Aged Care - iPad version

Aged Care

The complete Australian guide

The 7th edition of the most authoritative text on the process of receiving government assisted aged care either at home or in an aged care facility.
The first edition was published in 2008.

Aged Care - Paper version

Aged Care

The complete Australian guide

The 7th edition of the most authoritative text on the process of receiving government assisted aged care either at home or in an aged care facility.
The first edition was published in 2008.

Aged Care - iPhone version

Aged Care

The complete Australian guide

The 7th edition of the most authoritative text on the process of receiving government assisted aged care either at home or in an aged care facility.
The first edition was published in 2008.

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

Chapter 2: myagedcare gateway

There are three types of aged care available through the government system:

  • Basic support in your own home. This is called the Commonwealth Home Support Programme (CHSP) and it offers a range of services covering domestic help, personal care, social support and allied health services.
  • More complex support in your own home. This is called a Home Care Package (HCP) and it provides all of the same services as a CHSP but in a co-ordinated manner.
  • Residential aged care where Mum moves permanently into a care home which provides for all her needs when she is unable to continue independently in her own home.

You can only access these programs through the Australian government’s myagedcare gateway either through its website or by phoning its Contact Centre. Unless Mum is a DVA client (in which case she has to access to all the same facilities through the DVA) then this gateway is now the single and only place that you can access any of the services. This is irrespective of whether Mum only needs a podiatrist once a month right through to needing a secure residential home for advanced dementia.

The following diagram is intended to guide you through routes of the most popular parts of the myagedcare system. The abbreviations are explained in this chapter and are in the Glossary at the end of the book.

Chapter 5: Home Care Packages

Consumer Directed Care (CDC)

All Home Care Packages (and from 2017 residential care) are founded on a philosophy called consumer-directed care which means that in theory you or Mum are in control of what services she wants and when they are delivered. This is achieved by the government paying the subsidies to the care-provider but Mum has control over how she spends them. This allows her to make choices about the types of care and services she receives and who will provide
those services. She will be encouraged to identify her personal goals which could include wellness, independence and personal safety. These will form the basis of a legally binding Home Care Agreement and a care plan.

Mum will decide how much involvement she wishes to have in managing her package. This could range from participation in all aspects of it to a less active role in decision-making and its management. The provider should undertake ongoing monitoring and a regular reassessment of the plan. This is to ensure that the package continues to meet Mum’s needs which are likely to change as time goes on.

Suitability

A Home Care Package (HCP) provides the same range of services as the Home Support Programme but under an HCP these are co-ordinated because the recipient’s needs are more complicated than someone who is only receiving a couple of services periodically. The rules for access are also more complex and interwoven but there are no restrictions on eligibility.

The easy way to be fairly certain that a HCP is appropriate for Mum is to ask her these questions. If she can answer yes to any of them, then you or she should go ahead and phone the myagedcare Contact Centre to progress this:

  • is she an older person who needs some help to stay in her own home?
  • is she finding some aspects of living at home hard?
  • does she manage most of the time?
  • does she think that if she doesn’t get some help at home, she might have to go into an aged care home before she’s ready?

A booklet called Five steps to accessing a Home Care Package is available from the myagedcare website to guide you through this process. A print version can be ordered or it can be downloaded. The five steps are:

  • check Mum’s eligibility,
  • find an HCP provider,
  • work out the costs,
  • accept an HCP, and
  • begin the services

Chapter 7: Residential homes

Today’s big picture

To give you some idea of the profile of aged-care homes and their residents in 2014, let’s start by painting a picture of the Australian industry. While you may ask what this has to do with your own particular situation, having some broader understanding can give you an insight into the nature and structure of the homes even to the point of influencing your choices.

Firstly, over 270,000 Australians aged over 65 were in permanent residential care during 2014. This was 8% of the population. For a more detailed picture, the following figures are taken from the Australian Institute of Health and Welfare’s Residential age care and Home Care 2013-14:

  • male/female split: 31% male, 69% female
  • women: 62% widowed, 22% married/de facto, 16% single/divorced
  • men: 25% widowed, 45% married/de facto, 30% single/divorced
  • ages: 77% were aged over 80, 33% were aged over 90
  • main health reason for admission: dementia (67%)
  • other admission reasons: 47% low care, 40% with complex care needs
  • preferred language: 90% English
  • country of birth: 69% Australia, 31% overseas
  • reason for leaving: 78% death, 13% changing homes

Industry perspective

Although historically, residential aged care was provided by the churches and other not-forprofit organisations, by 2014 the shape of the industry moved on a long way:

  • number of places: over 189,000
  • number of homes: 2,688
  • number of providers of homes: 1016
  • homes with 60+ places: 50% (compared with 28% in 2004)
  • providers: 57% not-for-profit, 5% government, 37% for-profit
  • care offered: 60% high care only, 2% low care only, 38% mixed care

Chapter 10: The first weeks

Mum is going to take quite some time to adjust to her new surroundings and routine. At least a month, possibly several. She has been completely removed from her comfort zone and her own routine in the space of just one day. She is likely to be feeling grief and loss (of her independence, her home and possessions, her pets) and abandonment.

If Mum has come from her own home even if this was a small apartment, moving to live her whole life in a single room is likely to feel extremely restrictive to the point of being claustrophobic. Try to encourage her to use the home’s facilities, the lounge and outdoor spaces as well as taking part in their activities.

