Demystifying In-Home Aged Care

When we think of Aged Care, most consumers think that it means moving into residential care (nursing homes) until the end of life. People who enter residential care have to face their own mortality. Commencing the process to look for Aged Care can be daunting. There is fear, uncertainty and doubt. It tends to bring on feelings of being overwhelmed and anxious. It brings up discussions that most of us are not comfortable with. The big question is ‘where do you start?’

You will need to investigate, research and understand what’s available for you and how much is it likely to cost. And with a tsunami of ‘baby boomers’ coming and all be looking for aged care, working with professionals to plan early is your best solution.

Entering residential care may not be the consumer’s wish, but in reality some people have no option due to their high care needs, fiscal restrictions or severity of illness, injury or disability. Residential care facilities are suitable for people with high level care needs and also end of life care. There are some good quality care facilities out there, but how do you choose the right one for you? How do you know if the care being provided is of top quality?

Many people are unaware that there are other options available for aged care. Financial advisers, accountants, estate planners, lawyers, social workers and GP’s are now being educated to start difficult discussions of care options with their consumers and patients. We are working with them to educate them not to be ‘blinkered’ about advising people to sell their homes and move into residential care.

Other care options include, but are not limited to retirement living which allows people to live independently until care is needed (with care available on site at some villages or out-sourced when it’s needed), group homes (mainly for dementia care for up to 10 residents at this time), assisted living, respite care, hospital in the home and in home care. My main aim is to assist people to remain in their home for as long as possible.

Staying in your own home may be easier than you think and working with your trusted advisers and your family means that together we can make a plan to make your wishes happen. The Government is encouraging consumers to remain at home for as long as possible. They have developed Home Care packages to assist people but not everyone is able to obtain one. The amount of funding from the Government is minimal. The Government only has ‘one bucket of money’ and they are hoping that those with their own financial means will pay for and obtain their own care. Government funding will allow those from low socioeconomic means to receive the care they need. It is recommended that you and your trusted advisers investigate what you can receive from the Government prior to paying for supplementing care with a ‘fee for service’ provider.

If the consumer is entitled to receive a package, how do you know that it’s enough help? From my many years experience in the industry, it’s usually not enough assistance. Even the DVA (Dept of Veteran Affairs), which has a slightly more generous amount of support, many times falls short. The consumer, their family or designated representative will need to ensure there is adequate coverage for care but if not, you will need to advise them they may need to consider outsourcing additional care / support services, particularly if family are working full time or the primary carer is ageing too and it’s affecting their health and well being.

From my 30+ years experience I can tell you that most people wish to remain at home if they can. In most cases we make that happen for them. In-home care allows you to remain at home for as long as you want. You receive all of the support and services you might need to live independently, healthily and safely, in the comfort of your own home. Yes, it is possible for you to gain your wish to remain at home with quality, accredited care, even if you don’t have access to Government funded packages.

The Government and every person working within the industry needs to educate the consumer and their families about their choices to obtain the best outcome. We need to take into account the consumers care needs but also what their wishes, wants and goals are.

How do we encourage and enable the consumer to participate in this conversation? We all need to be ‘planting the seed’ early about aged care and the options available. People in their 50’s and 60’s with ageing parents and relatives, need to have the difficult conversation with their parents and trusted advisers so that everyone is on the same page.

What usually happens is that a ‘life event’ or emergency situation occurs and the decisions must be made quickly. Usually not fully informed, the decision may not provide the best outcome for the older person. The hospital or rehabilitation facility requires the bed and they hand the family a ‘list of residential care facilities’. It is then up to the family to sort out the maze of facilities, vacancies and costs involved for their relative.

When the family have not research or planned they are not at all prepared or equipped to consider options, they end up quickly admitting their relative into any aged care facility. Too often the long process of finding a better, more suitable place only then commences. It becomes tiring, frustrating and extremely stressful for all family members and their advisers. Many of who are already time poor and unable to dedicate the very time consuming and costly navigation of the aged care and disability care systems. We do not believe that this is an acceptable or desirable outcome.

Some forward thinking corporations are now offering financial or subsidised ‘employee benefits’ to enable the employee to pay for commercial assistance to navigate the aged care system. Instead of taking the usual 3 to 4 weeks off work to sort out ‘caring’ responsibilities, the employee takes minimal time off. It’s definitely a good ‘business’ case to increase employee productivity and engagement by providing this benefit.

One of the easiest questions to put to someone who is ageing is “Have you thought about what your future in Aged Care looks like?” Even someone in their 50’s is vaguely thinking about where they want to be and whom they wish to be cared for.

Once the decision has been made that a family member would like to remain at home, how do you go about obtaining care and assistance that is right for them? How will you know how much it will cost? What sort of care and assistance do you need? Do you need someone to guide and assist you through the maze?

With the changes being made to the Government Funding, the care provider will no longer be receiving the funding to disburse services as they see fit but it will be the consumer in charge of their own funds (Consumer Directed Care) and the consumer will decide which provider they would like to use with total flexibility to suit their needs.

Firstly, a comprehensive care needs assessment needs to be undertaken. It can be performed by ACAT (Aged Care Assessment Team) organized via the My Aged Care website. This is Government funded. It often has wait lists and covers only the consumers care needs. Alternatively, an assessment can be undertaken by a private assessor or placement consultant who charges a fee for their service.

