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Semelhante a ILC-UK Seminar - The Private Sector's Role in Care - supported by partnership
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ILC-UK Seminar - The Private Sector's Role in Care - supported by partnership
- 1. ILC-UK Seminar: The Private Sector’s Role in Care 5 April 2011
- 2. Baroness Sally Greengross ILC-UK
- 4. Private Finance Products in Partnership Model Les Mayhew Faculty of Actuarial Science and Insurance Cass Business School April 2011
- 8. Affordability of long term care based on income and savings by household type Assumed cost of LTC £500 p. wk. Only 400k out of 6.5m 65+ households can afford institutional care for more than 1 year on the basis of income alone, but this increases to 3m if savings are included
- 9. House prices versus RPI House prices versus RPI: Chart shows how house prices have moved relative to the RPI. In 1971 the value of a house would have roughly pay for 3.7 years worth of care. In today's prices it would pay for approximately 8.8 years. But not everybody will wish to sell up…
- 10. Affordability of long term care based on total wealth by household type If housing wealth is included then 4.6m households could afford care for more than 1 year Of the 1.8m households that cannot afford care for more than one year if housing wealth is included, 0.9m are female
- 14. Example of a DLA based on an initial lump sum of £100k ADLs = Activities of daily Living Units £000s p.a
- 15. What is the market? Income-wealth map and market penetration Key A= Equity release B= Top up insurance C= DLA D= LTC bonds Something for everybody…………
- 18. Proposed system 1. People are placed into ‘wealth bands’ according to the years of LTC they can afford based on both income and assets. Stage 1 Stage 2 P Q 2. People needing LTC receive a proportion of their LTC costs based on which band they are in as shown in example A B C D E P Q
- 20. Case studies Illustrative public support rates: A = 90%; B=70%;C=50%;D=30%;E=10%; others: self funding
- 21. Income asset map with bands Income £11,600 Assets £46,000 Band D Public contribution £4,020 Shortfall £9,380 Income £8,600 Assets £25000 Band B Public contribution £11,480 Shortfall £4,920
- 22. Income asset map with bands Income £11,600 Assets £60,000 Band E Public contribution £1,390 Shortfall £12,510 Income £8,600 Assets £10,000 Band A Public contribution £14,760 Shortfall £1,640
- 23. Income asset map with bands Income £14,600 Assets £100,000 Un-banded Public contribution £ (zero) Shortfall £25,000 People with access to LTC as an employment benefit treated as un-banded Capital limit under present system
- 24. Income asset map with bands SEL F- FUNDING MINIMUM INCOME CAPITAL RICH Not eligible
- 25. Income and asset distribution % people 65+ by band A – 19.8% B - 2.1% C - 2.2% D – 2.8% E – 3.1% Self funding 69.9% Under present system ~22% could be under the threshold Under new system ~ 30.1% would get something Each point is an actual individual aged 65+ A B C D E
- 26. Income and asset distribution % people 65+ by band A – 19.8% B - 2.1% C - 2.2% D – 2.8% E – 3.1% Self funding 69.9% Under present system ~22% could be under the threshold Under new system ~ 30.1% would get something Each point is an actual individual aged 65+
- 27. Cohort effects % of individuals by band reaching age 85 in given years Note that the proportion that cannot self fund for more than 1 year goes down over time
- 28. Annual insurance premiums based on top up mechanism Policy triggered by failing 3 ADLs (Activities of Daily Living)
- 32. [email_address] Mayhew, L., M. Karlsson, and B. Ricklayzen, B. (2010) The Role of Private Finance in Paying for Long Term Care. The Economic Journal, Vol 120, Issue 548, F478–F504, November 2010 Karlsson, M., Mayhew L, Rickayzen, B. (2007), 'Long term care financing in four OECD countries: Fiscal burden and distributive effects', Health Policy, 80(1), p.107-134 Karlsson. M, Mayhew L, Plumb.R, Rickayzen.B, (2006), Future costs for long-term care: Cost projections for long-term care for older people in the United Kingdom, Health Policy, 75(2), p.187-213 END
- 34. The role of insurance in paying for care today Chris Horlick MD Care Partnership
- 35. What exists today? One specialist insurance product, the immediate needs annuity Equity release Investment bonds Pensions and savings Money under the mattress/bank account No pre funded care products available in Britain today
- 39. Because of a lack of funding advice , many self funders run out of money Source: Oliver Wyman Research 130,000 new care home residents per annum 14,000 get financial advice 68,000 need of financial advice every year 7,000 talk to a qualified advisor 75,000 privately funded 53,000 Fully self funding 22,000 co-funding
- 40. The Outcome
- 41. The average stay in a care home by a self-funder is 4 years £116k-£168k Laing & Buisson, Care of Elderly People, 2009
