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What is long-term care?
Long-term care is split between a range of organisations
Long-term care covers everything from residential and nursing homes to home care.

It is provided by a range of different organisations, including local authorities, the NHS and private and voluntary organisations.

Most people have no idea how the complex web works and prefer to turn a blind eye until they come face to face with it when they or a relative needs help.

They may not then be in the best position to make a decision on what to do.

This is a guide to how the system currently works.

Home care

Home care services include meals on wheels, respite care, community nursing and day care centres.

Local authorities provide 60% of publicly-funded home care help, compared with the NHS which funds the rest.

Private and voluntary organisations can be contracted by local authorities to provide support, such as meals on wheels services and respite care, on their behalf.

NHS care, which includes home adaptations and community nursing services such as chiropody, are free.

Local authorities can charge for services and are increasingly doing so because of budget cutbacks.

Since April 1993, social services have increasingly being targeting the most frail, providing more services for fewer people.

According to the King's Fund, 75% of home care is now provided to people over 75.

Local authorities also provide grants for hom adaptations and aids.

Carers, who are relatives or friends, also provide support to people living at home on a voluntary basis.

The government has recently published the first National Carers' Strategy which includes extra funding for respite care to give carers a break.

Residential and nursing care

There has been a big fall in the number of places in local authority residential care homes since the introduction of legislation to encourage them to contract services to private and voluntary sector homes.

In 1984, there were 137,200 local authority places, but by 1998 there were just 64,100.

Local authorities must first assess elderly people's care needs to see if they qualify for a place in a residential care home.

The cost of care homes varies across the country.

Under means-testing, residents with more than 16,000 in capital must pay the full costs of care home places.

People with between 10,000 and 16,000 get some help from the state to pay for their care.

Those with under 10,000 get the maximum state support, but are still expected to use their savings to pay towards some of their care.

Local authorities currently support 200,000 residents.

The NHS provides long-term care in hospitals or wards and pays for continuing care at independent nursing homes. Places cost around 100 a week more than residential homes.

In 1997, the NHS is estimated to have paid for 15,000 places at nursing homes.

There is no charge to the patient, but state benefits are gradually reduced.

The NHS also funds some services, such as continence supplies, to people receiving means-tested care in residential and nursing homes.

Some residents on income support qualify for funding through the Department of Social Security. The DSS is currently funding around 80,000 residential care places.

Places in private and voluntary care homes have risen since the 1980s.

But the number of people in private homes has fallen since 1993 when community care reforms were introduced.

Some 95,000 people in residential and nursing homes fund their own care. They pay on average 20-40 a week more than people funded by the DSS or the local authority.


Charities for the elderly say the system is complex and does not promote older people's right to live as independently as possible.

They want a simpler set-up which does away with regional variations and power struggles between different agencies.

The Royal Commission on Long-Term Care for the Elderly, which has received evidence from a vast array of organisations over the last year, recommended in March that all personal and nursing care be provided free.

This argument is also the subject of a test case at the Court of Appeal.

Pamela Coughlan says her health authority should not be able to close her NHS care home and move her to a home where she has to pay for her care costs.

The government has yet to respond to the Commission's recommendation, but is acting as an expert adviser against Ms Coughlan.

See also:

28 Feb 99 | Your NHS
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