A discussion paper commissioned by the Joseph Rowntree Foundation has claimed that Britain's system for paying for long-term care is unfair and incoherent.
It calls for a national debate on how better to share the cost between the state and private individuals, in order to meet the growing care needs of an ageing population.
The paper argues that the present system is unsustainable because it provides neither a clear-cut set of entitlements according to how much care people need, nor a well-accepted set of rules about how much they should contribute according to ability to pay.
Stakeholder Response: The Joseph Rowntree Foundation
Report author Donald Hirsch said: "In the next 50 years we will have to spend about four times as much in real terms on long-term care as we do now.
"If we keep our present system of public funding, most of the increase will fall on individuals, many of whom will find it difficult to pay.
"But before we can raise the extra public money that is needed, we need a system that is fair and clear to users.
"If we can create such a system, people are likely to be more willing to contribute the extra tax or national insurance - amounting to perhaps half a percent of national income - needed to avoid an excessive burden on families in terms of financial and direct caring commitments.
"The private contribution will also grow, and again we need a system under which such contributions are levied on a basis seen to be fair."
Sir Christopher Kelly, former permanent secretary at the Department of Health and who chairs the group advising the JRF on long-term care funding, said: "We need to build a new consensus on how we pay for long-term care, and this discussion paper is a first step.
"One way or another, we will have to pay the growing care bill: if we avoid raising more public resources the burden will fall on hard-pressed families.
"But, as this report shows, the present system is full of anomalies and is extremely hard to understand even for the professionals who work in it, let alone for individuals.
"This report gives some examples of possible policy changes, but more importantly it puts the case for change, identifying some key challenges which we cannot duck out of.
"As with pensions, if we delay for too long in confronting the realities of an ageing population, it will become much more painful to make the necessary changes than if we act now."
Stakeholder Response: Help the Aged
Jonathan Ellis, policy manager for Help the Aged, said: "Confusion over eligibility for state funding has been the order of the day for years.
"This report offers some encouraging suggestions to alleviate the current uncertainties over who pays for what and how much. It’s vital that the system for paying for care is fair, transparent and sustainable.
"As a society we tend to fear ageing and what it may bring, yet with a one in five chance of ending up in care, we must all plan ahead for the possibility of one day needing long term care.
"Help the Aged would welcome more practical thought about how care costs can be met through general taxation, while encouraging younger generations to save for their care in older age.
"But more urgently, the government must first get its own house in order with regards to how care costs are met. Investing in adult social care and providing better choice for older people as consumers of care, regardless of their income or postcode, will ensure a fairer system for all."
Stakeholder Response: Age Concern
Gordon Lishman, Age Concern's director general, said: "This report shines a spotlight on the state of older people’s care in Britain. The current system is a shambles which is both'‘unfair' and 'incoherent'.
"Yet despite overwhelming evidence of the problems and an ageing population, too few improvements have been made.
"The government cannot continue to bury its head in the sand on the care crisis. The severe under funding of long term care must be addressed.
"Greater investment is needed and a lasting solution found to make clear what the state should fund and what individuals should pay for."