- 42. 1 in 10 self funders is in care for at least 8 years £232k-£336k * Partnership data
- 43. The Care Funding Plan benefits all parties Immediate Care Plan Average premium £85k Average home equity £165k
- 45. What else could we look at developing post Dilnot? Re introduce pre funded care products Home income plans for domiciliary care Deferred annuity tail risk for dementia Joint life claim products Pre funded care or life insurance
- 48. Andrea Rozario Director General SHIP equity release
- 59. Supply and Risk Issues RISKS / ISSUES COMMENT MITIGATION / ACTIONS REPUTATION Media has been negative to the point of scaring off brands, distribution and consumers. Progress is being made – respected brands supporting effort e.g. Aviva, SAGA, Age UK. SOLVENCY II As firms tackle uncertainty around Solvency II, their focus is on their core business issues – ER is immature and is generally the junior product line. Action needed to ensure risks /rewards are understood by firms /FSA – so they can be sensibly reflected in capital and pricing. REGULATORY/LEGAL/ EUROPE Short term capital treatment of equity release – potentially disproportionate to the risk. Changes in Europe – gender / distance selling. New FSA lending rules may encourage banks to re-examine current books, which are held by retired consumers. FSA & BoE could review proposition to lighten / change capital requirements. European dimensions add uncertainty, e.g. annuity funding – but UK govt and FSA appear to have this in hand. MORTALITY & PROMISES Consumers/ trustees/ IFAs don’t fully understand mortality, so undervalue some of the promises, e.g. no negative equity guarantees. Consumer education work of CFEB and others. No government proactive support yet, although LTC may be a driver.
- 60. Supply and Risk Issues RISKS / ISSUES COMMENT MITIGATION / ACTIONS LENDING/ACCOUNTANCY Accounting basis / changes, IFRS, differences in treatments between banks and insurance firms. Lending criteria by firms and valuing of property is disenfranchising some consumers – limited funding means firms can be risk adverse. Accounting changes / Solvency II all adding to better assessment. House value / volatility impact on consumers and lenders. It tends to short term – rather than longer term solutions – improving capital /reward treatment could transform availability. FIRMS LACK MORTALITY IP Only a few firms are really able to price and value mortality risks. A more mature market and incentives would encourage development. But also markets in trading the risks. CONSUMERS – RISK & REWARD Providers can obtain greater margins /profits from shorter term mortgage products. No profit incentive to support longer term consumer needs. Also Equity release could be seen as under priced / good value, considering the length of the promise. Uncertainty – drives firms and consumers away from long term savings and commitments. Equity release is only starting to be “normalised”.
- 67. Martin Green Chief Executive ECCA ILC-UK The Independent Sector's Role in Care 5 th April 2011
- 71. ILC-UK Seminar: The Private Sector’s Role in Care 5 April 2011
Notas do Editor
- The nominal value of houses have outstripped the growth in the nominal cost of care represented in this graph by the RPI plus 1.5%. House prices are subject to boom and bust but have stayed well ahead of care costs. In 1971 the value of a house would have roughly pay for 3.7 years worth of care. In today's prices it would pay for approximately 8.8 years. The planned unlocking some of this wealth is part of the solution but this is not the only means and so we now turn to different products that could be made widely available.
- Equity release is well known concept – do not need to dwell on. Comes in different forms. As envisaged here it would be a point of need product with payback after death. Top up insurance is like LTC insurance which has never sold in great volume because of cost which is designed to be more affordable bridging the care/income gap. Immediate needs annuities need little introduction. Another point of need product for converting a lump sum into an income stream for one’s remaining life Accelerated life insurance is designed to pay out on entry into a care home and not at death. LTC bonds are designed for the those on very low income DLAs are a form of enhanced pension. Lets briefly look at both as we are least familiar with these.
- For the technically minded it works by trading off competing risks since LTC risk tends to be negatively correlated with longevity risk
- Such is the variation in wealth and income that there is no one solution for every individual. This figure shows a map of income an wealth in the UK. The colourer areas show areas on the map where one or more financial products will be most suited. Those with sufficient income are deemed self-funders and they wont need any of these. D for example is LTC bonds and are designed for the low wealth/income groups but anyone is free to buy them.
