Caroline Abrahams: Carers need a combination of support to fulfil their vital role – here’s how the Government can play its part

12 Mar

Caroline Abrahams is the Charity Director at Age UK.

In the week during which International Women’s Day falls I want to focus on an experience which, if not quite universal among older women, is extremely common, and that’s of being a carer. By this I mean taking on the role of looking after someone else, typically a partner or parent, on an unpaid basis. Some people are carers over a lifetime for their adult children with learning disabilities, while others, so called “sandwich carers”, find themselves caring both for younger and older relatives at the same time – an onerous responsibility indeed.

I am a carer myself, for my 92-year-old mum, who was fit and well until she had a tragic accident four years ago, robbing her of most of her mental capacity in an instant and making her dependent on others for all activities of daily living. I am now doing the “hardest yards” of caring, helping to care for her as she approaches the very end of her life. Like so many others, my caring role will come to an end when the person I am caring for dies. Then I will have to rebuild my life again.

I didn’t become a carer for my mum from a sense of duty, less still because of exhortations from some policymakers that “families must do more”, but because of a feeling of reciprocity. We have been the best of friends and my mum would have done anything to help me, whatever it took. Therefore, I wished and wish to do the same. It has been an amazing experience, one I took on willingly and with no regrets.

But I would also be the first to say that despite the tragedy that befell my mum I have been immensely fortunate to have been able to make the system work for her and for me, since I knew my way around it owing to my professional role. I have also been able to combine my caring responsibilities with continuing to work, because Age UK has been a marvellously sympathetic and flexible employer. Most people are not nearly so lucky in either respect.

What would most help older women, and men too, who care? Not one thing but a whole raft of measures. Above all a properly funded and effective system of social care would back up what unpaid carers do and make caring a less scary and lonely experience. I am thinking especially here of the legions of older people who care for a partner with dementia; something that is both extremely challenging and also often very isolating for them. Too many are left without the support they need, in the most heart-breaking of circumstances.

As Danny Kruger has observed in his recent report on the future of social care, produced with Demos, many people who need care get it from a combination of informal, unpaid support from family and sometimes friends, plus the input of formal care services. This is important because the debate about the future of social care often erroneously assumes it’s one or the other. This reality, that it’s both, reinforces the importance of formal services wanting and being able to work collaboratively with unpaid carers. From what we hear at Age UK, sometimes this happens but not always.

The same is also true of the local NHS. The vast majority of older people with care needs also have health needs, so if you are a carer for an older person you are highly likely to find yourself interacting extensively with GPs and their teams and district nurses and the like. Some health professionals are great at working with unpaid carers, but it’s not a given.

A more collaborative, properly funded approach between formal services and unpaid carers would also remove a disincentive to informal caring: that is the sadly legitimate fear that if you take on a caring responsibility you will be “dumped on” and formal services will back off, leaving you to it. We hear many examples of this at Age UK and while its wrong that it happens it is scarcely surprising, given that social services are stretched beyond endurance in trying to reach all those in need.

What I have just described is a form of “rationing” by formal services, something that manifestly happens in many other ways within social care too. Access to state-funded help with care is invariably a tortuous process, requiring resilience and staying power – often from the unpaid carer if the person needing care is unable to advocate for themselves, as was the case with my mum. Both NHS continuing healthcare and council care are underfunded and when applying for them it is not unusual to encounter barriers that may or may not seem fair or based in law – with few apparent opportunities to challenge them. This piles huge additional stress onto carers.

The fact is that the decisions about social care, or lack of them, in Whitehall eventually result in unpaid carers as well as the people for whom they are trying to do their best losing out financially as well as in terms of the quality of life they are able to lead while caring. The financial hit on unpaid carers who give up work to care is huge, often condemning older women to penny pinching in retirement. Capping very high care costs would help, but for full-time unpaid carers not enough on its own: the benefits paid for caring must go up too. They are currently below those for the unemployed – a travesty.

Then there’s flexible working. It is invariably in the best interests of a carer to stay in employment, both in terms of their quality of life and their finances. For older women like me, once caring ends you may be unable to get another job, leaving you in a real financial mess if you gave up work to care. The pandemic has seen a sea-change in attitudes towards and experiences of working from home and other forms of flexible working. I would like the Government to solidify this cultural change through amending the law to increase access to flexible working, from day one in a job.

When he entered office the Prime Minister promised to “fix social care” and he has repeated that pledge many times since. I sincerely hope we will see his promise bearing fruit later in the year and, if and when it does, that it fully factors in the need to support our carers, including our older women carers. And I believe most readers of this and other articles on ConHome would say they – we – deserve it.

Julian Brazier: A single allowance rate for Inheritance Tax – and five other proposals for making social care more resilient

23 Jan

Sir Julian Brazier is a former Defence Minister, and was MP for Canterbury from 1987-2017.

A great deal is currently being written about resilience – normally an underrated subject in politics. Building resilience should not just be about considering major national or global crises, but also involve asking questions about the likelihood of – and the solutions to – more frequent and more local crises. These range from NHS winter pressures to power cuts to cyber and terrorist attacks.

At the same time, there is an overwhelming view today that social care needs urgent reform and greater intervention from government. Yet there seems to be little appetite for considering these two great issues together:  the care of the elderly and its implications for national and local resilience.

