A two-stage survey to explore people's beliefs about the relative
responsibilities of the individual, the family and the state for
providing and funding care in old age, and their actual behaviour
in this area.
For more details contact:
Professor Gillian Parker, Nuffield Professor of Community Care,
University of Leicester, 22-28 Princess Road West, Leicester,
LE1 6TP; Tel. +116 252 5422; Fax. +116 252 5423.
Demographic, social, economic and political changes have stimulated
recent political and academic debate about how to provide and
pay for the care of older people. Public awareness of means-testing
for care and consequent asset loss has also increased and pushed
the issue up the policy agenda. However, evidence about what people
think is the appropriate balance of responsibility between the
individual and the state for meeting care needs has, until now,
been limited.
Our research provides evidence by: (i) surveying attitudes towards
the increased use of personal financial resources to secure care
in older age and establishing how these vary with personal and
socio-economic circumstances; (ii) modelling different attitudes
and exploring the relationship between attitudes and behaviour
in relation to securing care in old age; and (iii) relating findings
to current debates about the role of the state and personal financial
decision-making.
A nationally representative sample survey of men and women aged
between 25 and 70 years was carried out in England and Wales.
Structured interviews with 957 people, focusing on attitudes and
beliefs towards care finance, were conducted by Social and Community
Planning Research in late 1995. Weighting to compensate for non-response
provided an effective sample size of 950. In stage two we returned
to a sub-sample of 102 respondents to investigate their actual
and planned behaviour for covering care needs in later life. We
sampled on the basis of the views expressed in stage one from
those who were "pro-state", "pro-individual",
in favour of a "mixed economy", or whose views were
inconsistent. One-hundred-and-two people were interviewed by the
SCPR field force in June 1996.
Stage 1 Findings
Most people believe that the state should take primary responsibility
for the provision of older people's care, and that it can afford
to do so. However, most also believe that support should be related
to people's ability to pay, although the greater the need, the
more support there is for state help for all, regardless of income.
But views about how personal resources might be used to pay for
care are confused. When prompted (using vignettes) the majority
of respondents saw saving for old age as a first priority for
a couple at different life stages (couples in their forties, near
retired, and retired). Further, over three quarters of the sample
felt that people should be able to purchase long-term care insurance
to protect against future care costs. However, when respondents
considered specific cases of older people with a variety of care
needs, support for using privately paid-for assistance was very
low amongst respondents of all political persuasions. In addition,
there was little support for using housing capital to fund care
needs.
Multivariate analysis and modelling showed that the strongest
influence on attitudes towards the role of the state is political
affiliation, as one might expect, but that this is mediated by
age and personal experience of caring and/or disability.
Stage 2 Findings
Only one of the 102 people interviewed had any long-term care
insurance (LTCI). While the "pro-individual" and "mixed
economy" groups were more likely to think that LTCI was a
"good idea", this was not paralleled by their expressed
likelihood of taking out such insurance.
However, respondents were making these judgements while relatively
naive about current risk levels for the need for care: they over-estimated
both the risk of needing different types of care and the average
amount of time people spend in residential or nursing home care
in old age. When we gave them information about current risk levels
(which are around 25 per cent at the age of 85), and asked whether
they would now consider LTCI, if they could afford it,
the proportion saying that they would increased from under 10
per cent to almost half. As this level of risk is lower than the
sample's own estimates, this suggests that cost is a major disincentive
to those who would otherwise be inclined to insure. Further, the
"pro-individual" group were significantly more likely
to say that they would consider insurance.
Those who were resistant to insurance were asked to consider even
higher levels of risk, but remained largely steadfast in their
reluctance, regardless of which sub-group they belonged to.
We asked people for their views of suggestions put forward in
a government discussion paper for "partnership" insurance
schemes and variable pensions as ways of individuals paying for
their own care. Partnership schemes were most popular, but still
only gained the support of around half the respondents. The "pro-individual"
and "mixed economy" groups were most likely to approve.
On the whole people's actual or anticipated behaviour broadly
followed the views expressed in stage one. However, views and
behaviour in this area are confused. People want the state to
be responsible for older people generally, but are strongly in
favour of support being means-related. Yet people are reluctant
to contemplate using available means, either now or in
the future. The second stage identified issues concerning justice
and fairness which influenced perceptions about the balance between
the individual and the state and which seem to explain some of
the confusion. Mistaken understanding of the role of the state
in providing social (rather than health) care, expectations
that tax and national insurance should provide personal protection,
and the belief that "the state" recoups the funds raised
from selling a home when an older person enters residential care
are all important. Those who thought that home ownership would
assure their successors a substantial inheritance also feel a
sense of betrayal.
Uncertainty, about both individual risk and public policy, also
contributes to people's confusion and hence to their reluctance
to make major investment or insurance decisions.
Political thinking about the balance between the state and the
individual in guaranteeing welfare has changed radically in the
last twenty years. Our research suggests that the bulk of the
population has not changed its thinking along the same lines,
and even less its behaviour. A national debate about the level
of state support we wish to see for older people, and the amount
we are prepared to pay for it, whether communally or individually,
is long overdue. This project provides a representative picture
of current views and behaviour which can inform such a debate.