Aged care explained
Is home care or residential aged care the right path to take?
14 March 2023
Thinking about aged care for yourself or a loved one is a sensitive issue and with Australia’s ageing population, it’s something more of us will have to make decisions about. Choosing the right aged care path can feel overwhelming as you navigate the different options (and varying costs) available to you. But the good news is that support is out there to help older people maintain their independence for as long as possible.
The two main options when it comes to aged care are home care and residential aged care (sometimes called aged care homes, nursing homes, or aged care facilities).
Home care refers to support services which help you to stay in your own home (and community) for longer, which gets the thumbs up from many seniors. Home care support can vary from a little, like help with the weekly shopping or gardening, to a lot, like high level assistance each day for personal care and meals, depending on your needs and wishes.
Residential aged care on the other hand means leaving your home for an aged care facility, which will provide a higher level of services, security and peace of mind if you’re no longer able to live independently. There are different types of facilities to choose from which can cater to your changing needs. It’s well known that loneliness can impact on our mental and physical health and social isolation is common in the elderly, so residential aged care can also include social groups and activities (trip to the art gallery, anyone?), introducing residents to a new community of people.
There are privately funded and government subsidised options for both types of aged care. You don’t need a government assessment to access private home care and private residential aged care (often called supported or assisted living complexes), but if it’s subsidised support that you’re looking for then your journey starts with My Aged Care which is run by the Australian Government.
Whichever route you decide to go down, it’s never too early to start the conversation with loved ones about aged care. Avoiding the need to decide quickly or during an emotional time (like after an emergency or health scare) will give you more time to discuss your needs and the options available, as well as giving you more choices (as availability can sometimes be an issue). Small changes, like finding chores around the home more difficult or forgetfulness, can be a sign that it’s time to start thinking about a little extra support.
There are two main options of government subsidised home care. The more basic supports (where only a small amount of help is needed to keep you in your home for longer) fall under the Commonwealth Home Support Program (CHSP). More intensive support (for more complex needs) is provided through Home Care Packages (HCPs). Support through these programs will be tailored to your specific needs and goals to help you maintain your independence.
To receive either a CHSP or HCP you’ll need to be assessed to see if you’re eligible, identify what services you need, and work out which option is the best for you.
The first step is to contact My Aged Care to register for assistance. You’ll be asked a few simple questions about your needs, preferences, and any services you already have. Based on this conversation, you’ll be told if you qualify for an aged care assessment.
Aged care assessments are done through either a Regional Assessment Service (RAS) for CHSP or an Aged Care Assessment Team/Service (ACAT/S) for HCP support. Your RAS or ACAT/S assessor will visit you (in your home, hospital or wherever you’re located) and ask questions to help understand what support best meet your current needs. You’ll talk about things like:
- your medical history
- your current living arrangements
- your support networks
- support you’re already receiving
- how well you’re managing at home (e.g. completing daily tasks)
- any health/lifestyle concerns
- any other issues.
It’s also a great opportunity to ask questions you may have about the support services available, financial assistance, or your rights and responsibilities if you choose to go down the home care path.
The assessor will discuss everything with you and let you know what support you’re eligible for. You’ll be sent a referral code to access the services you’ve been assessed for once you’ve been approved for CHSP service or when a HCP becomes available. If you’re not eligible for CHSP or HCP, you can look into non-government funded (private) support services.
Commonwealth Home Support Program
The CHSP provides funding for entry-level support services for people aged 65 years and over, or 50 years and over if you’re Aboriginal or Torres Strait Islander. If you’re supported by the CHSP, you’re mostly able to care for yourself but just need a bit of extra help with things like cleaning, gardening, transport, or personal care. The services are tailored to your needs and can provide short-term or ongoing support. CHSP is the entry point to home care services for a lot of people.
To make sure support is affordable for people who need it, the government gives funding (subsidies) to service providers to deliver care and services at a subsidised price. The cost (typically an hourly rate) depends on the type of support and the individual provider, so it’s important to discuss the fees when you’re choosing a provider. You’ll also be expected to contribute to the cost of your care if you can, but if you can’t then it’s important to talk to your provider as they have policies in place to help (so you don’t miss out on receiving the support you need).
Once you’ve been approved for CHSP support, you can either search for providers yourself using the Find a Provider tool on the My Aged Care website (your assessor will give you a referral code for each service you’re eligible for) or your assessor can send a referral to the provider(s) for you (with your consent). Once you’ve decided on a provider, you’ll develop a care plan together which includes the services you’ll receive, costs, and a start date. You can use more than one provider through the CHSP, so think about your priorities, needs, budget, and location and connect with providers.
