There is a call today for a national debate on how to share the costs of long-term care between the state and private individuals to meet the growing needs of an aging population. It comes in a discussion paper commissioned by the Joseph Rowntree Foundation, which also says that the present system of paying for care is unfair and incoherent.The paper, written by JRF Special Adviser Donald Hirsch, says the number of over-80s is set to double in the next 30 years and people of all ages need reassurance that they will be able to get good quality care when they need it and will not have to impoverish themselves in the process.

The present system, the paper argues, is unsustainable, providing neither a clear set of entitlements – based on how much care people need – nor accepted rules on how much people should contribute according to their ability to pay. Countries such as Germany and Japan, meanwhile, have produced more coherent systems for assessing needs and sharing costs.The discussion paper sets out various options for reforming the system. Firstly it suggests improvements in helping to pay for residential and nursing care according to an older person’s diagnosed condition. At present some people’s costs are fully met by the NHS while others receive very little in spite of facing similar care bills. The paper goes on to suggest limiting the extent to which people are required to use the proceeds of selling their homes before they are eligible for local authority help with care costs and giving a better deal to people on low incomes. It says a simpler and more balanced approach to sharing care costs would be in line with developments in other countries.

Donald Hirsch said that in the next 50 years Britain would have to spend about four times as much in real terms on long-term care.”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,” he added.