Public preferences for paying for social care in later life in England: A latent class analysis.

Sanna Read,Gerald Wistow,Eva Cyhlarova,Martin Knapp,Bob Erens,Raphael Wittenberg,Nicholas Mays,Francis Dickinson

doi:10.1016/j.socscimed.2021.113803

Abstract

There is ongoing debate about how the funding system for social care of older people in England should best be reformed. We investigated how public attitudes to individual and state responsibility for paying for social care in later life vary with demographic and socio-economic characteristics. Four vignettes of individuals in need of home care or residential care with varying levels of savings, income and housing wealth were presented to a sample of people aged 18-75 years (n=3000) in December 2018. Respondents were asked if care costs should be paid by the user, the state or shared. They were also asked about the best way to pay for social care in old age. Latent class analysis was used to identify sub-groups with similar preferences for paying for care, and to explore their socio-demographic characteristics. We identified five classes. The majority (Class 1, 58%) preferred that the state and the user should share social care costs. Class 2 (18%) thought that the state should pay all costs regardless of users' savings, income or housing wealth. Class 3 (15%) preferred users to pay all costs at all levels of savings, income and housing wealth, with the exception of those unable to afford the costs. Classes 4 and 5 (5% each) were characterised by different patterns of 'don't know' answers. Socio-economic status was higher among those proposing higher user contributions (Class 3) and lower among those with several 'don't' know' responses (Classes 4 and 5). Concerns about care costs in old age were high among those proposing that the state pays all costs (Class 2) and those preferring that users pay all costs (Class 3). This study shows that public views on social care funding vary with respondents' characteristics and that proposals to reform the system need to be carefully calibrated.

Highlights

While most older people today are living longer and healthier lives than previous generations, the proportions of those living with low and high levels of dependency have increased (Kingston et al, 2018)
When the data reported here were collected, the government was committed to publishing policy proposals by the end of 2020, to honour an election promise to end the situation where an individual’s housing assets are used to meet the costs of their care. Such a promise is relevant to older people who are the most likely in society to need costly residential care and to have significant housing assets
The results showed that two-thirds of the sample favoured sharing the social care costs between the state and the user, while fewer than one-fifth preferred that the state pays all, and an even smaller proportion preferred that the user pays all regardless of the user’s re sources

Summary

Introduction

While most older people today are living longer and healthier lives than previous generations, the proportions of those living with low and high levels of dependency have increased (Kingston et al, 2018). High-quality community and residential care are costly, which increases longstanding concerns – expressed across many countries – about how care should be paid for and by whom. When the data reported here were collected, the government was committed to publishing policy proposals by the end of 2020, to honour an election promise to end the situation where an individual’s housing assets are used to meet the costs of their care. Such a promise is relevant to older people who are the most likely in society to need costly residential care and to have significant housing assets. Perhaps, the demands of the coronavirus pandemic have delayed government action

Methods

Results

Conclusion