The Care Conundrum

"The issue of funding for adult social care has been ignored for too long. We should be celebrating the fact we are living longer. But instead we talk about the ‘burden of ageing’ and individuals are living in fear, worrying about meeting their care costs."
Andrew Dilnot, July 2011

Andrew Dilnot hit the nail on the head with this statement when he delivered the Commission on Funding of Care and Support. Rather than seeing our increased longevity as a positive consequence of modern life, there is a current tendency to focus on the negative. Living longer does indeed mean that more of us may need to access elderly care in some shape or form, but assessing the options available at an early stage can place a positive, conscious spin on a subject often mired in misery.

However the vast differences in the costs and types of appropriate care available can be overwhelming, even when thinking hypothetically. We all know that it makes sense for us to consider our preferred options at an early stage.  However, the wealth of information out there, designed with good intentions to educate and inform, can actually cause more confusion and give us the perfect excuse to put off making any plans. 

Exploring all of the care options available and understanding what funding will be required is always best tackled when in a position of good mental and physical health.  The alternative is delaying until you actually need to access care, a time when you’re likely to be in a stressful or vulnerable situation – hardly the best circumstances for you, or your family members, to make a well informed decision in.

Type of care available

Domiciliary Care
More commonly known as 'care in the home', this option allows you to stay in your home while accessing whatever level of support you need. Carers can provide a range of services according to your needs, from short weekly visits to assist with shopping or general admin, or more frequent visits to help with personal care.  It can even extend right through to full-time, live-in care or medical assistance, in agreement with medical professionals. 

There are as many different caring arrangements as there are domestic circumstances, and this flexibility is one of the upsides to domiciliary care – you can tailor help to suit your needs, adding or reducing as necessary.  For some, this could be considered the most desirable form of elderly care, as it allows you to continue living independently in your own home for longer than you might have expected to otherwise, keeping you in touch with your existing network and community.  It also could allow couples to continue living together at home, rather than become separated if one moves to a care home.

This flexibility means that costs can vary enormously too, depending on how much support you might need to access.  Domiciliary care can be expensive, however can also prove cost effective in some circumstances, for example if there are two of you benefiting from it.

Sheltered accommodation
Sheltered accommodation is specifically designed and built to suit the needs of older residents.  It is usually made up of 20-40 self-contained flats or bungalows on a single site, all with their own front door, which allow residents to come and go as they please.  However, sheltered accommodation schemes offer additional support for residents, which could take the form of a dedicated warden who arranges maintenance, repairs and ensures all communal areas are kept clean.  Some may have round-the-clock alarm services which allow residents to call for assistance if required, or even organise regular communal social events such as bingo, excursions or quizzes.

All sheltered accommodation schemes vary slightly and they can be bought or rented either privately or, if eligible, rented via local authority housing schemes.

Most sheltered accommodation does not offer personal care on-site, but there are some extra care housing schemes which allow residents to access on-site assistance with bathing, dressing, housework and some other forms of personal care.

Care homes
When the mainstream media talks about the high costs of elderly care, it is quite often care homes that they are referring to – and with good reason.  The term ‘care homes’ actually refers to two different types of provision:  residential care homes that provide accommodation, meals and assistance with personal care and nursing homes that also provide nursing care on top.  Both types provide round-the-clock care for those unable to live independently and as such, can be very costly. 

Research undertaken in 2016 shows that care home fees vary widely across the UK, but the average weekly cost of a room in a residential home was £600, and a room in a nursing home cost £726. These figures can rise further if additional support is required, such as specialised dementia care for example.

Care homes provide safety and assurance that individuals will receive 24/7 care, and can also provide companionship for those who might otherwise have lived alone. However, even leaving the high costs to one side, there are other drawbacks.  Care home residents can experience feelings of isolation or upset at the loss of their independence, and their families can also struggle with guilt at not being able to provide suitable care themselves. There is also a wide variety in the quality of care homes, making a decision on which best suits your needs even more challenging.


Funding appropriate elderly care

Financing any of these options requires research, time and planning.  It is always worth exploring what benefits or assistance you might be eligible for by way of a care needs assessment, which your local authority can arrange.

This assessment will generate:

  • A Care Plan, which makes recommendations about your needs,
  • A Personal Budget, which calculates how much it will cost.

You will also be means-tested to assess how much you will need to contribute towards your care. This will take into account all your savings and assets, and will determine whether you are eligible for any local authority assistance.  At the time of publication, if you live in England or Northern Ireland and have more than £23,250 in capital, you would be eligible to pay the full costs of any elderly care. Beneath this threshold there is local authority assistance available, although the amount will vary according to any other income you may have.

It’s impossible to see into the future and truly understand what level of financing you will need. However, having a financial plan in place may give you the luxury of choice when making decisions around the type of care you can access, rather than having a limited pool of options to draw upon.

If you own your own home, you may have seen its value rise in recent years.  It could be wise to consider this asset in your elderly care planning.  You have worked hard for your home and it could carry on working for you.   

As a homeowner, you have the option of downsizing to a smaller and cheaper property, which could free up some cash for your care needs later.  This would however mean moving from a home, and potentially an area, you are familiar with and have built up networks within. 

There’s also the option of releasing equity from your home with a lifetime mortgage, which lets you access some of your property’s value as cash. It can allow you to remain in your home and access domiciliary care there if you wish, or use the money for other purposes.  Lifetime mortgages are only repayable when you die or move into long-term care, and there are no monthly payments to make.  This does mean that interest builds up and the debt can grow quickly.


Whichever care option you consider, and whatever plans you make to access it, at a minimum you should speak with your family members or close friends.  Making them aware of your preferences at an early stage can ease stress for all parties later and make you more likely to end up accessing the type of care that’s right for you and your circumstances.