Aged Care - iPad version

Aged Care

The complete Australian guide

The most authoritative aged care text
A how-to-guide to accessing and maximising aged care whether that be in your own home or in a nursing home
This book is written for the "care-receiver" and the "care-giver"

Aged Care - Paper version

Aged Care

The complete Australian guide

The most authoritative aged care text
A how-to-guide to accessing and maximising aged care whether that be in your own home or in a nursing home
This book is written for the "care-receiver" and the "care-giver"

Aged Care - iPhone version

Aged Care

The complete Australian guide

The most authoritative aged care text
A how-to-guide to accessing and maximising aged care whether that be in your own home or in a nursing home
This book is written for the "care-receiver" and the "care-giver"

3840

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days to paperback edition

What you will discover

Home Care or Nursing Home

As Mum becomes more frail there is a range of options to choose from;

  • downsize or move into a retirement village;
  • arrange for help at home either privately, or through a government package;
  • permanent residential nursing home care.

How to choose which one is right for Mum?

The process

Mum's care can be arranged privately but this would mean that she would pay full fees for every service she needs, otherwise to obtain funding assistance she will need to arrange for an aged care assessment of her needs.
The assessment will determine the level of the governments financial contribution to her care and how much she will have to pay from her own resources. Armed with this she can begin the search for suitable accommodation at a budget she can afford.

Formal stuff

Legal issues such as: powers of attorney; medical power of attorney; wills; the aged care needs assessment; the rights of individuals in care, their responsibilities and the mechanisms for complaints.

Financials

How do I pay the entry fee? Do I have to sell my home or can I keep it? What are the different types of ongoing fees and can I afford them? How can I reduce the costs?
Strategies to handle these concerns and answers to the most commonly asked questions are addressed.

Checklists

Detailed lists of things to check for in the homes you visit. Be guided by these if you are really pressured for time. Otherwise use them in conjunction with the book.

Resources

These include: sources of support services and places to go for additional information, links to find accredited aged care homes, where to arrange for an governmental assessment of care needs throughout Australia.

Video reviews

Interview with Val Nigol – Author of ‘Aged Care – The complete Australian guide’

Sample pages from the book

Preface

This book is intended to be a one-stop shop. A how-to guide to the process of accessing and maximising aged care whether that be in your own home or in residential care. It has been written for you, the carer and/or the care-receiver. It has been designed to dip in and out of as the need arises and to step you through the processes. To that end it has been structured in four parts or sections:

  • Part 1 covers criteria that are common to both home-based and residential care,
  • Part 2 talks about home-based care, 
  • Part 3 looks at residential care, 
  • Part 4 provides many resources including checklistsfor care homes.

As with any specialist field, there are many abbreviations that are specific to the aged-care world and there is a Glossary of these at the end. The anecdotal stories are all true but some names have been changed to protect individual privacy. The word ‘Mum’ has been used throughout to signify the care-receiver. This is primarily to make the book easier to read, but none of this is intended to preclude or offend Dad, other relations or friends, or couples. If the English language had a word for a genderneutral elder which implied dignity and respect, then I would have used that word instead.

Over time things will change, particularly the financial details. For the most up-to-date information, you should check the appropriate websites (including mine at www.agedcarefinfree.com.au) or with Centrelink. For financial issues, I strongly
recommend that you consult Centrelink or an independent financial advisor who specialises in this area. For legal issues, you should seek the appropriate professional advice.

Where medical information has been given, the quotes are from experts. If this material raises any queries or issues for you, then I suggest that you consult an appropriate medical practitioner.

The financial advice comes from a qualified specialist and the practical processes have been enhanced by the experiences of aged-care experts.

Lastly this book has been written independently of any organisation or sector in the agedcare industry.

Chapter 4, Care Packages

To access the services you need find a local provider and discuss your needs. A search facility is available at www.myagedcare.gov.au/service-finders#block-findercommunity-care-finder-communitycare. The provider will visit and carry out a simple assessment and if you have a carer, they should be present for this. This will determine what services will best meet your needs and what the fees will be.

Fees are usually small and are based on your income, the number and type of services you want and unavoidable expenses like rent, medicines and utilities. All providers must make allowances for hardship.

