Is it just me…?

Editor, Emma Morriss examines Four Seasons’ research that residential care can be more cost-effective than homecare for those with high-level needs and asks if silo-thinking will ever stop.

I read with interest, this week, a release from Four Seasons Health Care in which they had analysed the cost of homecare versus residential care for individuals being supported by local authorities. The analysis revealed that, ‘Providing just a few hours of care visits a day for elderly people in their own homes may be costing the taxpayer more than it would to provide around the clock care in a care home.’ It goes on to say that, ‘If the person has a requirement for more complex nursing care needs or they are receiving supplementary social benefits on top of basic State Pension and Attendance Allowance, then less than two hours of domiciliary care every 24 hours could cost the public purse more than a full-time care home place.’

According to GMB research also out this week, the amount local authorities pay for residential care varies from £326.45 to £597.87 depending on the local authority in question. Domiciliary care costs, according to the same GMB report, vary from £7.88 per hour to £24.00 per hour, with an average of £13.59. Looking at these figures the cost of, say, three hours a day, over the course of a week is less than the lowest residential care fees paid in the GMB report. However, that’s just looking at the costs to the average social care budget. What Four Seasons is factoring in, is the cost to the overall public purse when considering State Pension, Pension Credit, Attendance Allowance, Housing Benefit and the personal expense allowance, which come from the Central Government budget.

Four Seasons explained, ‘People who have homecare funded by local authorities and who are receiving basic State Pension and Attendance Allowance need only require a carer in their home for a total of about three and three quarter hours out of every 24 hours for the total cost to the taxpayer to be comparable or more expensive than it is to provide around the clock care in a care home.

‘If the person is receiving more complex nursing care or receiving additional social support such as Pension Credit and Housing Benefit then providing between one and three quarter and two hours of domiciliary care every day is likely to cost the taxpayer as much as it would to provide a care home place. When a high level of care is required, the care home will almost invariably be a more cost-effective and much safer option.’

The Four Seasons calculations are based on slightly different numbers to those I’ve used above but they still come to the same conclusion. Their figures show, ‘Typical costs of nursing care in an independent sector care home of circa £583 and typical costs of independent sector domiciliary care of circa £14.90 per hour.’

Obviously, by looking at just the social care budgets, it is cheaper for local authorities to provide care at home, but by factoring in the implications on the wider Government budget, there must be other considerations. Those specialist providers out there will identify the parallels between this and some of the reported early drivers towards supported living – where supported living was deemed to be cheaper than residential care, due to the reduced social care costs, however the other costs were just passed on to other departments. It feels as though we’re still unable to move beyond the silo-thinking of, ‘This is my budget and any impact on other budgets isn’t my issue’. With a drive to integrated health and social care and the combined Better Care Fund, surely this type of thinking isn’t helping progress?

And, of course, choice has to be a main consideration too. Ian Smith, Chairman of Four Seasons said, ‘People should be supported to live in their own home provided it is what they want and in their best interests. But the decision should not be driven by ideology or financial considerations, rather there should be an informed choice that includes understanding the real costs involved.
For this to happen requires a more joined-up approach to health and social care funding.’

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