People are living longer than ever before due to continuing improvements in healthcare and scientific research.
As a growing percentage of our population, older people contribute as workers, taxpayers, volunteer and carers. While the States of Guernsey is looking at various ways to make the most of the opportunities provided by the older population, it also recognises the growing impact of the ageing population and those living with long term conditions on health and care services.
In 2016, the States Assembly agreed the Supported Living and Ageing Well Strategy (SLAWS) within which it was recognised that there was a need to change how community long-term care is provided in the future. This was in recognition that changes were needed to support those needing care to maintain their independence for longer and to offer them more choice, while recognising the increasing demand for care would need to be rebalanced as more of the population ages with fewer people of working age.
The Long-term Care Insurance Scheme (the Scheme) assists islanders in Guernsey and Alderney in covering some of the costs of residential or nursing care in a care home through the long-term care benefit. The Scheme was launched 20 years ago with a 15-year lifespan given future unknowns which led to the development of the SLAWS in 2013.
In 2020, the States Assembly agreed to some changes to the current community long-term care model including increasing the benefit and co-payment rates to fund care in care homes. The States Assembly also agreed some changes in principle, such as a higher rate of benefit to cover more complex care needs and factors to consider if homecare is to be covered by the Scheme.
In response to factors which have put additional pressure on long-term care funding including the islands' growing ageing populations the States Assembly agreed in principle in 2021 to increase contribution rates to fund the Scheme by 0.4% over four years, which is currently being implemented. However, this will not cover its expansion toward homecare or address the funding sustainability and resilience issues of providing long-term care.
Currently, work progressing under SLAWS is giving consideration to a new model of community long-term care including expanding the current model of community long-term care to cover homecare, alongside other changes. Homecare supports people to continue living independently at home by providing help with activities of daily living such as bathing and getting dressed.
It is expected that the options for a new model of community long-term care will be presented to the States in the first half of 2024.
Capturing the views of islanders on the options for a new community long-term care model is an important part of this work. If you are interested in applying to participate in upcoming focus groups on this topic, please see the media release. Additionally, public events will be planned to gather the community's views on potential options for a revised model of community long-term care.
Useful documents and links
- 2021 Policy Letter - Billet d'État XX of 2021 - Contributory Benefits and Contribution Rates for 2022 (CfESS)
- Billet d'État XVI of 2020 - Supported Living and Ageing Well Strategy: Extending Life of the Long-Term Care Insurance Scheme (CfESS)
- Billet d'État III of 2019 - Health and Care Regulation in The Bailiwick (CfHSC)
- Community Health and Social Care - States of Guernsey (gov.gg)
- Long-term care benefit - States of Guernsey (gov.gg)
- Severe disability benefit and carer's allowance - States of Guernsey (gov.gg)
- Income support - States of Guernsey (gov.gg)
- Joint Strategic Needs Assessment for People Over 50
Frequently Asked Questions
What is the Supported Living and Ageing Well Strategy (SLAWS)?
- SLAWS encompasses policy and operational initiatives designed to support islanders who are ageing or in need of care, as well as the social care entities and individual carers who support them.
- Workstreams under SLAWS span several areas of the States. The Policy & Resources Committee has responsibility for coordinating and overseeing it, collaborating closely with the Committee for Health & Social Care and the Committee for Employment & Social Security.
- There are 17 workstreams underway or planned under SLAWS at this time (July 2023). The majority of these workstreams are contributing to designing the delivery and funding of a new model of community long-term care, the others are looking at short-term interventions to address the delivery of long-term care or how best to incentivise investment within the long-term care sector to meet growing demand for services.
Why are the States revisiting the community long-term care model now?
- Changes need to be made to how care is delivered to meet the known challenges, make the most of opportunities, meet increases in demand for services and to continue to provide good health and wellbeing outcomes for individuals. For example, globally there are a shortage of care workers and technology is playing a much greater role in health and care delivery.
- Similarly, funding for the current model is not sustainable and it is not sufficient to cover any expansion of the Long-term Care Insurance Scheme (the Scheme) toward home care. While the funding of the Scheme at current rates was revisited in 2021 based on financial, actuarial and demographic projections which continue to change, this is a short-term measure while further consideration is given to how best to address current and future increases in demand for community long-term care.
- For decades, birth rates across western democracies have declined while medical advances and life expectancy have increased. Increased longevity is enormously positive news, but it means that a higher percentage of the population is in older age brackets in which they are more likely to need care. Not only are there more older people, but their increased longevity corresponds to an extension in the years that they live in a state of health that requires care support. At the same time, these population shifts result in a smaller percentage of working-age people, which means that governments' revenues to fund care services and the pool of care workers are diminishing.
