Committee for Employment & Social Security - P.2020/125
Whether, after consideration of the Policy Letter entitled 'Supported Living and Ageing Well Strategy: Extending the Life of the Long-term Care Insurance Scheme', dated 29th June, 2020, they are of the opinion:-
1. To agree that the 'co-payment', when aggregated with the Long-term Care Benefit in payment for a care home bed, results in a sum too low to ensure the stability of the private care market and to promote the ongoing investment required to ensure that there is a sufficient supply of care to meet the long term demand of the market.
2. To agree that the 'co-payment' is increased from £209.37 to £229.37 per week with effect from 5th October, 2020.
3. To agree that the weekly rates payable in respect of Long-term Care Benefit are increased from 5th October, 2020 as follows:
Residential care £521.00 (current rate £463.89)
Residential respite care £750.37 (current rate £673.26)
Residential dementia care £681.00 (current rate £611.24)
Residential respite dementia care £910.37 (current rate £820.61)
Nursing care £940.00 (current rate £866.11)
Nursing respite care £1,169.37 (current rate £1,075.48)
4. To approve the draft ordinance entitled the 'The Long-term Care Insurance (Guernsey) (Rates) Ordinance, 2020', attached at Appendix 2 to the Policy Letter, and to direct that the same shall have effect as an Ordinance of the States.
5. To note that the increase in the co-payment of £20 per week, from £209.37 to £229.37 will increase Income Support formula-led expenditure by £40,000 in 2020.
6. To agree that the 'co-payment' shall be further increased, over two years, to be £280 per week from January 2023, in line with the lower estimates for the cost of providing 'living and accommodation' services indicated by the LaingBuisson analysis.
7. To agree that the total of the 'co-payment' aggregated with the Long-term Care Benefit rate for the provision of residential care beds, residential dementia care beds and nursing beds should be increased to the mid-point indicated by the LaingBuisson benchmarking by 2023 with allowance made for inflation (RPIX) in the intervening period; and the mid-points in 2020 terms are as follows:
Residential care £801.00 (current rate £673.26)
Residential dementia care £961.00 (current rate £820.61)
Nursing care £1,220.00 (current rate £1,075.48)
8. To agree that a review of the adequacy of benefit rates should be conducted in conjunction with each five-yearly actuarial review of the Long Term Care Fund to ensure that benefit rates remain appropriate; and that additional or interim reviews should be conducted by the Committee for Employment & Social Security if there is evidence of significant pressure on the cost of delivering Long-term Care services.
9. To agree in principle to introduce a higher rate of benefit payable for exceptional and complex cases to be provisionally set at £1,112.00 per week, and to direct the Committee for Employment & Social Security and the Committee for Health & Social Care to develop suitable eligibility and assessment criteria for access to this benefit by no later than December 2020.
10. To note that if the foregoing propositions are approved, and future benefit rates are maintained in line with the same methodology, it is estimated that the contribution rate necessary to ensure the sustainability of the Long-term Care Insurance Fund will need to increase by 0.9%, taking it from 1.8% to 2.7% for people under pension age and from 1.9% to 2.8% for people above pension age.
11. To agree, in principle, that the Long-term Care Scheme should be extended to incorporate care provided at home and to direct the Committee for Employment & Social Security and the Committee for Health & Social Care to develop detailed implementation plans for this proposal no later than June 2022 and to agree that such plans should include:
a. A minimum care need threshold to be eligible for subsidised care from the Long-term Care Insurance Fund;
b. Additional rates of benefit, lower than those that apply to care homes, to support people receiving care in their home;
c. A scheme whereby claimants receiving a subsidy towards residential or nursing care could in the future have the option of using this subsidy towards care in their own home
d. Criteria for establishing long-term need (for example care requirements likely to persist for at least six months or until end of life) which would qualify for a claim from the Long-term Care Insurance Fund; and
e. A suitable assessment process capable of establishing eligibility for benefit for those requiring care at home in a time and cost-efficient manner.
12. To note that if proposition 11 is approved, the estimated contribution rate necessary to ensure the sustainability of the Long-term Care Insurance Fund, referred to in proposition 10 will need to increase by a further 0.4%, taking it to a total of 3.1% for people under pension age and 3.2% for people above pension age.
13. To note that if the above propositions are approved and there is no substantial change in the financing methodology, the necessary increase of 1.3% in the contribution rates for the Long-term Care Insurance Fund will be an increase of approximately 70% over the current rates.
14. To agree that a reliance on increased contribution rates to ensure the financial sustainability of the Long-term Care Insurance Fund, in the context of the changing demography, risks an increasing and significant intergenerational unfairness.
15. To direct the Policy & Resources Committee, in conjunction with the Committee for Employment & Social Security, to investigate the formation of a States-run or supported scheme for deferred property loans to be made available to those seeking or receiving Long-term Care and to report to the States no later than December 2021 and to agree that such a scheme should be fair and equitable and include protections for any spouse, partner or dependant relative resident in the property.
16. To agree in principle that, subject to the development of a suitable deferred loan scheme, those with property assets (including their primary residence) with a value in excess of £350,000, should not be entitled to income support to assist in meeting the cost of the personal allowance and co-payment payable in respect of care beds under the Long Term Care Scheme and to direct the Committee for Employment & Social Security to provide updates on the implementation of this policy in its annual 'non-contributory benefit rates' Policy Letter.
17. To direct the Committee for Employment & Social Security and the Policy & Resources Committee to report to the States, by December 2021, on the options that exist to moderate the increase in contributions which will otherwise be required and to agree that those options should include a model similar to the scheme in place in Jersey, which includes a requirement that those with assets above £350,000 (including their primary residence) must meet the first £35,000 of the costs otherwise covered by the Long-term Care Benefit Scheme.
18. To note that, subject to the outcomes of the States' decisions on the report set out in Proposition 17, the Long-term Care Fund will require additional funding of up to £25million per annum, equivalent to an increase in the social security contribution rate of 1.3%, in order to become financially sustainable; and
a. to direct the Policy & Resources Committee, as part of the Review of Taxation and in consultation with the Committee for Employment & Social Security, to identify a suitable source of funding to ensure the long term stability of the Long-term Care Fund, in accordance with the principles of the Fiscal Framework; and
b. to direct the Committee for Employment & Social Security, if the Review of Taxation does not identify measures to ensure the long-term stability of the Long-term Care Fund, to propose within its annual contributory benefit report an increase in the social security contribution rate of a maximum of 1.3% with effect from January 2022.
19. To direct the Committee for Employment & Social Security, in co-operation with the Committee for Health & Social Care, to continue to work towards establishing contractual arrangements with some or all care homes providers in order to provide certainty of income for the care home and certainty on the number of beds available at 'States rates'.
20. To rescind Resolution 6 of the 1st March, 2001 on Article VII of Billet d'État No. III of 2001 ('Long-term Care insurance scheme for Guernsey and Alderney') which has the effect of requiring the Committee for Health & Social Care to set the standard charge for occupants of long-term residential and nursing care beds provided by the States of Guernsey at an amount equivalent to the standard Long-term Care Insurance Scheme co-payment.
The above propositions have been submitted to Her Majesty's Procureur for advice on any legal or constitutional implications in accordance with Rule 4(1) of the Rules of Procedure of the States of Deliberation and their Committees.