The service you want might not be available immediately so it’s important to stay in touch with your preferred provider(s) to check availability.
Home Care Packages
An HCP is available to eligible Australians over 65 years, or over 50 years if you identify as Aboriginal or Torres Strait Islander, with more complex needs. Support services through HCP might include personal services like bathing and dressing, meal and food support, continence management, help with mobility and dexterity, or assistance with communication. There are 4 levels of HCP which cover basic care needs (level 1) up to high level care needs (level 4).
Your HCP budget is made up of the government’s contribution (the subsidy you’re eligible for plus any supplements – an additional payment for people with specialised needs, like dementia) and your contribution which is made up of your basic daily fee, your income tested fee (if you can contribute) and any additional fees you agree to. The amount you contribute depends on your income and unavoidable expenses, like rent, utilities, and other living expenses.
HCP costs vary depending on the level of care you need, the services you want and the provider you choose, so it’s important to discuss any fees or charges with a provider before you start services with them. The service provider can spend your HCP budget on things you both agree to in your Home Care Agreement, which outlines the types of services you’ll receive, who’ll provide them, your individual goals, and any conditions or exit fees if you no longer need services. You’ll receive a monthly statement so you can see how the money’s being spent.
It’s important to remember that, though the Increasing Choice in Home Care model, you have choice and control over who delivers the HCP you’ve been approved for. So, if your care needs change or you’re not happy with a service you’re receiving, you can move your funding to another provider.
The high demand for HCPs means that, even if you’ve been assessed and approved for a HCP, you might have to wait. You’ll be placed in the ‘national priority system’ based on your needs, plus how long you’ve been waiting since your assessment. You can look into other forms of support to help get you by while you’re waiting, such as CHSP services including private home care (no government subsidy), community/council services, help from family or friends. Though wait times are now much lower than they previously have been with more HCPs now available.
Residential aged care
Eligibility for government subsidised residential aged care also involves an assessment and again the first step is contacting My Aged Care to organise this. Once you’ve been approved (by an ACAT), you can start looking at residences – either by yourself with a friend or family, or by hiring a placement consultant to help you.
Things to think about
Just like if you’re buying or renting, it’s a good idea to connect with and visit as many residences as possible (and ask lots of questions!). You’ll get a feel for the accommodation and see if what’s on offer suits your care and lifestyle needs.
Are you looking for accommodation for a single person or couple? Think about the location and size of a home. Is there a separate or secure dementia unit or wing if needed? Some homes cater to a specific cultural or linguistic group or offer culturally appropriate services. Some homes accommodate fur babies! And remember to check the home’s accreditation status.
The type of residence you choose will affect the cost and services you receive. Options can range from single rooms with an ensuite to shared rooms and bathrooms, but they must provide specified care and services to all residents at no extra cost – including beds, mattresses, linen, bedside lockers and chairs, general laundry and cleaning services, maintenance of buildings and grounds, utilities such as water and electricity, meals, and toiletries. Additional services which you’ll be charged a fee for might include things like therapy services or registered nurses to assess, plan and manage care.
Residential respite care can be a great way to ‘try before you buy’. Short-term care, whether it’s a few hours, a day, a night, or a few weeks can give you the opportunity to trial a home to help you make the right decision.
Some aged care homes may have waitlists and generally places are offered to people who have a health priority or have progressed to the top of the waitlist. You can be on as many waitlists as you like but once you accept an offer, you’ll be removed from the other lists. It’s important to keep in regular contact so they know you’re still interested in the home, or you can engage the services of a placement consultant to keep on top of vacancies for you.
Fees can vary enormously between facilities, and from resident to resident. The cost of care is divided into three payments:
- daily care fees – a contribution to the cost of care and living expenses
- accommodation payment – used by the aged care home to improve the quality of the building and services they provide
- a means-tested care fee – an extra contribution which varies from person to person and can fluctuate if your income and assets change.
There are also a range of payment options available. As this can be a complex area, it’s a good idea to get specialist advice from an aged care financial advisor to help you understand the rules and minimise costs.
While starting the aged care journey can seem overwhelming, there is lots of information and support out there which aims to make the transition a smooth and positive experience. Reach out to health professionals, aged care professionals, or friends and family for help. Talking to others who’ve made the move before you have to make any big decisions is also a great way to gather tips and understand your options. For more information head to My Aged Care.
My Aged Care www.myagedcare.gov.au