All HACC service providers support people from linguistic and culturally diverse backgrounds and some HACC providers specialize in these areas.

Home Care Packages

The objectives of the Home Care Packages are:

  • to help you to remain living at home for as long aspossible, and
  • to enable you to have choice and flexibility in theway that care and support is provided at home.

There is no minimum age requirement for eligibilitypurposes, but the home care packages are targeted at frail older people.

Consumer Directed Care (CDC)

This is now the philosophy underpinning the government’s home-based care. CDC is a way of delivering services that allows you to make choices about the types of care and services you receive and how those services will beprovided. You are encouraged to  identify personal goals which could include independence, wellness and re-ablement. These will form the basis of the Home Care Agreement and care plan.

You will decide the level of involvement you wish to have in managing your package which could range from involvement in all aspects of the package to a less active role in decision-making and its management. The care-provider should also undertake ongoing monitoring and a formal re-assessment (at least every 12 months) to ensure that the package continues to be appropriate.

Process

The system is quite straightforward. Once your ACATassessment has approved your home care package you just follow these simple steps:

  • Find a care provider
  • Agree a care plan and budget
  • Sign a Home Care Agreement
  • Start care
  • Regular review of plan and fees

Chapter 6, Homes

Types of homes and care

There are a range of types of homes and different levels of care provided by both accredited and private homes. Sometimes different words are used to describe the same type of care, just to confuse. So it is worth looking briefly at these before we move onto the details for each:

  • permanent care covers personal care, nursing needs and dementia
  • specialist care is available for people with dementia or other psychiatric conditions or possibly vision and hearing impairment.
  • extra-services homes provide a more luxurious standard of accommodation and facilities (but the same standard of care) for an extra cost. These are available for both low and high care but the vast majority are high care.
  • respite care is a short-term stay in a residential home.

As well as looking at these in more detail, there are a few other types of care which exist for specific situations and we will cover these too . All the following (except respite care) require an ACAT assessment to determine the level of care needed.

Respite care
Respite care is short-term care usually taken to recover from an injury or illness or to give the carer a break and Mum is entitled to up to nineweeks per year. Once Mum has her ACAT paperwork, she can book into respite without any medical need. For low care assessments, this is a useful ‘try before you buy’ strategy to see if Mum can adapt to the lifestyle, although not all homes offer respite care.

Your GP can help you find a local home or the Commonwealth Respite and Carelink Centre has a directory of providers on its website at www9.health.gov.au. or phone 1800 059 059.

Permanent homes
From 1st July 2014 homes can provide one or more of:

  • low-level care – personal and domestic care,
  • high-level care – akin to nursing care in addition to low-level care,
  • dementia care – specialist facilities.

Dementia care
This is a specialist care which caters for residents with high levels of dementia or other forms of mental or cognitive dysfunction. These homes will have specialist dementiatrained staff and higher levels of security. Residents receive the same care as provided in general homes plus additional dementia-related practices and services. Given that 45% of all new residents have dementia as their primary health problem, there are increasing numbers of dementia-care units available.

Extra services
Some aged-care homes choose to provide higher standards of accommodation, food and services for an additional daily fee. However, the level of care will be the same because all homes are obliged to provide this to the same standard. These homes are increasingly offering suites or double rooms (rather than a single room) which can include a kitchenette and a separate living room. The single rooms may also be larger than normal.

Chapter 8, Financial Strategies

If Mum is particularly well off with enough income-generating assets, she might choose  periodic payments as a deliberate strategy to maximise her finances. This assumes that the home is agreeable. Most homes prefer a lump sum payment, so you might have to argue your case, possibly on the grounds that some disadvantage or hardship would occur if you had to make a lump sum payment. An example could beif Mum’s assets were tied up in the family business and to free up cash would causehardship for the business.

Installments

If Mum was faced with a bond of $180,000 and had immediately available funds of say $80,000 she could do a combination of both. She could pay the $80,000 as a partpayment of the total bond. She then makes a final payment on the remaining $100,000
(the interest payable is currently 6.6% pa) once those funds become available – with the home’s agreement.

