Dr Max Pemberton
WHEN my grandfather developed dementia, my grandmother was adamant that he wouldn’t go into a home. nan’s reason was simple. She didn’t want to have to sell the house they had scrimped and saved to buy to pay for nursing care. They were from workingclass backgrounds and their home was their only real asset, which they were determined to pass on to their family.
Even when nan began to show signs of dementia herself, she insisted on continuing to care for my grandfather at home. Then my grandfather died and she was diagnosed with cancer.
Despite our pleas, she remained adamant that she wanted to stay at home until, increasingly frail and confused, she fell and broke her pelvis. She spent her final few weeks in a care home worrying that her house would be sold to pay for her care and berating herself for becoming so frail. not the peaceful ending we had wished for.
In the end, nan didn’t have to sell her house, as she didn’t live long enough. But when I worked with dementia patients, I met countless sufferers who were forced to sell up. It seems grossly unfair that not only do so many dementia sufferers — generally those with assets of more than £23,250 — have to fund their own care, but they are often charged more than those without any assets whose fees are paid by the council.
Other arbitrary factors such as where you live or whether you have other health problems may determine whether you are required to pay for care or not, which is why I wholeheartedly support the Mail’s campaign for a fairer deal for dementia sufferers.
The present system is in crisis. For many old people unable to live independently, the founding principle of the nHS — that care is free at the point of access — has largely been abandoned.
To understand what’s gone wrong we must look back to 1948.
The Labour government wanted to create the kind of care for older r people that was previously the preserve of the rich. Before state provision, the wealthy who were tired of looking after themselves, but who had no serious medical l problems, often moved into hotels, with private nurses if needed. The majority, however, lived at home with only basic care provided by family members or were at the mercy of charitable institutions. The 1946 nHS Act and the 1948 national Assistance Act promised these inequalities would be swept away. Unintentionally, they created two parallel systems: free medical health care for everyone and a supplementary system provided by local authorities for those in need of ‘care and attention’. The latter system was intended for elderly people who wanted to be looked after in ‘ hotel- like’ accommodation and was therefore means-tested. It was never meant to accommodate those who were infirm or ill, who would be cared for by the nHS.
These well-meaning pieces of legislation unfortunately left a grey area that subsequent governments have exploited. By dividing medical care and personal care, an artificial line was drawn that has been slowly shifted over the past few decades as nHS trusts desperately try to cut down on their expenditure. For instance, so someone who has dementia or suffered a stroke and re requires help with washing an and dressing is now assessed as needing personal care, wh which is means- tested, de despite the fact they clearly hav have a medical problem. B But if a patient also has an ong ongoing medical need, they ma may be eligible for long-term nHS nH care, in which case they won’t have to pay a penny. (Ironically, given her fears, this is the situation my grandmother was in, because she had cancer as well dementia, so she wouldn’t have had to sell her home.) Hence we now have an absurd lottery where some elderly people are forced to pay for care while others receive it free depending on whether they are judged to need medical or ‘personal’ care. A Mail poll has shown that a shocking one-in-three dementia sufferers now has to sell their home. An overhaul of this desperately unfair system is long overdue.