There are management consultants in the US who advise the owners of nursing and residential homes on how they can make their residents more dependent. In that great free market, the entrepreneurs who run old people's homes know that they will make more money from people who have greater physical needs and who are too frail to shop around for help elsewhere. The Alzheimer's Society is concerned that a similar sit uation could develop here. The Government's plans to refocus the funding of long-term care will give a clear incentive to homeowners to provide nursing care whenever they can.
Under the proposals announced in July and likely to be debated in parliament this year, people going into homes will find that their nursing costs are paid for by the state. However, they will still have to fund their own 'personal care costs'. The owners of most nursing homes peg their fees in relation to the level of government funding available. At the very least, most will automatically raise their fees to absorb the extra funding available. At the worst, some will find ways of making their clients more dependent. This is not as far-fetched as it might sound. There is already considerable evidence to show that home residents are systematically over-drugged and in a state of chemically induced dependency.
The Government is soon to receive a huge blast from charities representing the elderly. A letter from a consortium of groups, including Help the Aged and the Alzheimer's Society, is to be sent to all MPs by the middle of this month, expressing their 'profound disappointment' over the plans.
Moves to overhaul the present system of long-term care were started in 1997 when the Labour Government announced the creation of the Royal Commission on Long-Term Care for the Elderly. This reported last year, urging that all nursing and personal care costs be met by the Government. The Government was understandably wary of the costs involved. It decided to go for a much cheaper option, funding the nursing care element, which it announced in July this year. (Personal care costs would still be funded if the elderly people involved could not meet the bill themselves - but many people would still be forced to sell their homes and use up all their pensions on homes' fees.)
The big problem with the proposals is the narrow definition of nursing care. Under the plans, someone with Alzheimer's would get very little financial assistance. Helping someone get dressed is defined as personal care, as is helping them eat their food or go to the toilet. Nursing care is something done by a registered nurse. As the law stands, there need be only one nurse on duty in a nursing home at any one time. Nursing care will largely be restricted to medical duties such as dispensing drugs.
The charities are also angry that the Government has done little to encourage healthy living and prevent dependency. 'We are profoundly disappointed with the proposed Government solution,' says Mervyn Kohler of Help the Aged. 'It has missed the opportunity to do anything of any value whatsoever.'
Prevention has been very low down the list of Government priorities - though it is enormously cost-effective. Older people who keep themselves fit have a far higher chance of having a longer and healthier old age.
The tiny charity Research into Ageing has just commissioned research into reducing the effect of falls. Hardly a glamorous subject, the study of falls has huge implications for both individual and state.
One in three women over 65 and one in five men have a fall each year. About 20 per cent of these falls lead to injury or fracture. The majority of admissions into hospital in this age group, and 40 per cent of nursing home admissions, are due to falls. Fractures, which are mainly due to falls, cost the National Health Service £940 million each year.
Research into Ageing is now working on a short physical education programme which appears to cut the chances of falling by 50 per cent by, for instance, strengthening ankles, the lower leg and the physical confidence of pensioners. National programmes of this sort would have a negligible cost to the state. To the individual it might mean a weekly visit to a gentle aerobics class. But the costs saved could be enormous.
Similarly, early diagnosis can prevent people from losing their sight or developing osteoporosis, conditions that frequently send the sufferers straight into nursing or residential homes at a huge personal and financial cost. For instance, it is now possible to get a bone density test for £10 - an examination which, if you take it at 50 or 60, can steer you away from osteoporosis and give you several extra years of independence in your 80s or 90s.
The charities are all concerned that a major legislative change on long-term care is likely to come only once in a generation. The system adopted in parliament in the next year could still be in place in 20 or 30 years.
The Alzheimer's Society has launched a letter-writing campaign to encourage its members to write to their MPs, registering their demand for a more imaginative, equitable approach to long-term care.
Even the Government's most direct attempt to help the estimated 40,000 peo ple a year who sell their houses to pay for long-term care is being criticised as financially unsound for individuals. Someone in this position could take a loan from their local authority to postpone the sale of their home until after they died - but interest would build up on the fees they owed.
But if they went this route, they would lose any entitlement they might have to Attendance Allowance, worth £53.55 a week.
The Nursing Home Fees Agency, an independent financial adviser, calculates that they would be out of pocket by an average of £43,000 after five years.