Strategy 3 – pay a larger bond

If Mum paid a higher bond for a better home, or a better room in a home, or if Mum negotiated to pay a higher bond than the home originally asked for in exchange for a reduction in her daily fees, it could result in reducing her ongoing income-tested fees. This
is because the bond amount paid is exempt from boththe income test and the assets test. Her pension may also increase for the same reason.

Diana’s story

Diana, a Centrelink age pensioner, moved into an extra-services care home and was asked to pay a bond of $550,000. She sold her home for $850,000 leaving her with $300,000 available for investing.
A financial planner suggested to her that if she was willing to pay a higher bond than the $550,000 being asked for, then he could negotiate a reduction in daily fees for her. He recommended a bond of $850,000 on the basis that the care home then reduced its extra-services fees.

He calculated that the savings in the extra-services fees and the reduced incometested fees, together with the resultant increase in her Centrelink pension would bring a better financial outcome than investing the $300,000 elsewhere.

Lesson: Sometimes paying a higher accommodation bond is the most advantageous financial solution.

Strategy 4 – income-friendly investments

Investments that produce an income (such as annuities) may be an alternative to retaining an investment which would be included in the deeming rules. This is because a portion of the income will be a repayment of part of the original investment. This is called a
deductible amount, and it reduces the level of the assessable income which is included when the income-tested fees are calculated.

Chapter 12, Ongoing Care Concerns

The home may want Mum’s room cleared out within 24 hours of her death. This is obviously going to be particularly stressful at such an emotional time so anything you can do in advance is to be recommended:

  • start removing some of her belongings. This is moreappropriate for things like photos, valuables, items of sentimental value that you wouldn’t want to be lost.
  • take in a suitcase or two for packing up Mum’s belongings. In the heat of the moment, and often at short notice, this is not something you are likely to think about. (If you haven’t done this, Mum’s effects could end up in a plastic garbage bag in a store-room – she deserves better.)
  • when you are packing up her belongings, remember tocheck pockets and lapels for small items like brooches and watches, before you ask thestaff because you assume they are missing.
  • the home may require that Mum’s furniture is also collected within 24 hours. If you are unable to do this, they may be at liberty to dispose of it.

After death

Once Mum has died, the home will call the doctor for confirmation and the death certificate. They will then call your designated funeral director andhe will arrange to move Mum’s body to the funeral home.

You will then be asked to pack up Mum’s possessions. If Mum dies in the middle of the night, or you are unable to come immediately, they may pack them for you and store them until such time as you come to collect them.

Staff will assist you if they can, but be prepared that this is a time when the practical efficiencies of running a home has to work side by side with grieving and highly emotional relatives. If you can’t face doing it yourself, either get a friend or other family member to go, or leave the staff to do it for you. Whilst all this will surely feel cold and commercial, the home’s interest now lies in admitting the next resident. They have done all they can for yourMum, and it is now someone else’s turn.
If Mum has been a long-standing resident then don’tforget to advise the home (staff and other residents) of the funeral arrangements, as many of them will have become fond of Mum. Staff, like relatives, also need to have the opportunity to grieve. If any special carers weren’t on duty when Mum died, they would have missed the chance to say goodbye.

Peter’s story

Peter’s Mum was resident in a country-town nursing home for several years before she died. In the months near the end of her life she had troublesleeping.

One particular night nurse realised this, and in the small hours, she would come and sit with Mum. Over those months they had many long conversations about the changes that occurred during her nine decades of life. Very quickly this nurse became a special friend.

In due course Mum died. By the time this nurse cameon duty at 11pm, Mum’s body and her belongings had been removed. What opportunity was there for this dedicated nurse to say goodbye to her now-friend? Fortunately, she was able to attend the funeral to give her own good-byes. But before this, Peter didn’t know that this wonderful friendship even existed.

Lesson: The night staff may well contribute more than you ever know to Mum’s well-being, so don’t forget them.

Chapter 13, Dementia

There are many other symptoms and each person will have individual needs. For comprehensive and up-to-date information, advice and support, see the Alzheimer’s Australia website on www.fightdementia.org.auor phone their National Dementia Helpline on 1800 100 500.