This article seeks to show that incentives in current provision, for social care, benefits and tax, are reducing resilience. Some of the current proposals for social care ‘reform’ would worsen this.

The largest category of vulnerable people are those elderly people who cannot live without supporting care. Their domestic circumstances can be divided into four broad categories, listed in descending order of independence:

  • Those still in their original homes (whether owned or rented) with visiting carers,
  • the growing category of those in specially adapted sheltered accommodation
  • those living with family, in so called ‘inter-generational’ arrangements and, finally,
  • those in residential care.

How do these categories measure up for resilience?

At first sight, the least resilient group are those people living in their own, unmodified homes; they are reliant on visiting carers, who may not be able – or willing – to come in a crisis. They are also more likely to fall over or have an episode isolated in surroundings which have not been adapted, are most vulnerable in power cuts, for the same reason, and – crucially – they are often difficult to discharge from hospital.

But there are serious problems with the fourth category too. We have seen the problems with care homes in a pandemic. With their communal eating and recreation facilities, such homes have proved principal vectors of disease.

Equally, they have become a major cause of bed blocking, once the dangers of releasing patients to them was recognised. Britain’s higher-than-European-average concentration of people in residential homes has worsened our death rates and increased pressures on the NHS.

As Conservatives, we should also be concerned that residential care is not only the most expensive arrangement (whoever is picking up the bill). It also, for those fit enough to choose, offers the least independence.

This brings us to the two middle categories above.

Dwelling in adapted accommodation and living with younger family members are both comparatively resilient arrangements, and both are much less expensive than residential care.

They also have other features most Conservatives approve of. They offer a degree of independence absent in residential homes. There is also the potential for free childcare in inter-generational arrangements, or where nearby retirement accommodation has been chosen. Both categories offer an antidote to the loneliness of those still stranded with limited mobility in their original homes.

Any new system which aims to promote resilience should direct incentives towards rewarding, rather than penalising, these two middle categories: those who step down to retirement accommodation and those cared for by their descendants. That is how resilience is maximised.

Yet this is far from the case at present. Our commitment to ring-fencing the principal home for tax and benefit calculation purposes is a great policy, but one which has perverse unintended consequences when applied to transfers between generations. The state ends up penalising the heirs of those who aim for resilience, and rewarding many of those whose parents become most dependent.

For example, if an elderly person struggles on in their own home without much money, the state picks up the bill for their carers, and the potential strain on the NHS is maximised. Yet, if they own that home, their heirs will maximise the windfall when they die, compared to the alternatives. This has been exacerbated by the George Osborne tax break on Inheritance Tax, which greatly increases the exempt allowance, if and only if the inheritance is tied up in bricks and mortar.

On the other hand, suppose the same old person were to sell and move into purpose-built sheltered accommodation. They are less likely to have accidents where design has the frail in mind – and easier to release from hospital especially if there is warden assistance or such accommodation was selected to be close to relatives. Such people are also much less at risk in times of crisis – overall, a resilient arrangement.

Yet, from the point of view of their heirs, their estate diminishes, as the cash released from sale of the home is used to pay carers and service fees. If the original home was worth more than half a million pounds, thanks to the Osborne inheritance tax break, the heirs also face paying more tax than if the parent had soldiered on in the original house.

Similar points can be made about the position of families who look after elderly relatives at home, who have sold or moved out of their own houses. The one incentive such families currently get from the system for providing their loving care (and potentially relieving the state) is the carers’ allowance. Yet it is rumoured that there is a plan afoot to means test that. So, if the arriving parent or relative owns the proceeds of selling a property, that allowance would be lost.

It is time we built the promotion of resilience into our design of social care. My proposals are as follows:

  1. Abolish the Osborne bricks and mortar tax break by re-establishing a single allowance rate for Inheritance Tax.
  2. Extend that principle across the range of tax and benefit policies for the elderly to ensure that there is no financial incentive for potential recipients of inheritances to encourage their parents/relatives to stay in their homes, if they wish to move.
  3. Keep the carer’s allowance universal, so that those caring for relatives at home or in nearby accommodation can continue to draw it.
  4. Resist lobbying from the care sector and residents’ heirs for the taxpayer to take on more of the cost of residential fees to protect inheritances. Despite the political clamour, such proposals would be paid in part from by the taxes of those who are looking after relatives either at home or in neighbouring accommodation. That would doubly incentivise more people to move into residential homes, further increasing cost and – critically – still further reducing national resilience.
  5. Offer tax incentives to the elderly to move out of family homes into sheltered accommodation, including a permanent end to stamp duty on such properties. (Ironically, many councils pay ‘key money’ to release family accommodation but there is no scheme for owner occupiers). Gareth Lyon’s excellent article on this site pointed out how small this sector still is compared with Australia and new Zealand.

Shakespeare’s adage “sorrows … come not as single spies, but in battalions” is apt in the era of globalisation.  We simply do not know what shocks and challenges are just ahead. We must recognise that how we structure social care – and the associated tax and benefit framework for the elderly and their heirs – has profound consequences for resilience in major crises. It is also important for services under pressure in ‘peacetime’.