Duty of care – finding your way through the maze of red tape

None of us aim to spend our older years in a nursing home. We all want to stay mentally alert and physically fit for as long as possible; preferably in our own homes, and on our own terms.

But no matter how well you may think you are holding back the years, the Australian Bureau of Statistics tells us what is really happening in the populace.

The proportion of Australians turning 65 years is projected to increase more rapidly over the next decade as further cohorts of Baby Boomers (those born between 1946 and 1964) reach this age.

And if you’re wondering who’s permanently warming a bed in an aged care facility, the average age of entry is 82 for both men and women, according to a 2008 Government report into ageing and aged care in Australia.

Plenty of time – you may be tempted to think of delaying or even scuttling your plans for that unwelcome journey.

However, increasing life expectancy is another reason for not ignoring an action plan for our future ageing needs because the longer we live, the greater our risk of developing some type of dementia.

While dementia can happen to anyone, the condition is more common after the age of 65 according to Alzheimer’s Australia.

“Many Baby Boomers are already feeling the sting of advancing age by proxy”

Paradoxically, many Baby Boomers are already feeling the sting of advancing age by proxy. When home care services can no longer support the escalating needs of frail-aged relatives, there is the sudden call to find suitable nursing care.

Jenny, in her 60s, recalls how she and her husband were mostly unprepared for the convoluted crisis that lay ahead when her mother-in-law’s dementia worsened.

“I knew nothing about nursing homes or assessments,” Jenny says of that time before comprehensive information was available on the Government’s My Aged Care website (myagedcare.gov.au). “I didn’t even know where to start.”

She eventually had her in-laws, May and Bernard, assessed and approved by an Aged Care Assessment Team (ACAT) for home help. But as Bernard’s own health deteriorated, Jenny and her husband James were spending more and more time with his parents.

“May stopped being able to sign her name and because she had Alzheimer’s, she thought people were stealing from her so the support workers couldn’t do much cleaning,” Jenny says.

“I would fill out cheques for her to sign, and it was all very tricky and difficult. Finally Bernard’s health deteriorated to a point where he had to ask James to look after his finances, but only in a limited way.

“We formalised James’ appointment as his father’s attorney through a solicitor because it would have been opposed by his brothers.”

Jenny also organised pensions for May and Bernard as they had never sought any assistance from the government.

“That was just the most dreadful and time consuming process,” she says.

“So many questions and forms, and their claim was complicated because they were born overseas and had used various names during their lives.”

In the end, Jenny and James had to source a nursing home for May.

Through word of mouth they found an aged care placement consultant who recommended a number of facilities they could inspect, making their daunting task much easier.

May went into care first, followed by Bernard some months later. Though both have since died, Jenny says collateral damage to the family from that desperate time has been lasting.

“I think we should have had an official diagnosis of Alzheimer’s earlier for May,” Jenny says. “When you have brothers saying nothing is wrong, and their mother should never have been put into a nursing home, diagnosis is fairly important.”

Though the Government subsidises a range of aged care services, including home care packages, you are expected to contribute to the cost of your care if you can afford to do so.

In keeping with the Government’s health reform agenda, packages of support around the home for those not quite suitable for admission to an aged care facility will increase from 70,000 to about 100,000 nationally by 2018.

Two years ago, 50-something Barbara was introduced to the aged care system when her grandmother, Violet, fell and broke her hip two weeks before her 95th birthday.

“Gran and her partner Bob had been assessed for high care community packages, but would only accept domestic services once a fortnight. I think they may have not understood the help that was available,” she says.
“Bob still did the shopping despite his health problems. My cousin would stay with my grandmother at night if he had to go to hospital.”

But when Violet broke her hip and was in a Toowoomba hospital at the same time Bob was hospitalised in Brisbane, both were told they couldn’t go back home.

“She had macular degeneration, but quite frankly at her age she didn’t have the mobility to go back home,” Barbara says. “And we thought, my God what are we going to do?”

She says confusion and ill feeling between family members who were trying to help could have been avoided at the outset if they’d known who her grandmother had appointed as her enduring power of attorney.

If it’s too overwhelming to navigate pages of information on the My Aged Care website to find essential information on accessing the aged care required, a facility, estimate fees and charges and apply to an aged care home, a search on the Aged Care Guide website (agedcareguide.com.au) can track down an aged care placement consultant.

For internet-savvy, time-poor Baby Boomers acting on behalf of elderly relatives, a placement consultant may be worth considering.

Former personal carer, Berenice Wadham, operator of Aged Care Assistance Consultancy, offers an independent service she is at pains to explain differs considerably from that of a broker.

“The broker may have a client in hospital and the hospital rules are to list with at least five aged care facilities,” she says. “And then the client is to accept the first offer without having the opportunity to visit those facilities.”
She and other placement consultants, have an in-depth conversation with the client, find out their criteria for a nursing home and combine that with further information from the hospital about their care requirements.

“I present the family with the list of facilities, sometimes up to 10, and I get them to make appointments and go along and look at these facilities. When they’re happy they get me to send applications through,” she says.

“Family members care about each other and they want the best. What they don’t understand is that there’s so much research that has to go into which facility is going to be suitable.

“It used to be first to the top of the list is going to get in. It’s not like that now.”

Ms Wadham says aged care funding is complex and nursing homes are selecting people from their waiting lists that will generate a high level of funding.

People on the low to mid-range of the care spectrum are finding it more difficult to find placement.

Another important component of her work is guiding clients through the costs involved for entry to residential aged care, whether the applicant is supported or not supported by Government.