- A person’s wealth consist of both income and assets. We need to translate that wealth into a single index that can be used to assess state support. Each line in this graph represents a person with different combinations of income and assets that would be sufficient to pay for 1,2,3,4 or 5 years of care. A care costs of £25k a year. A person with an income greater than this would be assumed to be self funding. Someone at point Q (£10k income and £25k in assets) would notionally be able to fund care for 2 years. Someone at point P, 3 years. This information used to place people into one of five bands: A to E. In this example a person able to afford less than one year’s care would get 90% of costs paid after deduction of income; band B, 70% and so on.
- Take a simple example First income. In this example I assume just the state pension plus Attendance Allowance worth approximately £10k a year. Others may have occupational or widow’s pension on top so everyone will be slightly different. The slide shows the level of support provided in each case. Rates can be varied in terms of affordability. Individuals would be expected to meet shortfalls from one or more of the products described earlier in the presentation.
- Evidence to back up Key Message 1
- Intro slide to set the scene, to get audience on same page.
- Average cost over 4 years £100k-£140k…
- Average cost of 8 years residency is £200-280k
- Evidence to back up Key Message 2
- In future there may be greater scope for housing assets to support retirement. Home ownership has increased amongst older people. If as expected this trend continues, eventually around 80% of people over State Pension Age could be owner-occupiers. the value of housing wealth owned by people over State Pension Age could increase by around 40% from £907bn in 2009 to £1,274bn in 2030 (in 2009 earnings terms), based on reasonable assumptions about house price growth. UK housing wealth is unequally distributed: the top 10% of homeowners aged over 50 with the most housing wealth, own around 30% of UK housing wealth. Much of the growth in housing wealth is among pensioners who are over age 75. There could be a 70% increase in the value of housing that could be released in households where the head is aged over 75, from £124bn in 2009 to £211bn in 2030 (in 2009 earnings terms). Housing wealth is not equally distributed Housing wealth is unequally spread across the population. Although housing assets are the largest single asset held by many people in the UK, more than 20% of people over State Pension Age (SPA) have no housing wealth. The distribution of housing assets by region, age and other asset wealth show that certain groups are more likely to have housing assets than others. Regional differences in house values can affect the level of support in retirement Housing wealth is not uniformly distributed across the country . The average house price in London is just under £300,000, in the North East the average house price is £112,000. However whilst there is an uneven distribution of housing wealth the cost of care may well still lead to the need to use some of the equity, and poorer households still have many billions tied up in useable equity.
- The total cost to the state is not given in Govt accounts as funding streams are fragmented and routed through many different Govt depts. Most funding is through LA’s 7.21 billion and the benefit system 4.73 billion and the NHS spends about 4% of its budget 4.23 million on LTC for the elderly. Total LTC funding approx 16.17 billion in 2008 - 2009
- The older generation have had the ability to amass wealth through housing assets much more so than the younger generation are ever likely to. Student debt will naturally impact on the ability to purchase a property and future house price inflation may not be as high as it has been in the last 10 years. Student debt is estimated to be on average £15700.00 taking on average 12 years to pay off. Raising a deposit for a home is currently more difficult due to the need for lager deposits and lower LTVs The baby boomers in the main have benefited from DB pensions, High HPI and free education. Clearly it is not feasible for the younger generation to then pay higher taxes to cover the cost of this generations long term care needs.
- Some fear that taking equity release is too expensive, looking at the impact of compound interest over the longer term but often not taking into account the amount saved by not making monthly repayments, and the measurable benefits of this extra disposable income. There is an image of equity release being a complicated process which puts off advisers and customers, making it more difficult for a customer to find advice. No high street presence also has an impact on perception and availability, although over time the INTERNET may change accessibility and in turn customer perceptions. There is still far too much ignorance around the products and lack of knowledge about the safeguards. For instance SHIP members ensure security of tenure via the NNEG and some products allow you to ring fence an amount of equity for an inheritance, or in the case of a home reversion only a percentage of the home may be sold thereby ensuring customers can leave an inheritance if they so wish..
- High street brands are reluctant to enter the market due the supply issues therefore there is no presence of equity release on the high street where a customer can simply pop in and speak with an advisor. As there are relatively few advisors or companies operating in this market again it gives less choice for the customer. Advisers are not encouraged to enter the market as they see the process as too complicated and not enough return for their effort.