The private assessor ‘assessment and overview’ is more of a holistic approach and does not just cover the care needs, but also the social and psychological needs and wants of the consumer. As well as looking at their physical abilities to undertake their activities of daily living (bathing, dressing, toileting, feeding, transportation to appointments etc), the private assessor looks at their social likes and dislikes.

This same holistic approach includes a review of the environment and accommodation that they are living in. Ensuring that, if required, there is there room for a carer, whether the bathroom has got adequate access, whether there are ramps, rails or other equipment required. The home is now regarded as a workplace and a risk assessment is undertaken at the time of the assessment. The home needs to be safe not only for the consumer but the carers they have in their home.

After the assessment there are various considerations as to whether you are entitled to a home care package. Your level of care, eligibility, area you reside in and the service provider you select all determines if you are able to obtain a Government Funded package. Some providers have waitlists. Service providers are not allowed to charge you if you are added to a waitlist.

Essentially the support the Government offers is minimal. Depending on the provider you select, case management and admin fees, even the highest level of funding (ie: ‘level 4’) for in home care only allows for approximately between 10 – 20 hours a week of assistance (depending on the care providers fees and charges).

If you want or need additional care, it is likely that you will need to finance that yourself. Usually this is achieved via cash reserves, assets, superannuation, investments or family funding. Although, it is not uncommon for the family to provide ‘hands on’ supplementary care themselves.

The consumer also needs to be aware of and consider their legal obligations in relation to wills, an Enduring Guardian or Power of Attorney. A good estate planner / lawyer should be able to assist the consumer with these documents. If a life event occurs and there is no Power of Attorney or Enduring Guardian appointed, it means another whole process dealing with the Guardianship Board before anything else can happen. Should your physical or mental capacity alter, you will need someone to act on your behalf. Be prepared!

It is a good idea to speak with your trusted financial advisers or accountants about your personal and how much money you will have available to spend on your care. It is essential to know beforehand so that the care can be tailored not only for your care needs as well as for your financial situation and lifestyle requirements. The amount and type of care you get for your money is worked out once care needs are assessed and cash flow forecasts are undertaken. Every consumer is different.

Often the questions posed to the advisers are “Will I have enough money to last my lifetime?” “Do I need to sell the family home or an investment property?” “Can I remain at home with care?” “Do I need to obtain equity release from my home to enable me to remain at home with care?”

Some forward thinking advisers are running consumer seminars, morning teas, lunches, or evening events and get speakers in to discuss care options available to them. If your advisers are not offering this value added service, ask them to consider it. Advisers need to work with the consumers and aged care navigators to see what the consumer can afford and what they really need and want.

For in home care, we work with the consumer directly alongside their adviser to navigate the most appropriate and accredited care provider for their needs. We attend family meetings with the advisers, the consumer and the providers and after the meeting discuss the pros and cons of each provider with the consumer, their families and advisers. We act as a conduit between the care provider and the family. We can “hand hold” the consumer each step of the way and provide them with peace of mind knowing it’s their choice where to age. It is a very personalized service being offered.

All advisers must remain impartial and transparent throughout the process. All providers introduced have been vetted, selected for their quality of care and are accredited. They employ their carers and manage the employee / employer responsibilities for the consumers including insurance which is removing the risks away from the consumer.

Accessing in home care is a minefield. There are literally thousands of care providers out there...how do you choose a good one?

If you wish to navigate the process yourself, undertake the following:

• Check the care providers website and read their testimonials
• Find out how long they’ve been operating in business
• Do they have commercial premises or do they work from home on a mobile phone?
• What geographical areas do they cover?
• Are they accredited?
• Do they work with Culturally and linguistically diverse consumers?
• Do they have Home Care packages in your area?
• Do they work with the LGBTI community? (Lesbian, gay, bisexual, transgender and intersex)
• Do they offer registered nursing care and end of life care?
• Do they have qualified carers?
• Can they assist with complex care needs?
• Can they provide care from hourly through to 24 hours a day, 7 days a week?
• Do they employ their carers or do they use contractors
• Do they answer their phone professionally and call back when they say they will?
• Have you heard good reports about the provider from other people?

In days past, advisers would assist the consumer with the financial side of their life and let the consumers navigate the minefield of care options on their own. There are now options to work with private assessors and placement consultants to provide a value added service to the consumer. Yes, it is an added cost to bring someone else into the picture, but it alleviates the advisers from having to provide the service themselves or for the consumer to struggle through the process.

Advisers may already have an affiliation with a quality in home care provider or a residential care facility or a retirement village, but that is limiting the consumer’s choices. You can do all the homework for the consumer or consider outsourcing the guidance and placement service to an experienced person. Close the gap and provide a value added service to the consumer.

Communicate and listen to the consumer and their family. Really listen to them as to their wishes, wants and needs and work with them to achieve the best outcome. Each consumer has different needs and wants and it’s our job to ensure they have a great outcome of their choice, not yours or my choice – their choice!

About Danielle Robertson Consulting;

With over three decades of experience in the Aged Care and Disability Care industries as well as being an Expert Witness on the Cost of Care, I mainly work with financial advisers and planners, accountants, lawyers and estate planners, social workers and GP’s navigating and assisting their consumers/ patients, family or friends with options for Aged Care.

Additionally I am working in the corporate sector where employers are now supporting employees who have dependent relatives (Aged disabled or standard childcare) to find care and assistance.

Author: Danielle Robertson

Email: [email protected]

Website: www.daniellerobertson.com.au