be sufficient to pay for long-term residential care for any length of time.
Trends in survival of older care home residents in England: a 10-year multi-cohort study
- Authors:
- PUJOL Ferran Espuny, HANCOCK Ruth, MORCIANO Marcello
- Journal article citation:
- Social Science and Medicine, early cite 31 March 2021, p.113883.
- Publisher:
- Elsevier
Increases in longevity combined with a policy emphasis on caring for older people in their own homes could have widened or narrowed the survival gap between care home and community-dwelling resident older people. Knowledge of pre-Covid-19 trends in this gap is needed to assess the longer-term impacts of the pandemic. We provide evidence for England on recent trends in 1, 2 and 3-year mortality amongst care home residents aged 65+ compared with similar community-dwelling residents. We use the Clinical Practice Research Datalink, a nationally representative primary care database. For each of the ten years from 2006 to 2015, care home and community-dwelling residents aged 65+ were identified and matched in the ratio 1:3, according to age, gender, area deprivation and region. Cox survival analyses were used to estimate mortality risks for care home residents in comparison with similar community-dwelling people, adjusting for age, gender, area deprivation and region. The study sample consisted of ten overlapping cohorts averaging 5,495 care home residents per cohort. Adjusted mortality risks increased over the study period for care home residents while decreasing slightly for matched community-dwelling residents. The relative risks (RRs) of mortality associated with care home residence were higher for younger ages and shorter follow-up periods, in all years. Over the decade, the RRs increased, most at younger ages and for shorter follow-up periods (e.g. for the age group 65–74 years, 1-year average RR increased by 61% from 5.4 to 8.8, while for those aged 85-94 years and over, 3-year RR increased by 22% from 1.3 to 1.6). Thus the survival gap between older care home and community-dwelling residents has been widening, especially at younger ages. In due course, it will be possible to establish to what extent the Covid-19 pandemic has resulted in further growth in this gap. (Edited publisher abstract)
Winners and losers: assessing the distributional effects of long-term care funding regimes
- Authors:
- HANCOCK Ruth, et al
- Journal article citation:
- Social Policy and Society, 6(3), July 2007, pp.379-395.
- Publisher:
- Cambridge University Press
Using two linked simulation models, we examine the public expenditure costs and distributional effects of potential reforms to long-term care funding in the UK. Changes to the means tests for user contributions to care costs are compared with options for the abolition of these means tests (‘free’ personal care). The latter generally cost more than the former and benefit higher income groups more than those on lower incomes (measuring income in relation to the age-specific income distribution). Reforms to the means tests target benefits towards those on lower incomes. However, the highest income group are net losers if free personal care is financed by a higher tax rate on higher incomes and the effect on the whole population considered.
Paying for long-term care for older people in the UK: modelling the costs and distributional effects of a range of options
- Authors:
- HANCOCK Ruth, et al
- Publisher:
- Personal Social Services Research Unit
- Publication year:
- 2006
- Pagination:
- 115p., bibliog.
- Place of publication:
- Canterbury
How best to finance long-term care has been the subject of considerable recent debate in the UK. The Government established the first Royal Commission in many years, to review the financing of long-term care and to make recommendations about future financing. Its key recommendation was that the nursing and personal care components of the fees of care homes and home-based personal care should be met by the state, without a means test. In England, Wales and Northern Ireland, means-testing has now been removed for nursing but not personal care. Scotland has made both nursing and personal care free of charge. Much of the current debate concerns whether personal care should be made free of charge throughout the UK. There are, however, other ways in which the system for funding long-term care could be reformed. There is a need for a more comprehensive range of options to be considered, informed by the latest policy developments in the UK and drawing on experience in other European countries. The study aims to project expenditure on long term care services for older people under a wide range of options for reforming the current system. It will provide for each option, projections to 2050 of: the total cost of long-term care for older people, in absolute terms and as a proportion of Gross Domestic Product; its breakdown between public and private sources, and within the public sector; how the costs borne by service users vary by the level of their income and wealth; the sensitivity of projections to assumptions about future numbers of older people, dependency levels, costs of formal care, supply of informal care and future demand for formal care.
Older couples and long-term care: the financial implications of one spouse entering private or voluntary residential or nursing home care
- Authors:
- HANCOCK Ruth, WRIGHT Fay
- Journal article citation:
- Ageing and Society, 19(2), March 1999, pp.209-237.
- Publisher:
- Cambridge University Press
A minority of older people who move into long-term institutional care are married and have spouses who continue living in the community. This article uses data from the Family Expenditure Survey on the incomes of older married couples to examine the financial implications for couples of one spouse entering residential or nursing home care, taking into account local authority procedures for assessing residents' contributions to charges and Income Support rules as they apply to both spouse. It looks in particular at the consequences of alternative ways couples might share their incomes, and alternative treatments of such sharing by local authorities and the Department of Social Security.