Professor June Andrews is author of Dementia the One Stop Guide.

LAST month I made a BBC Radio Scotland documentary called The Care Home Dilemma.  We interviewed families living with the prospect, or the consequences, of moving an older person into a care home. Some spoke of a time when “the family” took care of their own. 

Those we interviewed sometimes expressed guilt, as if the care home move indicated family failings. In economic terms, “family care-giving” in the past was more accurately “women care-giving”. 

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Frail older people were relatively few, short-lived and looked after by female relatives. Now with the rise in numbers of dependent older people, it still makes financial sense for a family member to do the elder care if they can, rather than work outside. In some cultures, the daughter or daughter-in-law at home does it. 

READ MORE: Elderly ‘need home support not hospital’ that could save billions

Where women can access better-paid jobs, and families are smaller, institutions like care homes are necessary. 

Retired children provide care as long as possible, sometimes becoming frail and ill in the process. It is not a question of family values, but the complexity and cost of caring for our new, very old population.

In Hong Kong, you can access cheap labour – a female, live-in, overseas domestic worker to care for your parent. 

There is no economic sense in leaving a job to provide 24/7 family care unless you are very low waged. But how much should we pay?  

Rising demand, improvements required by regulators and the living wage are increasing costs exponentially. Do you expect care for frail older people to be provided free by the state, as it was for a short time last century? Should children have to pay for it, as in Singapore, when the parent’s money runs out? 

I see a marked shift from state responsibility to personal responsibility for age care throughout the developed world.  The care home I fancy costs £1,500 per week. I will have to sell my house, and use my savings for that. In the absence of money or property, the local authority would fund something for me, within their price limit. Currently that is set nationally in Scotland at nearly £650 a week. 

In England, the amount the local authority pays is often below any home’s fee level, so the family must “top up” with cash.  Scotland is headed in the same direction. Affluent people complain about fairness because they worked hard and saved, and now pay for care, while others get it free. They should be glad.  In some cases, in England, you’d not actually want what the state offers for free. 

Families are relieved to have the means to buy decent care.  My generation often owns property because of “Right to Buy” bargains, or houses that rocketed in value in our lifetime. But what about the next generation, who might never afford to buy?  What will they sell for care when their time comes? 

Care prices are rising. Demand is rising in line with the increasing elderly frail population. Yet in the UK care homes are closing, because costs are hard to control and it’s a tough business. There are difficulties in recruiting staff that won’t be helped if Brexit repels low skilled overseas care workers. The role is complex and challenging now residents mostly have dementia and intensive personal care needs.

Staff turnover increases costs through agency cover. State-funded care home care is in a way already rationed – it is limited to the most dependent in the last 18 months of life. Even affluent families fear running out of cash before the end.

We need a reality check. You can only do so much by living healthily. A fall, followed by hospital, can be a fast track to a care home. Plan now what to do if you ever need care. Without system reforms, we will widen the gaps between the current tiers of care; fabulous care for the rich, decent care that strips your family wealth for the affluent middle, and something unpleasant for those at the mercy of the future state.  
Other countries have laws obliging children to pay for their parents.

Even here local authorities check if parents have squirrelled away their wealth and children must return it to pay for care. Insurance for this can’t be bought. Death tax looms. Calls for assisted suicide will be more about care costs, than fear of frailty.

READ MORE: Elderly ‘need home support not hospital’ that could save billions

Not everyone will need a care home, but if you ever do, you may wish you voted for greater taxation and higher local authority rates so we’d all share the cost.