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Sunday, October 24, 1999

Some Britons Bitter Over Payment Ruling

By Thomas J. Cole
Journal Investigative Reporter
LONDON -- Britain's system of socialized medicine doesn't mean free nursing-home care for the elderly under all circumstances.
Under a ruling by the Court of Appeal in London this summer, the National Health Service has to pay for "continuous and intense" care in nursing homes.
Those nursing-home residents who don't require that level of care must pay for their stays.
The government does pay for the stays of residents who are poor, much like the Medicaid program does in the United States. But like the United States, poor residents must first spend most of their assets on the nursing-home care, including proceeds from home sales under some circumstances.
That has angered many elderly British who expected cradle-to-grave care when the National Health Service was created more than 50 years ago.
"The elderly and their children are very resentful," said Ginny Jenkins, director of the nonprofit group Action on Elder Abuse.
A government panel, the Royal Commission on Long Term Care, was formed to examine the issue.
In a report in March, the commission said personal care in nursing homes should be free, paid for from general taxation.
The commission said residents should continue to pay that portion of nursing-home costs that is for living and housing expenses.
Such costs could be covered by pensions. Poor residents would receive government assistance.
"To rely on income or savings, as most people effectively have to do now (to pay for nursing-home care), is not efficient or fair," the commission said.
The Labor government of Prime Minister Tony Blair said it would consider the commission's recommendation but didn't immediately embrace it.
In Britain, a relative or friend of a nursing-home resident who is receiving government assistance can provide additional financial help.
The added money from the relative or friend can result in the resident being placed in a more expensive home than the government would pay for.
The practice is known as "topping up," and about 14 percent of nursing-home residents who receive government assistance have their stays paid in part by third parties.
The practice is illegal in the United States. A nursing home must accept Medicaid reimbursement as full payment for a resident's stay.