- For example, it is estimated that between 50% and 70% of islanders will require community long-term care services at some point, particularly as they age. Delivering this care is expensive, with care home provision costing an average of £60,000 to £80,000 per person in 2020.
- The States is re-examining the community long-term care model and its funding to ensure that it can meet these coming changes. While the provision of care for islanders is not at risk presently, a fresh approach is needed to ensure that the delivery of long-term care is resilient and continues to achieve good health and wellbeing outcomes for individuals.
How will the new community long-term care model change long-term care provision in Guernsey and Alderney?
- An important part of the new model will be facilitating the stability and capacity of the Bailiwick's care sector. A thriving care sector with a range of options available for nursing, residential and homecare means that islanders have greater choice. The proposed extension of the Long-term Care Insurance Scheme (the Scheme) to include funding of homecare could further boost provider confidence to offer homecare.
- Guernsey's 19 care homes are mostly small, family-run businesses or operated by the third sector. Alderney has one care home. Most homecare in the Bailiwick is currently delivered by Health & Social Care.
- The current global shortages in care staff also present challenges for the Bailiwick. This low-supply-and-high-demand scenario creates competition for staff across the private, public and third sectors and affects affordability. Recent changes to immigration policy should help this situation, as well as recruitment campaigns underway by the Committee for Health & Social Care, but there is pressure on providing suitable accommodation for new staff from off-island.
- A significant proportion of long-term care is delivered by informal carers, with estimates that as many as 6,000 individuals provide informal, unpaid care in the Bailiwick. As of September 2022, 513 people provided enough care (at least 35 hours per week) to receive Carer's Allowance. It is recognised that informal carers play an important role in providing long-term care and how best to support informal carers will form part of designing the new model.
- The community long-term care sector has experienced some challenges in recent years - at times there are more islanders needing care provision than care homes and other providers can accommodate. Care system pressures can also impact healthcare provision, for instance when lack of care capacity impacts someone's timely discharge from hospital. With demand for care ever growing, not only will more homecare be needed but the number of care home beds needed between now and 2040 is expected to double. For the sake of the islands' health and social care system, these long-term care pressures need to be addressed.
Why change the model to fund more homecare?
- It is increasingly recognised that long-term care delivered in a home setting can have significant advantages. Homecare supports people to continue living independently at home by providing help with activities of daily living such as bathing and getting dressed. Financial assistance with homecare would represent a significant improvement to the model and enable more people to be cared for in their own homes than is currently possible.
- Many people interviewed for the Bailiwick's 2018 Joint Strategic Needs Assessment for People Over 50 conducted by the Committee for Health & Social Care expressed a desire to stay in their own home. For people, whose health status is sufficient for their care needs to be successfully managed at home, there are countless health benefits to doing so including continued independence, a greater level of control over their personal lives and the ability to stay tied to their community.
- The proposed expansion of the Long-term Care Insurance Scheme (the Scheme) to include financial support toward homecare would increase the choices available to islanders who need long-term care. While in some cases homecare can be less costly to provide than residential care, it is not inexpensive - for example, it is expected that private homecare in Jersey may soon cost £40 per hour.
- Most homecare is currently provided by Health & Social Care but those services may not be the best placed to meet the increases in future demand. While Health & Social Care will continue to deliver some long-term care services, it is recognised that it is not sustainable to increase Health & Social Care's budget to provide all long-term care at home. The States is currently operating under a funding deficit which is forecast to rise to over £100m per year by 2040.
- The new model will consider what care needs will need to be met, who is best placed to provide the care to meet those needs and how best to fund that care. This is likely to include increasing the number of private and third sector providers to meet demand, to work alongside services provided by Health & Social Care.
What is it intended will be achieved?
- In line with the States' Supported Living and Ageing Well Strategy (SLAWS) and the Partnership of Purpose, the overarching outcomes to be achieved include:
- person-centred, dignified care
- living independently, healthy and safely as long as possible
- financial sustainability of the long-term care system
- improved intergenerational fairness
- affordable, quality care now and in the future
- The proposals will include:
- how to make adaptations to allow for potential funding of homecare as well as residential and nursing home care, improving choice for islanders
- considering various aspects of the current model to determine how to improve resilience going forward
- new options for contributing to long-term care funding
- measures that government can put in place to incentivise investment and encourage market growth in the long-term care sector to meet future demand
- minimise the current challenges in delivery of care
- establish a proportionate regulatory framework to support care delivery with a regulated workforce with adequate training and care quality standards by 2027
- determine which sector can best provide which services, including which services should be delivered by the public sector
- an outline of how and when the new model will be implemented.