Her service fee is $880 (including GST) but, as Ms Wadham points out, when she submits an application it’s concise and contains all the documentation required by Government departments and the aged care facility.

Though every client is different, depending on whether a person is still at home on a home care package and waiting for a crisis to happen, or in hospital or transition care, her work is often frantic.

A Baby Boomer herself, who has placed both parents in care, she’s working on her generation to be prepared.
“They say, ‘what’s going to happen when it’s our turn? I don’t think I’m even going to be able to afford aged care,’” she says.

“All of these sorts of conversations come up because inevitably they bring it up.”

Invariably, she stresses the importance of making an enduring power of attorney, in accordance with your instructions while you still have capacity, and having a retirement plan overseen by a financial advisor with expertise in aged care.

Avoiding falls that can put a person in care can be as simple as ensuring any modifications made in the home now, are disability friendly into the future.

At the end of the day, she says, a person requiring aged care is competing against every other applicant and that’s why it’s important to have a strong application.

“A lot of people in the community just think the ACAT will do but it’s normally not enough,” she says.

The facts of the matter in brief

• One-third of all men and half of all women will go into permanent residential care at some point in their later lives, though community care is the preferred option of most Australians (ARC Centre of Excellence in Population Ageing Research (CEPAR) 2012.

• Over the next several decades, the ageing population is projected to have implications for Australia, including the more obvious ones such as demands on health, size of the working-age population, housing and skilled labour. From 1995 to 2015 the proportion of             people aged 85 years and over              almost doubled from 1.1 per cent of        the total population to 2 per cent            (Australian Bureau of Statistics).

• A person is assessed and approved by an Aged Care Assessment Team (ACAT), in line with the Government’s Aged Care Assessment Program, before being able to access home care packages or residential aged care (myagedcare.gov.au).

• A power of attorney is a formal document giving another person the authority to make personal and/or financial decisions on your behalf. There are two types of attorney: general and enduring.

• An advance health directive is a formal way of instructing another person about your future health care, effective only if you become unable to make your own decisions.

Government’s plan for future

THE Australian Government announced significant reforms to home care in the 2015-16 Budget.

The CDC (Consumer Directed Care) reforms are aimed at improving  the way home care services are delivered to older Australians and will be  implemented in two stages.

In the first stage, from February 27, funding for a home care package will follow the consumer who can choose a provider suited to them and to direct the funding to that provider.  The consumer will also be able to change their provider, including if they move to another area.

There will be a consistent national approach to prioritising access to home care through the My Aged Care gateway.

 The second stage will move towards a more integrated care at home system. There will be consultation with the sector on these reforms.

The changes are said to be an important step in moving towards a future aged care system that is more consumer-driven, market-based and less regulated.

The number of home care packages is to  increase from about 72,000 places to about  100,000 places nationally next financial year.

Home care reforms – Where to now?

Are you getting the best value from your home care package? MARY BARKER explains the six questions to be asking.

On February 27, the home care industry is in for a shake-up with government reforms to home care that will affect thousands of older Australians.

According to Kendall Morton of Home Care Assistance, the changes are good news for older Australians and their families as for the first time, clients will be able to move their funding to other agencies if they are not
satisfied.

“Home Care Package reforms are great news for older Australians”

They will have more choice and more control over their own home care.

Until now, the federal government has given a number of home care packages to agencies who have used them to support clients with different needs.

“Under the current funding arrangements, if you go into permanent care or pass away, the funds remaining in your package stay with the service,” Ms Morton says.

“There hasn’t been a lot of incentive for the agency to see that the person is getting all the care that they need.  If a client leaves the agency, the provider may have a $10,000 excess that they are allowed to keep.”

This all changes on February 27, when home care package funds will be assigned to the individual, rather than the service.

If you are satisfied with when and how you are getting home care, there is no need to do anything. This reform gives choices.

Ms Morton said there were six questions that older Australians and their families needed to ask when choosing a home care service.

1. Check the management fees.

These are legitimate fees that each agency charges but they vary greatly. Home Care Assistance, for example, charges 15 per cent management fees, others charge up to 40 per cent. This means that 40 cents of every dollar is gone before you a home helper walks through your front door. From a practical perspective, low fees mean that the client gets more hours of support each week. For instance, someone getting 10 hours of care with a 40 per cent management fee could get 16 hours of care with a 15 per cent management fee.

2. Check for extra charges such as entry and exit fees.

Many agencies have them and some don’t. Watch out for add-on fees. For example, if they find someone to mow the lawn, they may add a $5 charge. If they buy a new shower chair, they may add a shopping fee.
Ms Morton believes that imposing these fees is highly unfair as finding home help services or equipment is the service’s management responsibility.  

3. Ask about service times.

Some agencies will make a commitment to have a staff member at your home at a set time, say 7.30am, for a morning shower. Others will only give a time band, such as 7am to 10am. This leaves the client waiting and for clients with incontinence problems, it can be a long, uncomfortable and undignified wait.

4. Check if help is available weekends and evenings.

Home care packages are meant to meet individual needs so don’t accept “no, we don’t do weekends”. Also, ask the agency if they have a 24-hour assistance number.

5. Ask for a monthly statement.

An agency should provide a monthly statement to keep track of funds and fees. Be sure to ask.

6.  Ask how many different care workers will come into your home.

Having strangers in your space can be intrusive, especially when you are physically frail. Some agencies will arrange rosters to give you two or three carers over a week, others may have up to seven.

During February and March, Ms Morton is offering Sunshine Coast residents a free audit of their home care package and a safety assessment of their home, answering questions and helping understand the package to see if there are ways to get more hours of care from your funding.  

 Call 5491 6888 or 0499 022 567.