It’s been a difficult year for my 82-year-old widowed Dad. He had a strong heart, perfect blood pressure, complete mental capacity but a troublesome skeletal frame. In February this year, he collapsed out of bed and was unable to walk, even a little bit. He’d been wobbly for a while, then on a frame, then finally his legs just couldn’t support him anymore.
The surgeon gave the prognosis: endure two major neck and back surgeries, followed by a year of hard work and physio, or end up in a wheelchair in a nursing home. Not much of a choice. He chose the surgeries, and a long and horrific few months followed.
By June it was clear that the hospital and rehab environment was not doing him good. He was despondent and his progress plateaued. Although still in a wheelchair, it was time to find alternative accommodation where he could be looked after and continue with the rehabilitation.
My sisters and I weren’t in a position to take him in, nor did he want to live with us. He wanted to stay in Sydney near his friends and support network. An aged care facility (read: nursing home) was the only option available (we thought). Fortunately, he had the means to take his pick.
We found one that we thought would be ideal: Sydney harbour views, award-winning dining, luxury and style. Dad would love the company of others and a bit of nurturing that he hadn’t had since Mum died a couple of years ago. They even have an in-house physio programme.
We did the negotiations, he was discharged from the hospital and he moved in. No doubt, it was a better environment for him than the rehab hospital, but for poor Dad, it was not a positive step. They did look after him well, I emphasise that, but a nursing home is a nursing home, no matter how fancy it is. It is not filled with 65-year-olds discussing world issues. He felt he was the youngest there by years, and found no one on his intellectual level. He was lonely, sad and frustrated.
That, and the monthly bills, were enough to light a fire in his belly to work hard on his physio to get out of there. Eventually he moved from the wheelchair to a walking frame, and now after a 119 day stay, he’s headed home.
I’ve worked as a technical specialist and adviser in aged care matters for many years, and have written countless articles on the fees, charges, effect on age pension, and strategies. However, I now have a further – much more personal – insight into this process to share.
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Lessons learnt from personal experiences
1. No matter how pleasant the facilities, or how many awards it has won, it’s still a nursing home. In many (but not all) cases, the residents are there out of need, not desire. The food is never going to be as good as home-cooked. They are running a business and working within budgetary restraints. Scotch fillet made to order and fresh fruit are a thing of the past unless the resident goes out for it, or a family member brings it in.
2. Speaking of meals, dinner is at 5:30, then it’s back to the room by 6:30. Makes for a long, boring night for a person who has full mental capacity and wants someone to chat to. In summer daylight savings, they are having dinner at what is close to afternoon tea time.
3. Read everything in the Resident Agreement, read it closely and understand it. If you don’t understand it, get someone to read it who does. I do understand most of these things better than the average person, and was still taken by surprise by some of the charges that popped up on the monthly statement.
4. Residential aged care can be breathtakingly expensive, and every little extra thing is charged. It’s that feeling when you’ve spent a week at an expensive resort, charging everything to your room, then it’s time to look at the bill. Only it goes on, month after month. The temptation is not to look at the statements, but please do. We found Dad had been overcharged a whopping 25 days due to an error in accounts.
5. Even for a high means person, it is worth completing the awful Combined Assets and Income Assessment form (SA457) from the Department of Human Services. We didn’t for Dad, but in hindsight I wish we did, as I think we’d have had a clearer picture of where he stood.
6. The Means Tested Care fee is based on the actual daily cost of care as determined by the Government based on the ACAT assessment. However, it is subject to an annual cap of $26,566.54 or $72.78 per day. As Dad was assessed for a high level of care, the facility charged this daily capped amount on the assumption that he would be staying for the full year. However, when he gave notice that he was leaving 119 days later, we got a nice little surprise … his actual daily cost of care was $214. His Means Tested Care fee was back-dated to the day of entry, and he was hit with an extra $12,600, which kept him just below the $26,566 for the 3½ month stay. My training and experience failed to see that one coming, even though I probably should have. It’s a trap for when a person exits the Residential Aged Care system.
7. Dad’s mobility has improved, but still has a way to go. The reason he can go home is because there are some excellent home care service providers that provide home help, personal care, companionship, transport, and specialist care (24-hour, dementia, palliative or respite). They can also manage the overall care and tap into nursing services, specialist doctors, GPs, equipment suppliers etc. If you live in an area where these services exist, it is possible to stay at home and miss the whole residential aged care step altogether. BUT, and it’s a big BUT, if you need to rely on a ‘Home Care Package’ to help fund it, there’s a long wait. Following the ACAT assessment, you’re put on the waiting list. No one really knows (or reveals) how long the waiting list is but it’s months if not a year or two. Dad will have to pay for his home care services privately until the package comes through (which is also subject to a means test). You can get more information about home care here.
I’ve learnt that although aged care in Australia has vastly improved over the last few years, it’s still not a happy time for some. It’s expensive, impersonal and can be downright depressing, although to be fair there are many positive stories as well. Many years ago, my Grandpa – deep in dementia – loved it. He got his three square meals a day and familiar faces caring for him.
I think my Dad has learnt that he wants to be at home, he wants his independence, and he wants to stay connected with the world. Before all this, and since Mum died, he was feeling lonely and isolated at home, but this time around he will revel in being back in his own space. He’s already in touch with friends and filling up his diary with social outings. More power to him.
This experience was a revelation to me as a long-term adviser in the aged care field. Even a person in a comfortable financial position who has the means to enter a facility with many extra services over and above the government-subsidised standards faces unexpected and disappointing experiences. In future when discussing aged care matters with my clients, I will urge them to investigate home care options as well as residential ones. It’s horses for courses, and it’s heartening to know that there are increasing options available for our ageing population.
Alex Denham is a Senior Adviser with Dartnall Advisers. Prior to becoming an adviser, she spent 20 years in senior technical roles with several financial services companies. This article is general information and does not consider the circumstances of any individual and is based on a current understanding of the rules.