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Becoming Old and Needing Care – What are their options?


Home care, residential care, private nurse? What are the practical options for Australians who need help with everyday living as they age? 

With some “admirable exceptions”, the aged care royal commission said recently in a damning report, aged care services are poorly managed, unsafe and uncaring. And yet, given Australia’s ageing population, many of us will require care as we grow older. 

What options are available to people who need care when they’re elderly? What are the costs? And how do you make sure you or your loved ones are getting good and safe care? 

How much care do families provide? 

The royal commission found “most support” for older Australians is provided by unpaid carers. Nearly three-quarters (73 per cent) of older people who needed assistance had help from family, friends or neighbours, a 2015 Australian Bureau of Statistics survey found. 

According to the ABS, about 9 per cent of people aged 80 and over live with “other relatives” (not their spouse). This is projected to increase to as much as 14 per cent by 2041. 


What if family help isn’t enough? 

The federal government has two main programs that help people who need care stay in their homes: 

  1. The Commonwealth Home Support Program (CHSP) provides entry-level support. It subsidises a wide range of services such as meal deliveries, help with showering, toileting and medicines, home modifications (such as ramps or rails) and home maintenance. 
  2. Home care packages include similar services to the CHSP but the care is co-ordinated. 

Theoretically, home care packages are for people with more complex needs – for example, someone living with dementia – but, in practice, there is a lot of overlap between the two schemes. 

To be eligible, you must be 65 or older; 50 and older if you are Aboriginal or Torres Strait Islander; or younger, if you are on a low income or at risk of being homeless. 

You also need to be assessed as needing the support. To start this process, you must register your interest through the federal government’s My Aged Care phoneline or through a health professional, who will arrange an over-the-phone and an in-person assessment. 

For the CHSP, the federal government subsidises most costs and payment is usually charged by the hour. While costs will vary,people might be out-of-pocket by about $15 for an hour of domestic help. This service is not income tested. 

Home care package costs will depend on the level of package you are given, and your income. You will pay a basic daily fee of up to $10.63, and may pay an extra fee of up to $30.49 a day, depending on your income. There may also be management fees from chosen service providers. 

There are caps on the income-tested fees. For those with income below $53,060.80, you won’t pay more than about $5550 a year. For those earning more than $53,060.80, you won’t pay more than about  $11,100 a year. No one will contribute more than about $67,000 in their lifetime. Total government help for a year for home care packages ranges from $8750 to $50,750. 

But the royal commission noted that people literally die waiting to receive a package (16,000 in 2017-18). The average wait time is more than a year for about half the people who are eligible for a level 4 (highest level) package. About a quarter of this group wait for about three years. 

As of June, there were about 120,000 people on the waiting list. 

To address the wait, some – but not all – people are offered a package at a lower level of care. It is also possible to get help from the CHSP while you wait for a home care package. 


What happens if home care is not enough? 

Going to a nursing home is “often a last resort and can be one of the most daunting of life experiences”, the royal commission noted. But, for some people, frailty or cognitive decline mean they need round-the-clock care. Nursing homes help with activities such as cleaning, laundry and meals, dressing and going to the toilet as well as providing nursing and other clinical care. They can also offer social activities. 

 There is a reason why there are financial planners who specialise in aged care. The fee system is complex but there are four basic components. 

  • First, you need to pay for accommodation. Going in, you will either pay an upfront lump sum (refundable when you leave) or a daily rental payment (which is not) for your room. You can also pay a mix of the two. The average refundable accommodation deposit is currently more than $500,000 in NSW and Victoria for a single room with its own ensuite. The rental payment is based on a maximum permissable interest rate, currently set at 4.98 per cent of the refundable accommodation deposit. 
  • Second, all nursing home residents have to pay a basic daily fee of $51.63. 
  • Third, there is an additional means-tested fee, which looks at your income and assets. You may not need to pay anything. The most you will pay here is about $28,000 a year and about $67,000 in a lifetime. 
  • Finally, there may be other fees for extra services provided by the nursing home (a bigger room, say, or fancy food or services such as Netflix). 

Luisa Capezio, an accredited aged care navigator and director at Phillips Wealth Partners, advises people to seek professional help when looking at aged care options and how to pay for them. 

The main message is, it’s not a one-size-fits-all. People really need to do their maths, and need a good team around them. Otherwise, you could make decisions you may regret, like selling the family home or assets that you don’t need to. 

There are professional aged care advice services, such as the one Capezio runs, across the ACT, NSW and Victoria. My Aged Care also has a fee estimator and the government has a free Financial Information Service through the Department of Human Services. 





How can I check a nursing home is safe and suitable? 

Initial indications from the royal commission are that almost a third of aged care services may not be up to scratch. The commission also heard evidence about the huge frustration people can face finding useful information about potential nursing homes. Expect to see recommendations around this when it hands it final report down at the end of 2020. 

There are eight minimum standards that all aged care providers (both nursing homes and home care services) must meet every three years to remain accredited by the government-run Aged Care Quality and Safety Commission. These include “consumer dignity”, personal care and clinical care. 

You can search the Commission’s database for audit reports and “serious risk” reports, which are made if a provider has failed the quality standards check and the Commission decides this failure places an aged care consumer at “serious risk”. The Commission also conducts “consumer experience reports” for different services, asking questions such as, “Do you like the food?” and “Do staff treat you with respect?” 

On top of this, My Aged Care has a “non-compliance checker” where you can see places that haven’t been up to scratch and what has been done about it. For example, Bupa facilities in Sydney’s Roseville and Victoria’s Traralgon are currently not eligible for government subsidies for new aged care recipients for nine months and must employ extra staff and conduct more training. 

But Sydney University associate professor in ageing and health Lee-Fay Low warns that the government’s accreditation processes pick up only the very worst cases, and people should do their own first-hand research – visiting homes, comparing them, asking questions of staff. 

Low says that, beyond basic questions such as food and hygiene, people should look at how staff treat residents and how residents appear. Do they have access to outdoor areas? What kind of activities are planned? Will you have access to your family GP? 

She also advises you ask questions about staff levels (how many staff are there per resident?) and training. 

“Observe their interactions,” Low says of staff, adding that one way of making sure is to stay at a facility for a short respite stay first. 



What else can you do? 

The Australia Institute made a submission to the royal commission in support of home sharing, where a younger person lives with an older person (or a person with a disability) for reduced rent, in return for about 10 hours per week of help around the home. It describes the idea as a “win-win”, both for older Australians who want to stay in their homes and for younger people navigating a tough housing market. 

There is also a push to provide a more home-like environment in nursing homes – and one that is more resident-oriented. This includes smaller facilities with flexible routines (so you don’t necessarily have to eat at a set time), access to outdoors and opportunities to make meals or do other domestic jobs. A 2018 Flinders University study found the home-style model creates a better quality of life for people with dementia, as well as fewer hospitalisations. 

Australia’s first dementia village will include 15 houses and shops in a complex in Hobart’s north. Following similar initiatives in France and the Netherlands, it will aim to provide real-life experiences and freedom for people with dementia. 

Can you skip the system and pay for your own care? 

You can have 24-7 care at home if you are willing and able to pay for it. Capezio says the costs of this ranges but carers charge about $50 an hour, Monday to Friday, with a registered nurse costing about $90 an hour. Weekends and overnights are more expensive. Capezio says she has clients who spend an average of $10,000 per week for care in the home. 

“If you have means to pay for private services in the home, then the sky’s your limit.” 


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