Deciding on residential care

As with all decisions to move a loved one into care, this is a particularly stressful and difficult process. The best place to start is with an ACAT assessment (see Chapter 4)to determine whether Mum requires residential care. The ACAT team should provide you with names and addresses of suitable aged-care homes for you to visit. You and the family can discuss any concerns or issues that you may have with the team. Although your choice may be limited to specialist facilities, there are increasing numbers of homes providing dementia care.

Specialist dementia homes or units

While general aged-care homes cater for residents with some degree of dementia, others provide more targeted dementia services. These homes generally have staff who are specialists and separate units or wings that have been specifically designed for person
living with dementias who may not otherwise be safely accommodated in a general care home. They are also likely to have noticeably higher levels of physical security both in the buildings and around the grounds. This is not for any imprisonment-type reasons, but rather to protect those residents who are prone to wandering.

There are many factors to weigh up when you are assessing aged-care homes. A general checklist is given in Part 4 plus an additional list with dementia-specific criteria. You should use both of these lists if possible. There are also Help Sheets available from Alzheimers Australia at www.fightdementia.org.au/understandingdementia/section-4-residential-care-and-dementia.aspx

It’s also possible that your preferred home will not have a vacancy. If this is the case try not to be pressured into accepting the first offer you receive and keep in touch with your preferred home in case a place should become available.

Alzheimer’s Australia produces a checklist and fact-sheets that may help you choose a home. You can get a copy by calling the National Dementia Helpline on 1800 100 500or by visiting the Alzheimer’s Australia website at www.fightdementia.org.au.

Planning for the move

People living with dementia can be disturbed by change, so if possible introduce Mum to the new home gradually, so that the place becomes alittle more familiar and less confusing and frightening.

Sometimes this is simply not possible, especially if the move has to be made quickly, but even then, it’s important to emphasise the positiveaspects of the move, such as the possibility of making new friends and enjoying new activities. Over time, and with careful
planning and sensitive handling, you should find that Mum will make the adjustment. If you have concerns about the move, talk to the DON.

Choose a chapter

  • Preface

    -
  • Chapter 4, Care Packages

    -
  • Chapter 6, Homes

    -
  • Chapter 8, Financial Strategies

    -
  • Chapter 12, Ongoing Care Concerns

    -
  • Chapter 13, Dementia

    -

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Chapter overviews

Messages from readers

Sue Field, <small>Fellow in Elder Law, University of Western Sydney</small>

Sue Field, Fellow in Elder Law, University of Western Sydney

At last – a comprehensive guide to assist families and carers to understand and work their way through the mire known as aged care.

Dr Steven J. Enticott, <small>Principal CIA tax</small>

Dr Steven J. Enticott, Principal CIA tax

We cannot recommend this book highly enough – for many years since the first edition we have used it extensively at CIA tax as our number one source of knowledge in advising our clients at a time when they need it most, when a loved one is contemplating the next stage in their lives, just buy it and in most cases the cost will be tax deductible!!!

Anthea Wynn

Anthea Wynn

I had to find a care home for Mum in a great hurry as the hospital wanted her bed. Her assets were small and I found a home whose bond was double what she could afford. Using the book as my guide I contacted Val. His ability to negotiate the bond was just amazing - he got it down to less than half the asking price and Mum was able to move in. That was exactly the support I needed at such a stressful time.

Camille Barker, <small>Chief Executive Officer and Director of Nursing, Mary MacKillop Aged Care</small>

Camille Barker, Chief Executive Officer and Director of Nursing, Mary MacKillop Aged Care

This book captures all the information you need in one publication. Val has combined years of experience, conversations with families into a very easy to read book.

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About the author

Val Nigol

Val Nigol is a Financial Planner and Chartered Accountant with more than 35 years experience in the financial services industry.

His career has spanned accountancy and taxation as a Chartered Accountant with several leading accountancy firms. He formed his own financial advice business over fifteen years ago and is a specialist in aged care advice and post-retirement financial planning.

Val’s unique contribution to Aged Care are the up-to-date explanations of the complex rules and costs, together with mix-and-match strategies for families to consider when they are faced with moving a loved one into care. He has brought to life what might have otherwise been a “dull” text with real life “stories” of his experiences, making the messages in the book practical as well as easy to read and relate to.