Paying for Care

Key Points

Many people believe that social care is paid for through public agencies on a similar basis as the NHS and that their taxes and national insurance contributions go to achieve this (Citizens Advice Wales 2016). They are horrified when they are confronted with the reality that social care is chargeable and means tested and has been for more than 50 years. Despite the attention given to this issue there is still misunderstanding and confusion about social care as a chargeable service and its relationship to NHS Funded Nursing Care and Continuing Health Care. This must not continue. Absolute clarity is needed to enable people to plan effectively for their long -term care.

Successive Governments have failed to address this issue and although Commissions, Green Papers etc have offered a number of different solutions these have been “pushed into the long grass” because of the high costs whilst older people and their families have faced increasing costs and uncertainty. Whilst the increase in the Capital Limit in Wales is welcomed, this only impacts at the margins of the debate. A radical and sustainable long-term solution is needed.

There is a tangible injustice in the care system for people with dementia – the Dementia Tax. Dementia is currently a condition with no cure and people who develop it receive most of their support from the social care system, not the NHS. They therefore become liable to significant levels of charging for care over a number of years. For many other long-term health conditions, such as cancer and heart disease, medical treatments are available for free on the NHS.

It should not be the case that because you develop one condition such as dementia over another, you can be left facing care costs of £100,000s. Andrew Dilnot described the means testing of social care as “the most pernicious means-test in the whole of the British welfare state”. We want this issue to be dealt with equitably and fairly.

There is evidence that self-funders in care homes are cross subsidising council funded residents (Commissioner for Older People 2018) by £100s a week because austerity and pressures on council budgets. This cannot be allowed to continue.

Reports from the Commissioner for Older People suggest that the quality of care and life in a care home is at best variable and the high standards of the best are not being achieved by the majority. We support the recommendations made by the Commissioner for Older People in her 2014 and 2018 Reports on Care Homes.

The lack of funding resulting in unsustainably low levels of fees paid to care homes by Councils is one of the major contributory factors to levels of quality in care homes. The Competition and Marketing Authority has said (2018) “The current model of service provision cannot be sustained without additional public funding” We support that position

There is increasing evidence that the Statutory Code of Practice on Top Up Fees for Care Homes is not being applied consistently (Age Cymru 2018) and some families are being asked to unfairly pay significant sums for their relative’s care. The Code of Practice must be followed by all Councils consistently and families dealt with fairly and in a way that is equitable and legal.

The requirement for some older people to sell their family home to move into care is a huge blow to older people. The introduction of a new statutory Deferred Payments Scheme in 2016 was meant to provide a solution so that their care costs are dealt with as part of their Estate. Awareness of this facility and its conditions needs to be improved and all Councils and other interests should promote it consistently when people are considering moving into a care home.

The Guidance on Continuing Health Care (CHC) and the rules on who qualifies and in what circumstances is complex and “professionalised” in a way that makes it almost impossible for older people and their families to understand. A simpler and more transparent system of assessment and qualification for CHC is needed. that avoids the current “cliff edge” consequences for people.

What Do Cymru Older People’s Alliance Want?

We want robust and radical change to the Paying for Care arrangements so that they are based on key principles of equity and fairness and alignment with NHS and Housing arrangements and so that age discrimination in the provision of care and support is ended. No more prevarication.

We have adopted an approach of agreed principles and outcomes for older people rather than trying to “back” any one of the Paying for Care models that have been mooted. This will provide a stronger basis for representing older people’s interests. These are:


  • A shared risk across society
  • a long-term sustainable solution;
  • Arrangements founded on key principles of equity and fairness, regardless of condition or assessment;
  • Arrangements which are transparent and simple to understand and implement;
  • Removal of “cliff edges” due to different eligibility criteria i.e. for
  • Continuing Health Care;
  • End self-funders in care homes cross-subsidising council funded residents.


  • A collective societal responsibility for paying for care, with responsibility for paying shifting from the individual to society
  • There is enough money in the system to ensure high quality for all and appropriate prevention, early intervention, re-ablement and care;
  • All components of the care and support system are adequately funded to produce high quality outcomes for all older people, irrespective of how much they have paid;
  • Quality of life in care homes and through care at home is supported by sustainable levels of funding;
  • People are able to plan for their long-term care;
  • Services are person-centred;
  • Older people and their representatives co-produce the new policy from the earliest stage;
  • Reforming the arrangements for Paying for Care will clearly involve a great deal of work on the details but COPA believe that any “model” proposed must be assessed and validated against the “principles and outcomes” based approach described above.

Any major change to the Paying for Care arrangements will obviously take time to introduce so we want interim measures to improve fairness of paying for care introduced. The Welsh Government’s powers in the Social Services and Well-being Act 2014 on charging for care should be utilised for this purpose. We want a clear and transparent timetable with commitment to action from the earliest possible date to be agreed on an all-party basis and that older people’s representatives should be involved in the debate from the outset.

Approved by COPA Board March 2021

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