The truth about putting off an aged care assessment

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You don't want to put off the aged-care assessment process.

Once you know you or your elderly parents can't cope without extra home help, start the ball rolling.

It can take a long time between applying for help and the help arriving. There are a few steps each with a wait time.

Once you know you or your elderly parents can't cope without extra home help, start the ball rolling. It can take a long time between applying for help and the help arriving. There areĀ a few steps each with a wait time.

In September last year, about 76,000 people were waiting to receive a home-care package, while more than 273,000 were receiving some sort of home care.

Yet many elderly people put off the aged-care assessment. For example, my mother didn't want anyone she didn't know in her home.

Others expect - unrealistically - that family and friends will step up and help.

What is sometimes missed by stoic elderly parents is that home care helps them to be independent and stay in their community.

It is largely reliable and assists them to maintain their home and garden, reach appointments, go to the shops and keep up their hygiene.

They can function better with home care so they aren't hospitalised or prematurely admitted to residential aged care. Importantly, it can mean adult kids don't burn out acting as carers.

Yet many people who need home-care help determinedly soldier on, often to the frustration of their adult children who are working full-time and juggling their own families.

New package to cut delays

In response to research that shows older people want to age and die in their home, the Federal government is bringing in new home-care rules, called Support at Home, from July 1 this year.

Anika Wells, the Minister for Aged Care, says the program will offer better features such as shorter wait times from the initial assessment to receiving support.

The changes will have eight classifications up to about $78,000 a year, replacing the current four levels that pay up to $61,440.

There are new payments for modifications to make the home safer, up to $15,000. There will be access to assistive technology, such as walkers and wheelchairs, including a new equipment loan scheme.

For people with less than three months to live, there's funding of up to $25,000 and a high-priority assessment to help them stay at home for as long as possible.

Once you have the home care, you have to stay on top of it. Needs can change and this involves an application and assessment for higher levels of care. But there comes a point when unexpected health problems can mean home care isn't enough.

In my mother's case, emerging dementia meant she was a hazard when someone wasn't with her. The home carer found her cooking plastic bags in the microwave, which started a fire.

She couldn't remember taking her prescription medicine and would jumble the pill-organiser packs. She never ate. She needed full-time dementia care.

There are so many tough decisions to make when dealing with frail parents. One of the hardest is whether to move into a nursing home.

Tough decision for families

More than 5000 nursing home residents have died of COVID since the start of the pandemic and it remains a problem.

Not surprisingly, this high toll, as well as alarming revelations from the aged care royal commission, make a decision about a nursing home even more difficult. But sometimes there is no other option.

Aged care can be a lottery. Often it falls on the family to do the research and handle the mountains of administration. You need to constantly monitor and tweak it so your loved ones get the best care.

It is common for families to ricochet between different levels of care: hospitals, nursing homes, keeping a retirement village unit so they can die at home.

The decisions and paperwork can be exhausting. It is important to get help from aged care providers as well as doctors as early as possible.

My aunt's aged care journey

My aunt was as sharp as a tack and doing nicely with home care once a week in her retirement village unit.

In her early 90s, she was most comfortable at home, wanting to live and die there.

A home carer helped with cleaning, podiatry and shopping for a few hours once a week.

Then her doctor said she needed to wear tight, elasticised stockings during the day to help her circulation.

But they were impossible for her to put on and take off every day without help. Her home-care level only provided morning and afternoon support on some days.

So, she either had to risk wearing them only three days a week or enter a nursing home.

When she had a cancerous growth removed from her foot and had to keep her leg up for three weeks, my aunt had a stint of respite in a nursing home.

She didn't want to burden her adult kids, but the nursing home respite turned out to be a disastrous stay. She lost eight kilograms in three weeks.

The power frequently went out in her room, which meant she couldn't buzz anyone for help or when food failed to arrive.

Later, a test revealed my aunt had bowel cancer and after surgery she wasn't fit enough to go home. The hospital needed the bed, so she was back in respite care.

The new nursing home for respite was better than her previous one, but it was being renovated and there were building works all around my recuperating aunt.

But the real problem was that the Department of Health and Aged Care provides nine weeks respite care per financial year (plus a possible extension of three weeks if approved by an assessor) and nursing homes will usually allow four weeks maximum respite accommodation for each admittance.

My aunt's doctors said she could live for anywhere between two weeks or two years. How much of the nine weeks does she use?

While in respite, my aunt was admitted to hospital twice for a total of 14 days. The nursing home agreed to keep her room, even though it wouldn't be paid during respite absence.

There is a limit to how long it will keep a respite room but it could take her on as a permanent residence.

The doctors couldn't say whether she would be able to go back to her retirement village to die or would need continuous care in a nursing home.

In the meantime, the nursing home was showing other applicants my aunt's room so her family decided she should become a permanent resident there.

Her family applied for support from the local palliative care team and my aunt wants to return home at some stage when her death is imminent.

So while taking a permanent nursing home room she kept her retirement village unit to die at home.

The family liquidated my aunt's bank account and pays half the refundable accommodation deposit (RAD) as a bond and half the non-recoverable daily accommodation payment (DAP) to retain the eventual home option.

Once registered as a permanent in the nursing home, the home-care package is withdrawn and so there is no cleaning or garden maintenance.

One of the dilemmas for her adult kids was that my aunt and uncle chose a nursing home a long way from where any of them lived.

It was more affordable and when they sold their coastal home they had some money left over to help fund costs such as private health insurance.

For their oldest son it was a four-hour return trip. Their daughter could make it out and back in two hours in non-peak times.

My aunt's situation became very complicated, even with the support of three competent adult children.

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Susan has been a finance journalist for more than 30 years, beginning at the Australian Financial Review before moving to the Sydney Morning Herald. She edited a superannuation magazine, Superfunds, for the Association of Superannuation Funds of Australia, and writes regularly on superannuation and managed funds. She's also author of the best-selling book Women and Money.