In Britain, a Debate Over Care for the Elderly [removed]//
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LONDON — Every Tuesday, Janet Isobel Bishop walks the few blocks from her rented one-bedroom apartment in Notting Hill to a painting course, followed by tai chi lessons. The classes are paid for by the British government, just like the weekly one-hour visits she receives from a caregiver, who also helps her clean her home.
Enlarge This Image [removed]pop_me_up2(" Jonathan Player for The New York Times
Janet Isobel Bishop says home help would let her stay in her London apartment. A proposal before Parliament could give it to her.
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Clutching her walking stick, Mrs. Bishop, 85, says she would never move into a nursing home because she resents "people knowing exactly where I am all the time."
Yet ever since six months ago, when she was trapped in her bathroom, unable to walk, for about an hour until a neighbor heard her screams and summoned help, she has wanted additional support at home. But she cannot afford to pay for it. Her three daughters have full-time jobs and can visit only on weekends.
Governments across Europe are struggling to cope with the needs of rapidly aging populations at a time of shrinking revenue.
Prime Minister ?inline=nyt-per" Gordon Brown , who is facing a tough election, probably this spring, has pledged free home care for elderly people with "severe care needs" in England and Wales, regardless of a person's financial situation. The change would be a fundamental shift from the country's traditionally means-tested system.
But the plan is already proving controversial because it would require additional spending when Britain is under pressure to substantially cut its record budget deficit.
The government estimates that 400,000 people would be eligible for free home care, at a yearly cost of £670 million, or $1 billion. That would come on top of the £15 billion the government already spends each year caring for the elderly in England, including people like Mrs. Bishop.
Most of the care for the elderly is still provided by relatives and friends, while state-financed care is available only for those with low incomes. As a result, many pensioners are forced into poverty or into selling their houses if they move into a nursing home.
In Europe, there is a growing consensus among lawmakers that such a system creates "perverse incentives" by discouraging saving, said Jon Glasby, professor of health and social care at the University of Birmingham.
In the Netherlands, people can insure themselves against future care costs; in Germany, taxpayers are required to pay a percentage of their income into a fund that later covers their costs.
Mr. Brown's plan, which is being debated in Parliament, will come to a vote before October. If it is approved, free care could soon become available in Britain and be a first step toward creating a national long-term care system for the elderly alongside the health care system, which has provided Britons with free medical care for 60 years.
Mr. Brown's government said the changes would make the system fairer and reduce some of the cost and the strain on hospitals and nursing homes.
Some "older people in hospital linger when their treatment has been completed because the services they need to return home — nursing care, rehabilitation and simple domestic support — are difficult to organize or simply not there at all," Mr. Brown said in a speech last month.
But some lawmakers called the policy proposals a ploy intended to win votes before the general election. Skeptics also raised concerns about the costs of free care, pointing to Scotland, where some home care has been free since 2002.
Scotland offers the service to about 55,000 people but has been under pressure to curb or scrap it as costs have spiraled.
Those costs rose to £358 million in 2009, up 11 percent from a year earlier and almost triple the £125 million a year originally earmarked to support the service, according to Scottish Parliament figures. An auditor's report suggested costs could reach £500 million in two years.
Jenny Owen, president of the Association of Directors of Adult Social Services, an industry group, accused the British government of "significantly underestimating the true costs involved" and estimated costs would be twice the original forecast of £670 million.
The local authorities in England, which — unlike in Scotland — are expected to pay about a third of the plan's costs by cutting spending elsewhere, also complained.
David M. Finch, a cabinet member in the Essex County Council, northeast of London, agreed that the current care system needed urgent reform.