She may also be confused by the geography of her new surroundings, and feel overwhelmed that she has to make friends with all these unknown fellow residents. The dementia residents will have unpredictable and unusual behaviour which is a whole new lifestyle issue and potential irritant she has to learn to cope with.

The care home should understand Mum’s mixed emotions and take steps to help her settle in. However it is always a good idea to ask them how Mum is doing and if there is anything that you, her main carer, can do to help.

If Mum is in the home because the family has recognised the need for this move, but she does not see it or perhaps does not agree, then she is likely to also be resentful, frustrated or just plain angry. She may feel trapped in a situation from which she sees no escape. Over the coming weeks take her home for the weekend and let her try to manage on her own. The chances are she will not cope as well as she imagined and in time she will come to realise the benefits of the move. As one carer commented, ‘It’s the agony and the ecstasy. The agony of leaving your own home but the ecstasy of never having to cook or clean again.’

As the main carer, you too will have a period of adjustment to cope with. Initially take time out to recover, to recharge your batteries and indulge in a little pampering – you deserve it. Be sensitive to Mum’s situation through this time – she may react or behave differently each time you visit. This doesn’t necessarily mean there is a big problem or that she is reacting against you; it could just be part of her own settling-in process.

Chapter 12: Ongoing care concerns

Over the months that follow Mum’s health will inevitably change. Some things are to be expected as a normal part of the ageing process but there are other conditions for which you can get help. When information is offered in this chapter, it has always been taken from an informed source which will be quoted.

Depression

This topic has been included to encourage awareness of the potential for this problem. A proper diagnosis can only be made by a qualified practitioner but if you are aware of the symptoms, then you may be able to alert the staff or Mum’s doctor when the problem might have otherwise gone undetected.

The following is taken from the Australian Institute of Health and Welfare’s publication National Health Priority Areas Report, Mental Health, Chapter 2 (1998).

A depressed mood is ubiquitous, common and generally lasts minutes to days. The individual feels ‘down’, hopeless, helpless, pessimistic, self-critical and has lowered self-esteem. Such moods may be quite severe, but by themselves are generally brief.

Depressive symptoms are given below and these represent a reasonable list of common features:

  • depressed mood most of the day,
  • loss of interest or pleasure (in all or most activities, most of the day),
  • large increases or decreases in appetite (significant weight gain or loss),
  • insomnia or excessive sleeping,
  • restlessness as evident by hand wringing or similar activities, or slowness of movement,
  • fatigue or loss of energy,
  • feelings of worthlessness, or excessive or inappropriate guilt,
  • diminished ability to concentrate or indecisiveness, or
  • recurrent thoughts of death or suicide.

Chapter 19: Financial strategies

Almost everyone entering residential aged care will need to assess their financial situation carefully. Mum’s primary objectives in this regard are to minimise the means tested amount by reducing assessable assets and, linked in with this, to reduce assessable sources of income so that you can preserve her assets as far as possible. These objectives should be balanced with the idea that she will need to retain access to some liquid funds to help towards her living costs or other unforeseen expenses. These are likely to exceed her government pension even if she has modest assets.

Since 90% of people entering aged care are age pensioners (either Centrelink or DVA) it is particularly important to organise Mum’s finances so that her pension income and/or other benefits are not affected.

Eleven strategies are discussed in this chapter – these are typical, but certainly not exclusive and they are not in any particular order. Two or more strategies can also work together to improve Mum’s and the family’s situation. So cherry-pick from them to suit her needs and circumstances.

Variations and more complex strategies are all possible depending on her individual circumstances. But (and this bears repeating) if you are in the least bit concerned or confused (and you won’t be the only one), get professional advice. You only get one chance to get this right – you can’t go back and renegotiate the RAD or other charges later on or even more importantly un-sell Mum’s home once it has been sold.

Choose a chapter

  • Chapter 2: myagedcare gateway

    -
  • Chapter 5: Home Care Packages

    -
  • Chapter 7: Residential homes

    -
  • Chapter 10: The first weeks

    -
  • Chapter 12: Ongoing care concerns

    -
  • Chapter 19: Financial strategies

    -

Newly updated ebook edition NOW available!!

purchase

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.

Joanne

Joanne

What a fabulous resource! I have just placed both my parents into more formal care, my mother in independent living and my father in low level care. This book has been invaluable in helping me to discuss available options with my brother, and parents, and to plan and manage these moves, ensuring the minimum of stress and the best financial outcome for my parents. I highly recommend the book for anyone who is caring for a parent, anyone who is thinking it is time to move their parent to formal care or who is currently negotiating the path to placing their parent in permanent care.

Ros

Ros

I found this book so helpful that I have actually downloaded it twice. The second time was to make sure I understood the new changes coming in as of July 2014. It takes a complex subject and breaks it down. The only difficulty is that with the changes coming in, it can be a bit confusing knowing what applies to pre and what is post as Val has to address both for people under the different systems. I’ve referred heaps of people to it including the administrators of the homes I am going to as I try and find a suitable accommodation.

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Paper Edition

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  • The first edition was published in 2008 and to reflect the regular changes to the aged care system the book has been updated 5 times. It incorporates the major reform of the aged care sector in 2014 and has been expanded to include more than 30 real life experiences to illustrate key points in a very easy to read and understand style, a key feature of this 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.