How many times have you heard someone say, “I’m never going into one of those places!” when the conversation turns to nursing homes?
A few months ago, my husband Bob was saying it too. And then we had to find one – and, let me say, he was very happy to be there.
Today’s residential aged care facilities are not the Dickensian horrors that so many of them were in the days when we still called them nursing homes.
But getting into one can be a lengthy, frustrating business involving enough paperwork to account for the demise of several forests because when it comes to aged care, the Australian Government doesn’t make anything easy.
So many departments within departments and all with different names: Department of Human Services, Services Australia, Centrelink for Older Australian, My Aged Care.
Everyone is helpful, everyone is kind and the further down this rabbit hole you go you, the more you end up like Alice – totally bewildered.
In our case, we waited more than a year for a home care package that didn’t come. And when we did finally hear something, as is so often the case, it came too late and an ACAT (Aged Care Assessment Team) assessed Bob as in need of full residential care.
For this, you are given a code. Armed with this code you go searching for a suitable facility.
Where I live there is a nursing home five minutes away but although it is adequate, we felt it was too old, tired and lacking in staff and facilities. We ruled it out, despite the fact that it would be convenient for me to pop in and out, bring Bob home frequently and allow local friends to visit.
Too many people automatically select their nearest option for those reasons but it is not necessarily the best solution and in our case, I knew Bob needed a place where he could feel a new positivity about life rather than just sink into oblivion.
So, we looked further afield, and made a list of what we wanted – and didn’t want.
I did considerable online research, firstly rejecting all those homes that were for-profit and especially those internationally-owned facilities that receive Australian tax dollars and repatriate their profits, because I have a problem with that.
I am also concerned that when aged care facilities are just part of a large corporate portfolio they are too easily sold off, or worse, run down, to compensate for profit loss in other divisions.
I am not saying there is anything wrong with these places and some are very appealing – but just not to us.
I also looked at track records in respect of compliance with the Department of Health’s Aged Care Quality Agency.
This agency regularly audits homes to ensure they are complying with the 44 expected outcomes, within four broad accreditation standards and today these checks are usually made without prior warning.
It also publishes a report of every audit, including notices of non-compliance or sanctions, available at agedcare101.com.au. This guide is useful but not foolproof because the government is reluctant to actually shut down non-compliant facilities because of the high demand for beds, especially for dementia patients.
One nursing home on the Gold Coast recently passed only one of the four accreditation standards and has been non-compliant for some years, yet it still operates.
I finally narrowed our search down to nine homes within my zone, operated by well-known Australian organisations, one of them owned by a family company and the others with the backing of major church charities behind them.
I toured each home (tours take about an hour) because this is the only way to judge one against another and find out which best matches your wish list. Statistically, it can take 13 weeks to gain admission to a nursing home of your choice so we selected our top three and applied to them all.
Amazingly, two days after taking Bob to see our No.1 choice, they rang to say a room was available and rather than risk losing it, he moved in two days later.
This meant a flurry of packing and paperwork. The paperwork was mainly a residential care client agreement, mental and physical health assessments and the all-important government statement of income and assets (see What You Can Expect to Pay).
Forget privacy – be prepared to have your finances and much of your life put under the most thorough scrutiny. Aged care facilities call the shots and a “good” one won’t take you if you don’t meet their criteria, which is not unreasonable but can still feel invasive.
If you are on a pension, Centrelink must be immediately notified so that each partner moves to the single pension. In my case, I had to notify them to stop my Carer’s Allowance; there is a fine if this isn’t done within two weeks.
I also had to notify the government and the care agency that we no longer needed assistance at home.
Bob is very happy in his new home because it meets our criteria. It is modern, light, bright, spacious, clean, sweet smelling (not all of them are!). He has a large room, well furnished, with good storage and room for his recliner chair, mobility scooter, walker and personal effects.
It has a large ensuite (some homes have mostly shared facilities). He also has his own small patio and a little sitting room next door for visitors, complete with refrigerator, tea and coffee.
There are many small sitting rooms rather than one big recreational area with a whole lot of health-challenged oldies all staring at the TV, as well as good social programs, day respite areas, attractive dining rooms set up like café/restaurants with scattered small tables, hairdressing salon and other amenities.
Fountains and ponds are scattered throughout the tropical gardens and the sound of water is everywhere.
Food is good with plenty of choice, served with beer, wine or soft drink. Registered nurses and care staff are relatively plentiful (although no nursing home ever has enough and must often depend on agency staff), doctors and various therapists on call.
The culture is caring, albeit not always efficient, and responsive; simply put, the whole place has a good vibe.
We were not prepared to settle for anything less than the best. And nor should you!
Sadly, Bob Lake has died and although he was not in the nursing home for as long as they had hoped and planned, Julie says it did make his final weeks much better than they ever could have hoped. He was very happy to leave the hospital and return to his new home. “It was a very positive experience and the palliatve care there couldn’t be faulted,” she says. “He was content and we felt very lucky that he was able to get in when he did.”
$$$ … WHAT YOU CAN EXPECT TO PAY
When I wrote on this subject in 2019, I gave the costs of nursing home care and accommodation in some detail based on My Aged Care information – but personal experience gives me a slightly different perspective.
Our first step was to ignore the up-front buy-in costs quoted on the various aged care facility sights (ranging from $250,00 to $500,00 and in a few cases higher) because we believe this is a long-term option or only for the wealthy.
The money is refundable (mostly) but while some singletons going into care pay this by selling their homes, this is rarely an option for married couples where one remains in the family home.
Next step was to apply to Centrelink, via the Aged Australian portal (after several attempts to get the information from Services Australia, Department of Human Services, My Aged Care etc) for the all-important assets and income statement.
All nursing home residents are required to pay a basic daily fee of $52.25 (at time of writing; like everything it goes up) a day. And those whose income is below $27,840 a year and assets are below $50,000 are fully funded by the Commonwealth Government – basically you contribute 85 per cent of your pension.
If you have income more than $70,320 a year and assets of more than $171, 535.20 you will have to pay an additional means tested per ratio accommodation fee which can range from about $10 a day to about $250 a day.
This is the figure given on the MyAgedCare website and which was also given to us; it seems to be contradicted by the next paragraph that states costs are capped at $28,087 a year or $67,409 a lifetime.
I have not been able to find anyone who can explain this.
Though the nursing home industry is reluctant to admit it, you do pay more for quality. “Our” home was chosen because it offered high quality at a reasonable price for the daily accommodation fee – a maximum of $43 a day if you have to pay the whole lot yourself. Billing is usually fortnightly.
In fact, most nursing homes don’t charge more than a $50 daily accommodation fee but some DO charge extra for certain services and add-ons such as wine or beer with meals. Ours doesn’t.
My other tip is, before embarking on the nursing home journey, consider downsizing your assets provided this doesn’t prejudice your future. When applying for government subsidy beyond the $52.25 basic fee, pretty well everything you own will be taken into consideration, including furniture, antiques and vehicles.
In our case, the home is exempt provided I remain in it. If I was to downsize, any price differential would be means tested.
Nursing home care costs seem high at first sight but when you consider what you get for your money in a good home … round-the-clock nursing and personal care, the many amenities and facilities, full board and lodging which can be to hotel standard, medical professionals and therapists on tap, administration, entertainment and recreation, domestic service … it’s not such a bad deal.