In Liverpool I saw the tough choices Louise Casey faces on social care – starting with who will pay? | Polly Toynbee

Preparing her first report on England’s social care system, the peer says ‘everything is on the table’. This should include older people’s wealth, rather than taxes on younger workers

Residents with advanced dementia lined the day room, glazed stares or sleeping mouths agape, with that terrible human vacancy everyone most fears for their own end days.

This was Millvina House in Anfield, Liverpool, which I visited with Louise Casey, who is heading the commission on social care in England, last week. Here is a snippet of what she saw: an angry man jolting into life, shooting out his arm at her and bellowing: “Out! Get out! Get out!” A young care assistant went to stroke his back and calm him down. It’s a hard job, and part of it is watching for warning signs of aggression, one of dementia’s dreadful symptoms. “People don’t want to know,” Casey said, “but if you are born, you will die. Chances are you will need care, and dementia is the biggest killer.”

Polly Toynbee is a Guardian columnist

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