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Long Term Care / Later Life Planning

Long Term Neglect!

Last year I oversaw an elderly lady’s instatement into a residential care home, post discharge from hospital. This lady had been admitted to hospital three or four times in the previous eighteen months or so, I thought that the Social Services assessment would be a breeze for a registered blind 80 year old lady, with many ailments, including high blood pressure and having suffered two pulmonary embolisms!

I was in for quite a shock.

The assessment that the Occupational Therapist (OT) carried out, in order to assess whether this octogenarian could cook and feed herself, consisted of the OT watching their “client” make a cup of tea! The nursing staff watched the virtually blind patient hobble to the loo during the day. These “thorough assessments” apparently meant that this lady needed no assistance during the day or night, save for the occasional visit from a carer.

What was not accounted for, among many other aspects of the life of this lady, was the fact that the prescription sleeping tablets were causing dizziness at night and—post admission to a care home—four collapses of the somewhat distressed lady later we find ourselves in dispute with both the Social Services and the hospital assessment team. This has been followed up with letters to the relevant Ombudsman about the poor processes that were deployed prior to the discharge from hospital of this particular patient.

It was finally agreed by the local authority that this “client” qualified for care. Great I thought, our troubles are really over, my client would be safely ensconced in the room of her chosen care home, quite happily, for the remainder of her life, in a good community of new friends, close to her local church community who visit her regularly, and with round the clock care and attention.

The client’s flat was sold and the equity release loan that was secured against the property was repaid upon sale. This left a small amount of money in a bank account. A few luxuries could be entered into, we thought. And then the result of the financial means test came through!

The local authority declared a mandatory amount that they were prepared to pay towards the cost of care. There was a shortfall of around £900 per month required to pay for the continued care in the chosen home. The Local Authority then asked the relatives to pay for this top up!

Further disputes have arisen. Ten months later we are no nearer to reaching a conclusion. My client is very worried that she will have to move out of what she considers to be her “home”, which is causing her unnecessary anxiety.

Leaving aside the obvious level of emotion that is involved in this, the thing that strikes me about this issue of long-term care is the legalistic nature of the system. In order to “fight for justice”, I catch myself poring over the rafts of complex legislation and I discover that the Local Authority is, almost certainly, acting illegally in at least one regard. But should we fight upon a basis of legality, for the rights of another?

The Local Authority will probably come back to us with a statement of their legal position. We will counter this, and so the whole process will continue. (I am reliably informed that this might carry on for two, or even three years, until a settlement is arrived at.)

I perceive that our society is so wrapped up in what our “rights” are that we have lost sight and touch with the nature of God’s grace, forgiveness and sensibility when dealing with one another. It is true that society cannot afford to pay for everything, without a significant increase in the various rates of taxation, but there appear to be so many issues surrounding our rights these days and many people demand their rights without a notion as to the economic impact that their demands will have. For every winner there is normally at least one loser.

Rules now abound, where the concept of grace once stood as a cornerstone of our society.

It is distressing to think that when, as a society, we consider the thorny issue of the funding of care provision that we are perhaps veering toward the treating of a person as a commodity that is to be kept in storage. When someone has attained a certain age they are considered to be like a vintage car, old and defunct—an old model—with little use, but occasionally they are polished up and bought out on special occasions, when everyone can murmur about the good old days, and how things used to be and that: “They don’t make em like that anymore.” We will keep these older models for sentimental reasons, but only for as long as is affordable, and for this the state will contribute as little as is possible for the retention of these worn out models.

The government, of various shades of both red and blue, have both ignored the recommendation and findings of various commissions that the provision of care, for the elderly, should be free of charge. If you are fortunate enough to reside north of the border then you will benefit from such a notion of free education, in the formative years of your life, with the addition of your care being paid for by the state toward the end of your existence.

Those of us who live in the rest of these isles will continue to need to save for our retirement, care in our dotage and we will live with a fear that our properties will be swallowed up by an ever increasing care bill that few of us can afford as we live longer.

