MAP2030 WP5 WORKSHOP FUNDING LONG-TERM CARE FUNDING LONG-TERM CAREAND DESIGN OF PSSRU MODEL PSSRU 7 MAY 2007

LONG-TERM CARE Informal care and formal services Social care, health, housing and other services Home-based and residential care

MIXED ECONOMY OF SUPPLY Informal unpaid carers Public sector Private for-profit sector Voluntary sector

MIXED ECONOMY OF FINANCE HEALTH SERVICES – NATIONAL HEALTH SERVICE - TAXATION SOCIAL SERVICES – CENTRAL AND LOCAL TAXATION AND USER CHARGES DISABILITY BENEFITS - SOCIAL SECURITY SYSTEM - TAXATION

CHARGES FOR RESIDENTIAL CARE: NATIONAL SYSTEM Assets above £21,500 - ineligible for local authority funded care, but nhs funds nursing care Value of person’s home taken into account unless occupied by partner Almost all income taken into account, except personal expenses allowance and savings credit (up to limit) Disability benefits not paid to publicly funded residents after 4 weeks

CHARGES FOR HOME CARE: WIDE LOCAL DISCRETION Capital limit (if any) must be as generous as for residential care Value of home always disregarded Income below buffer, set at 125% of pension credit guarantee, disregarded Savings credit disregarded If disability benefits taken into account, amount for disability-related expenditure must be disregarded Weekly maxima may be set

POLICY DEBATE Royal Commission recommended free personal care (1999) Government introduced free nursing care but not free personal care in England (2002) Scottish Executive introduced free personal care for older people (2002) Wanless Review recommended partnership scheme, with no means-test (2006) Joseph Rowntree Foundation recommended reforms to the means-test (2006)

AIMS OF PSSRU STUDY The PSSRU model aims to make projections of: Numbers of disabled older people Long-term care services and disability benefits Long-term care expenditure: public and private Social care workforce

SERVICES AND BENEFITS Residential care – in residential homes, nursing homes and hospitals Home care, day care, meals Day hospital, community nursing, chiropody Assessment and care management Disability benefits

NUMBERS OF DISABLED OLDER PEOPLE Age (five bands) and gender Disability (six groups- IADLs and ADLs) Marital status (two categories) Household composition (five categories) Housing tenure (two categories) Informal care (by spouse, adult children, others)

AGE AND GENDER ONS/GAD projections by age (5 age bands) and gender Variant ONS/GAD projections can be tested in sensitivity analysis Link with WP1

DISABILITY Six disability categories defined in terms of ability to perform IADLs and ADLs People in care homes included in the highest disability category Disability treated as function of age and gender Disability rates from 2001 GHS and care home rates from DH data/estimates Different scenarios around trends in disability tested in scenarios Link with WP2 Popsim model

MARITAL STATUS Two categories –married/cohabiting and never married/widowed/divorced/separated Marital status treated as function of age and gender but not of disability Marital status rates from ONS (Census for care home residents) Trends in marital status from GAD 2003 marital status and cohabitation projections Link with WP3

HOUSEHOLD COMPOSITION Single people divided into living alone, with children, and with others Married/cohabiting people divided into living with partner only and living with partner and others Household composition treated as function of age, gender, marital status, disability Household composition rates from 2001 GHS (PSSRU surveys for care home residents) Link with WP3

HOUSING TENURE Two categories – owning (including with mortgage) and other Tenure treated as function of age, gender and marital status Tenure rates from 2001 FRS (PSSRU surveys for care home residents) Projected trends in tenure from Caresim

RESIDENTIAL CARE Three types of residential settings – residential homes (local authority and independent), nursing homes and hospital Residential rates treated as function of age, gender, disability (highest category), household composition and housing tenure Rates estimated for base year, using DH data and PSSRU surveys) applied to projection years Shifts between residential care and home care examined in scenarios

INFORMAL CARE Informal care by source – spouse, children and others Informal care ‘assigned’ only for disabled people in the community Informal care rates treated as function of age, gender, disability, marital status/household composition and housing tenure Informal care data from 2001 GHS Shifts between formal and informal care examined in scenarios Link with WP4