New analysis reveals 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. If the person has a need 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.
Authorities tend to offer domiciliary care support, provided by mobile carers visiting people in their own homes, because it is widely thought to be the least expensive option but for many elderly people it is not the best way to meet their care needs and, when all the hidden associated costs are added, it is often not best value for the public purse.
Around 600,000 people in the UK receive home care, with the overwhelming majority being funded by local authorities.
People who have home care 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.
These calculations are based on 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. If the domiciliary care is delivered directly by the local authority then the hourly cost typically is more than double the independent rate.
Ian Smith, Chairman of Four Seasons Health Care, the UK’s largest independent care provider 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.”
It is cheaper for Local Authorities to provide care for elderly people in their own homes because they have responsibility for financing the care support but under the current funding structure most of the other associated social benefits costs come out of central Government budgets.
The “User experience survey” conducted on behalf of the NHS Information Centre showed that more people living in care homes are satisfied with the service they get compared to those who receive domiciliary care. About three quarters (73%) of respondents in residential care were “extremely or very satisfied‟ with their quality of life, compared to 56% who receive home care.
With an overall pattern of tightening eligibility criteria, it is estimated that more than 70% of councils only offer homecare services to those with “substantial” or “critical” needs.
- In England more than 500,000 adults receive home care through their local authority; in Scotland it is more than 63,000; in Northern Ireland more than 24,000 and in Wales over 17,000 (Source: United Kingdom Home Care Assoc compilation 2012)
- The United Kingdom Home Care Association publishes an estimated minimum price for homecare services of £15.19 per hour, which allows compliance with the National Minimum Wage and the delivery of sustainable homecare services to local authorities
- “The average cost of home care was £16.80 per hour. The cost of own provision home care in 2012-13, (£36.90) was higher than that for home care provided by others (£14.90).” Source: Health and Social Care Information Centre, Personal Social Services Expenditure and Unit Costs, England 2012-13. Page 24. Four Seasons Health Care additionally surveyed the hourly rates of a number of domiciliary care providers with a spread from North to South. In some regions rates will differ from this illustration but a 15-20% difference in hourly rates would not dramatically affect the proposition that a few hours in 24 of domiciliary care can cost the public purse as much as around the clock care in a care home.
- Elderly people being cared for in their own home may not eat properly balanced diets; they may have the heating turned off to save money. They may suffer from lack of social contact and interaction. In a care home they would have 24 hour care with nurses on hand; meals to meet their nutritional requirements; planned activities to stimulate them physically and mentally and social interaction. They would also have security with no worries about domestic bills.
Cost of Care illustrative calculations
Rates may vary across regions
Base Case: £/week
Care home: LA Nursing Rate 583.6(*1)
Benefits for person living at home:
State Pension 113.10 (*2)
Attendance Allowance 54.45 (*3)
Personal Expenses 23.75 (*4)
Base case care spend 392.30
(The amount available for care services to the point where care at home costs as much as a care home place)
Home Care costs
Cost of Care Per Hour 14.90 (*5)
Hours of care available per week 26
Hours of domiciliary care available per day 3.76