Figures show that world-wide every tenth person is aged 60 or more. In the UK today there are just 9,800 people who are aged 100 or more. By the year 2050 it is predicted that 95,400 of UK residents will have attained this milestone and will have become centurians.
(Source: Evonik Industries Magazine – 01/2011.)

As the population increases in age, dissent will almost certainly rise amongst the workforce regarding their reducing pensions. The arguments will continue as to who should pay for what, many will demand that their rights and promises of old be honoured, no matter the cost to those who are footing the bill?

New legislation will continue to be refined from time to time. But in the midst of all of the advice that I give regarding what assets can be sold and when; or what equity release loans a client should take out and when; I try to retain a sense of balance and proportionality, by just taking a moment to consider: How would I want to be treated if I were to find myself in the same position?

As an adviser it is my duty, under the regulation, to clearly outline to a client the options that are available to them, and the inherent costs, in a compliant manner. This includes advice upon matters such as: Equity Release and Home Reversion plans; investment contracts that are designed specifically for long term care planning; insurances and plans that will pay for care; annuities that can create an income to meet the rising cost of care. The vast range of products is bewildering and there is a growing need for quality advice within our ageing population. I also ask that the relatives and beneficiaries of my clients who are requiring this level of advice be present at my client meetings (for blood may be thicker than water, but in my experience money is often thicker than blood). But surely this advice should not solely be about compliance and regulations.

As an adviser I have seen my clients go through varying stages when considering the requirements of their care and the provision of such. The biggest hurdle that often needs to be overcome—and it is one that surpasses even that of disposing of valuable material assets such as the family home—is the concept of losing of one’s independence. Perhaps it is best to quote someone who has gone through this process:

Now we come to one of the last gradual slopes in our long journey of learning curves as old age finally catches up with us. Along this part of the climb we are actually going downhill which is normally more taxing than going up…Letting go of things which matter to us is usually painful. Even throwing away a worn out pair of slippers can fill us with regret for a few minutes. The new ones feel so unfamiliar and stiff…As we grow older the occasions for letting go seem to come more frequently and in bigger chunks. Hitherto we have been busy accumulating life’s accessories as well as a good deal of experience and maturity… One particularly deep and jagged edge is the time when we have to let go of our home which is full of poignant memories and results of our scrimping and saving, thinking and planning. We have to summon our courage and look the facts in the face…I must make my own decisions, face the regrets, and the pain and the grief that is involved while I am still able to think coherently about it and manage the upheaval of it all… All of this letting go adds up to the gradual loss of our independence as we grow seriously older. That is often the hardest thing for some of us to accept.
An extract from: “My Swan Song” – a reflection upon life, by the renowned psychotherapist: Myra Chave-Jones. This work is the final book of Myra’s. It was published just prior to her death in late 2010.

Myra illustrates that the role of the adviser must come with grace and understanding of a client’s position. We must—even with the legal knowledge that we possess as advisers, and even within a society that is littered with compliance and regulation, all of which has its place—acknowledge that the final stage of the giving up of our independence is often a painful one. As advisers we need to acknowledge this pain and emotion when advising our clients. After all, would I wish for grace to be a primary concern of any adviser or carer should I reach this position, or is it preferable that advice and care revolve around legalism, with strictures being placed upon discussions about the required funding for my own care? Yes there have to be rules and regulations, but grace should not, in my view, be squeezed out of the picture within a caring and civilised society. All of this talk of rights becomes less significant as we grow older, and perhaps as we grow a little wiser and the hard edges are knocked off and honed. After all, would I really care if a nurse or doctor were to wear a cross around their neck; and should I object if they pin a little silver fish upon their uniform?

Perhaps, when faced with one’s own demise and lessening length of mortality, questions about what comes next, if anything at all, gain greater importance and require more clarity and some answers, over and above that of having to deal with questions about the transitory and material, money and one’s rights. Having a bank of advisers and carers on hand who proffer a viewpoint of hope, rather than one of finality and oblivion, may be of some welcome comfort in our own final few days.

Arwyn Bailey

Arwyn is Managing Director of ‘JustAmo’ financial advisers who specialise in ‘Later Life’ areas of financial planning