Older people's care needs a major overhaul
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《英国医生杂志》
The Joseph Rowntree Foundation, a UK based social policy research body and think tank, has called for a major rethink of the way Britain funds long term care for its booming elderly population, warning that the existing system is unfair, inconsistent, and unsustainable.
A discussion paper commissioned by the foundation warns that Britain is ignoring a looming care funding crisis and its working generations are failing to plan for the cost of living longer.
"With the number of over 80s set to double in the next 30 years, people of all ages need reassurance that they will be able to get good quality care when they need it and will not have to impoverish themselves in the process," said Donald Hirsch, special advisor to the foundation and author of the paper.
"In the next 50 years we will have to spend about four times as much in real terms on long term care as we do now," Mr Hirsch said. "If we keep our present system of public funding, most of the increase will fall on individuals, many of whom will find it difficult to pay."
Christopher Kelly, a former permanent secretary at the Department of Health, who chairs the foundation抯 long term care advisory group, said, "As with pensions, if we delay for too long in confronting the realities of an ageing population, it will become much more painful to make the necessary changes than if we act now."
The paper says that previous attempts to improve the funding system for long term care have been inadequate and that the way funds are allocated remains deeply flawed. For example, some people with dementia do not qualify for government funded care because they do not need nursing care. Others have to sell their homes or contribute all but ?8.80 ($33.92; �27.96) a week of their pensions towards long term care costs before receiving any local authority support.
Although a Royal Commission report (BMJ 1999;318:622) recommended that personal (rather than nursing) care should be available for free, this has only been taken up in Scotland not in England and Wales.
Drawing inspiration from systems in place in Germany and Japan, the paper says that existing funds could be distributed more fairly by assessing the overall cost of care rather than the type of disability of a patient.
To cover the predicted quadrupling in long term care costs in the next 50 years, Britain should consider all realistic cost sharing options, such as offering public back-up to encourage private insurance programmes, the paper concludes.
Care organisations have welcomed the report. Gordon Lishman, director general of Age Concern, said that the government could not afford to "bury its head in the sand on the care crisis" any longer.
"Help the Aged would welcome more practical thought about how care costs can be met through general taxation while encouraging younger generations to save for their care in older age," said Jonathan Ellis, policy manager for Help the Aged.
"But, more urgently, the government must first get its own house in order with regards to how care costs are met. Investing in adult social care and providing better choice for older people as consumers of care, regardless of their income or postcode, will ensure a fairer system for all."
The Department of Health welcomed the discussion paper saying that it was "timely" as the government is currently consulting stakeholders and the public about what they want from community health and social care services in preparation for the white paper Your Health, Your Care, Your Say.(London Sophie Arie)
A discussion paper commissioned by the foundation warns that Britain is ignoring a looming care funding crisis and its working generations are failing to plan for the cost of living longer.
"With the number of over 80s set to double in the next 30 years, people of all ages need reassurance that they will be able to get good quality care when they need it and will not have to impoverish themselves in the process," said Donald Hirsch, special advisor to the foundation and author of the paper.
"In the next 50 years we will have to spend about four times as much in real terms on long term care as we do now," Mr Hirsch said. "If we keep our present system of public funding, most of the increase will fall on individuals, many of whom will find it difficult to pay."
Christopher Kelly, a former permanent secretary at the Department of Health, who chairs the foundation抯 long term care advisory group, said, "As with pensions, if we delay for too long in confronting the realities of an ageing population, it will become much more painful to make the necessary changes than if we act now."
The paper says that previous attempts to improve the funding system for long term care have been inadequate and that the way funds are allocated remains deeply flawed. For example, some people with dementia do not qualify for government funded care because they do not need nursing care. Others have to sell their homes or contribute all but ?8.80 ($33.92; �27.96) a week of their pensions towards long term care costs before receiving any local authority support.
Although a Royal Commission report (BMJ 1999;318:622) recommended that personal (rather than nursing) care should be available for free, this has only been taken up in Scotland not in England and Wales.
Drawing inspiration from systems in place in Germany and Japan, the paper says that existing funds could be distributed more fairly by assessing the overall cost of care rather than the type of disability of a patient.
To cover the predicted quadrupling in long term care costs in the next 50 years, Britain should consider all realistic cost sharing options, such as offering public back-up to encourage private insurance programmes, the paper concludes.
Care organisations have welcomed the report. Gordon Lishman, director general of Age Concern, said that the government could not afford to "bury its head in the sand on the care crisis" any longer.
"Help the Aged would welcome more practical thought about how care costs can be met through general taxation while encouraging younger generations to save for their care in older age," said Jonathan Ellis, policy manager for Help the Aged.
"But, more urgently, the government must first get its own house in order with regards to how care costs are met. Investing in adult social care and providing better choice for older people as consumers of care, regardless of their income or postcode, will ensure a fairer system for all."
The Department of Health welcomed the discussion paper saying that it was "timely" as the government is currently consulting stakeholders and the public about what they want from community health and social care services in preparation for the white paper Your Health, Your Care, Your Say.(London Sophie Arie)