How does our current model compare to other jurisdictions?
- Compared to some jurisdictions including Jersey and England, the Bailiwick's existing long-term care model is already a generous one in terms of who can access funding from the Long-term Care Insurance Scheme (the Scheme) and how much individuals must contribute to their costs of long-term care compared to the actual costs of that care.
- In England and Jersey access to funding for long-term care is means-tested in some form for care delivered in care homes, whereas in the Bailiwick it currently is not. Similarly, many other countries require user contributions (often means-tested) toward homecare.
- England's model has limited coverage in terms of who can access long-term care with most users funding their care themselves. There is no public long-term care insurance scheme in place and the financial threshold for public support in England is very high. Whereas in Jersey, access to the long-term care is wider, via an insurance scheme like Guernsey and Alderney's, but user's must contribute to their care, up to a care cost cap, where they can afford to do so.
- Of the more generous models, such as in Japan and the Netherlands, coverage is universal but funded through higher government taxes and/or larger user contributions to care. These models are generous but expensive to operate and are becoming more unsustainable to deliver due to the funding requirements.
How is the current model funded?
- The current model is funded by the Long-term Care Insurance Fund (the Fund), some user contributions and from Health & Social Care's budget. In some cases, those on income support may receive financial support for the co-payment through income support or ESS's budget.
- The Fund is financed from Social Security contributions and the Fund's investment income.
- In 2021, as part of the States Assembly's debate on the Committee for Employment & Social Security's policy letter on contributory rates, it was agreed in principle to increase contribution rates to fund the Long-term Care Insurance Scheme (the Scheme) by 0.4% over four years, which is currently being implemented.
- Currently, all employed or self-employed islanders who earn above the lower earnings limit pay 2.0% of their income toward the long-term care scheme. Those who are non-employed and under pension age pay 2.1% and those who are non-employed and over pension age contribute 2.3%.
- While the change agreed in 2021 secured funding for the current coverage of the Scheme at current costs, it will not sufficiently cover the Scheme's expansion toward homecare and was also based on financial, actuarial and demographic projections which continue to evolve.
What is the Long-term Care Insurance Scheme?
- The Long-term Care Insurance Scheme (the Scheme) has been in place for 20 years as the States' mandatory, contribution-based public scheme for assisting islanders with care home expenses. It launched with a 15-year timeframe in mind and was intended to protect islanders against the risk that they would face significant personal costs if they needed care and to encourage investment in the private care market. It applies to eligible islanders in Guernsey and Alderney and is one component of the islands' overall social care service offer which is delivered by public, private and third sector providers in various settings.
- The Scheme is funded by the Long-term Care Insurance Fund (the Fund), which is financed from Social Security contributions and the Fund's investment income.
- Islanders who are assessed as needing to move into a residential or nursing home may be able to receive a long-term care benefit, funded by the Scheme.
How does the Long-term Care Insurance Scheme (the Scheme) work?
- The Scheme is funded by the Long-term Care Insurance Fund (the Fund), which is financed from Social Security contributions and the Fund's investment income. Currently, all employed or self-employed islanders who earn above the lower earnings limit pay 2.0% of their income toward the long-term care scheme. Those who are non-employed and under pension age pay 2.1% and those who are non-employed and over pension age contribute 2.3%.
- To qualify for benefit from the Scheme to fund their place in a care home, an adult (aged 18 or older) must have been identified as needing residential or nursing home care and be in possession of a valid Needs Assessment Panel Certificate. Furthermore, they must have, at any time, lived in Guernsey or Alderney for a continuous period of five years and for at least 12 months immediately prior to claiming Long-term Care Benefit. The care home providing the care covered by the long term care benefit must be an 'approved provider'.
- At present, all eligible users are entitled to receive the full rate of benefit applicable to their circumstances irrespective of their wealth or assets, including their homes or property. There is no form of means-testing to determine if people with income or assets over a certain threshold should receive the same benefit as people with income or assets below a certain threshold, as is the case in many other countries.
- The Scheme is set up so that individuals who need to 'make a claim' receive a set amount of 'benefit' (called the long-term care benefit) from the insurance provider (in this case, the Scheme), but are also required to pay a 'co-payment' of £306.46 per week to the care home, which is intended to cover their accommodation and daily living costs. User contributions towards care home fees in Guernsey are lower than in other countries.
