Nursing, Residential and Home Care Project

The purpose of the Nursing, Residential and Home Care Project is to ensure the long term, financial sustainability of care by exploring new ways to fund care that will enable more people to remain in their own homes.

The project builds on the work of the 2018 Council of Ministers report 'Future funding of Nursing and Residential Care', It also responds to Recommendation 16 of the 2019 Independent Review of the Health and Social Care System on the Isle of Man.

Recommendation 16 states that:

'The provision of social care should be considered as part of the current review* of future funding of nursing and residential care with the intention of removing disincentives to people requiring care and support remaining in their home. This consideration should specifically include equalisation of the current threshold of financial assistance, a more flexible approach to funding to enable joint commissioning of broader care arrangements in the interests of the service user and provision of 24/7 social care access.'

*The ‘current review’ refers to the 2018 Council of Ministers report.

The project has been split into three workstreams:

1. Future cost models for how care is paid for
   
   Tynwald has approved work to develop detailed models for two potential funding options (narrowed down from the original six options presented in the 2018 Future Funding of Nursing and Residential Care paper). These models are explained below.
   
   
   • A ‘free personal care’ model
     This would be similar to the current system in Scotland, where personal care is provided to people at no charge, regardless of their income or assets. This would cover any care of a personal nature given at home or in a residential or nursing care home, including tasks relating to hygiene, medication, feeding, bathing and dressing.
     
     
   • A ‘mixed’ model
     This would be similar to the system in Jersey, also offering financial support for those receiving care in a Nursing Home, Residential Home or in their own home. It is based on a threshold and cap scheme, designed to protect the family home. This model would introduce a new benefit that would mean the Government covers care costs for those needing care, once costs have been paid by the service user (or their family) up to a pre agreed ‘cap’ (a maximum personal financial contribution set according to set criteria such as the person or family’s financial means).

   Take a look at the infographic on the models
   
   Both models require people to meet their own accommodation and living costs, with means tested support available to those who would struggle with those costs.

   Some principles for the changes have been agreed based on the work done so far. One of the principles is that any new way of funding adult social care should protect the assets of the person receiving care more than the current system does. This will require the Government (and therefore society as a whole) to pay more for providing social care for the Island’s population.

   This next phase of more detailed work on the models will help the team understand the potential impact of different scenarios for splitting this potentially greater cost of nursing, residential and home care between the user/families and the tax payer.

2. Resolve the existing perverse incentives in the social security system
   
   A ‘perverse incentive’ is something that drives the wrong behaviour or result. One example of this in relation to the current benefit system is that it is easier to access financial support for a person to move into a Residential or Nursing Home rather than receive care in their own home. This can result in people moving out of their own homes even when they would prefer to stay, which goes against the Government policy to keep people well in their home for longer and adds an additional financial burden on the tax payer.
   
   The current model also includes a ‘cliff-edge’ because those in receipt of Income Support can receive care at home free of charge but everyone else must pay for it.
   
   The Project will ensure that future models for how care is paid for do not include perverse incentives and is looking at whether the existing perverse incentives can be resolved in the shorter term.
   
   
3. A complementary model of care provision to support the changes made at 1 and/or 2
   
   Any changes to the cost model or financial assistance for home care will have an impact on future demand for care provision, which will need to be understood prior to implementation of the cost model.
   
   The Project will consider the broader impact of keeping people well at home and the impact on service provision to ensure that implementing the financial changes would not create other issues, such as a sudden increase in demand for home care or respite services that cannot be met.

Progress

• Presentation to the Government Conference.  
  
  
• Public consultation on the options.
  
  
• Baselined current cost of, and numbers in, nursing and residential care, including projections for funding requirements for the next 20 years
  
  
• Gained an understanding of the nursing and residential care market and completed best practice research
  
  
• Worked with stakeholders to understand the current system and fully identify issues and barriers being experienced by all
  
  
• Identified a range of service improvement initiatives, enablers and broader considerations
  
  
• Identified six possible options for nursing and residential care:
  
  
• Modified Manx offer, threshold and cap, asset protection guarantee, free personal care provision (Scottish model), hypothecated tax (social insurance model), mixed (Jersey model) with high level pros and cons to each
  
  
• Each of these options has been financially modelled to understand the sustainability of the option
  
  
• Contracted KPMG to provide specialist skills and knowledge to support the delivery of the project
  
  
• Developed design principles to set the blueprint for proposed changes to the future operating model
  
  
• Narrowed down the original 6 options to 2 options that Tynwald have approved for more detailed analysis:
  
  
  • Free Personal Care Model
    
    
  • Mixed Model
    
    
• Initial options identified to remove the perverse financial incentives in the current system, including research on a home care allowance, personal budgets and tax incentives
  
  
• Reaffirmed the objective and guiding principles to underpin a decision on the future cost model for nursing and residential care.

Aims for the next 12 months

• More detailed analysis of the two preferred options including any changes that would be required to fit the Isle of Man setting
  
  
• Create a dynamic cost model for the two preferred options that can be used to understand the costs to Government of operating the models and how that would change the costs to individuals
  
  
• Recommendations to be put in front of Tynwald by end 2024