Preferences for paying for long term care for older people

Previous studies have shown that large proportions of the general population never think about social care, including the possibility that they themselves might need support at some stage. Very few people have therefore thought about preparing financially or in other ways for their future social care needs. 

Moreover, the level of understanding of the current adult social care system — how it is organised, funded, eligibility, etc. — is very limited. There appears to be widespread unawareness about how to find out about the social care system or how to access support. This widespread lack of knowledge may be a contributor to the difficulties that providers, commissioners, lobbyists and others in the social care sector often encounter when trying to engage top-level decision-makers in discussion about the state of the social care sector and how well it is resourced. 

Existing evidence on the public’s views towards different funding mechanisms is relatively limited. Quantitative research varies, covering a range of funding options and mechanisms, with wide variation in how these are framed in survey questions. From the research that exists, there appears no single model for funding social care that attracts most support. Universal, government provision has strong support. However, qualitative research shows that people do not always accept that there is a need for significant new funding and many believe universal provision can be funded by, for example, transferring funds from other government budgets. 

The study aimed to look at public attitudes to different options for funding social care in England, particularly in the context of an ageing population.

The study originally consisted of three components: 

1. A rapid review of existing literature and studies on the subject of paying for long term care for older people was carried out, and key concepts and gaps in evidence were notes. This was used to inform a series of focus groups and a national survey examining the public’s attitudes to the funding of social care. The scoping review also highlighted other studies in England currently underway or being planned to avoid duplication of work.

2. Eight focus groups in different parts of England were carried out in the summer of 2018. These aimed to provide an in-depth understanding of people’s perceptions of behaviours in relation to planning for future social care needs and their values and priorities in relation to social care funding. Specifically, we focused on: 

- perspectives on the likelihood of needing social care 

- how people think they will get their care needs met 

- perspectives on the potential costs of care  

- barriers and facilitators to planning for social care needs 

- perspectives on different ways of paying for social care. 

3. A nationally representative online survey was carried out in December 2018, supplemented with a separate boost of older people aged 65 and over carried out using face to face interviews. The survey presented a number of scenarios to respondents and asked them to choose between different funding options (i.e. whether the state or individual should pay, or whether the costs should be shared). The data collection was carried out by Kantar, Public Division.

Further to the originally planned work, six focus groups were held in 2020. These focus groups were stratified by age and geography and explored how people understand shared public-private funding for social care and the factors that influence their perceptions of what constitutes an appropriate split between the individual and the state. The qualitative research focussed on the values, aspirations, expectations, etc. that people employ in constructing their views.

A key message from the study for policy development is that the majority of the public would support a reformed funding arrangement for social care where costs are shared between the state and service users. However, a majority would prefer that service users meet less than half of the costs of their care. This indicates a more generous means test than is currently in place in which fewer service users (if any) would be required to meet the full costs of their care without any limit or cap.