- The long-term care benefit is paid weekly and goes towards the cost of living in a private care home in Guernsey, in accordance with the type of care and care home that the user is receiving, or living in. Currently, there are three rates of benefit (as of 2 January 2023):
- Private residential home: £570.29 per week
- Private residential home and receiving Elderly Mentally Infirm care (for instance, dementia patients): £745.43
- Private nursing home: £1,028.93 per week
- If an islander cannot afford to pay the co-payment, they may be assisted by a means-tested supplementary benefit claim operated under Income Support. The value of their own home is excluded from this financial assessment.
- The co-payment is the same as the maximum weekly amount that is paid by Income Support for people living in a care home, apart from a small personal allowance. The combined total is more than the full rate of States' pension, which is currently £250.22 per week.
- Rates for Bailiwick care home beds can vary according to factors including supply and demand. It is sometimes the case that the care home will charge the individual receiving care an additional top-up fee. The so called 'States-rate' beds are those beds available where the cost is the benefit rate plus the co-payment only.
Is respite care funded from the Long-term Care Insurance Scheme (the Scheme)?
- Yes, the Scheme provides benefit for up to four weeks of respite care in any 12-month period. No co-payment by the user is required given that normal home expenses are still incurred, instead the co-payment to the care home is also paid by the fund.
Does the Long-term Care Insurance Scheme (the Scheme) apply to Alderney?
- Yes. The Scheme applies to eligible islanders in Guernsey and Alderney.
Who is eligible to benefit from the Long-term Care Insurance Scheme (the Scheme)?
- To qualify for benefit from the Scheme to fund their place in a care home, an adult (aged 18 or older) must have been identified as needing residential or nursing home care and be in possession of a valid Needs Assessment Panel Certificate. Furthermore, they must have, at any time, lived in Guernsey or Alderney for a continuous period of five years and for at least 12 months immediately prior to claiming Long-term Care Benefit.
- At present, all eligible users are entitled to receive the full rate of benefit applicable to their circumstances irrespective of their wealth or assets, including their homes or property. There is no form of means-testing to determine if people with income or assets over a certain threshold should receive the same benefit as people with income or assets below a certain threshold, as is the case in many other countries.
- Among other aspects, eligibility criteria will be examined as part of the current workstream to develop options for a new model for delivery and funding of long-term care.
Are people new to Guernsey and Alderney eligible to access the Long-term Care Insurance Scheme (the Scheme)?
- At this time, individuals must have, at any time, lived in Guernsey or Alderney for a continuous period of five years and for at least 12 months immediately prior to claiming Long-term Care Benefit.
- Eligibility to access the Scheme is under consideration as part of designing the new model of community long-term care.
Is the Long-term Care Insurance Scheme (the Scheme) means-tested?
- At present, all eligible users are entitled to receive the full rate of benefit applicable to their circumstances irrespective of their wealth or assets, including their homes or property. There is no form of means-testing to determine if people with income or assets over a certain threshold should receive the same benefit as people with income or assets below a certain threshold, as is the case in many other countries.
I am paying, or have already paid, into the Scheme through my Social Security contributions. Am I insured for the amount that I have paid in?
- As a public insurance scheme, the Long-term Care Insurance Scheme operates differently to individual insurance schemes. A percentage of islanders' Social Security contributions goes into a collective funding pot (the Long-term Care Insurance Fund) which then benefits whoever next qualifies for long-term care.
- This means that an individual's contributions are not held in place for that same individual or their beneficiary, as in a private insurance plan. Islanders who are benefitting from the Scheme's care provision now are using funds that were contributed by others between 2003 and now. It also means that, if the Fund were not financially sustainable in the long-term, islanders who are contributing now might not be able to benefit from the Fund's support when they reach the need for care.
Will I have to contribute more for my long-term care under the new model?
- It is certain that changes to the community long-term care model and its funding will be necessary to enable it to incorporate home care and ensure its sustainability long-term. In the same way that preventative healthcare can alleviate health problems in the future, it may be beneficial for islanders to have a greater range of options to consider in advance in funding their long-term care costs.
- This may require individuals to contribute more to their long-term care costs, where they can afford to do so.
What's the timeline?
- The States Assembly will consider proposals as early as possible in 2024.
How can I share my views on the new model?
- Understanding the views of islanders is an important part of developing the new model and will take place in the coming months. Information as to how you can participate will be posted on this page in August 2023.
