How To Fund Aged Care

The Royal Commission into Aged Care & Safety is presently looking at how to fund the future of aged care. With an increasingly ageing population as baby boomers advance in age the demand is set to grow.

Former Treasurer Mr Keating

proposed a scheme similar to the HECS scheme he introduced as Treasurer for university pupils, whereby the government provides a loan to cover university fees, to be repaid at a later date when the pupil graduates and earns the threshold income. In the case of a person needing aged care he proposes the commonwealth government provide a loan which covers costs for home care support or moving to an aged care facility. This loan would only be repaid from the recipient’s estate upon their death. Mr. Keating stated that this scheme would help reduce the long wait times for the elderly waiting on home care support.

Former Treasurer Mr. Costello

told the inquiry that income and assets tests should be part of future funding arrangements, but need to be simplified. He admitted he had trouble filling out aged care forms for his family.

“You all ought to do them you know, I think there are over 120 questions and 27 pages — I had a lot of trouble filling it in,” he said.

As a Placement Consultant,http://www.oasisagedcaresolutions.com.au/about.html assisting my clients to find suitable aged care accommodation, I find many have the same trouble filling in the forms. As part of the service I provide I fill in the forms for my clients when they are applying for a place in an aged care facility. My clients and their families are very grateful for this assistance.

Treasury secretary, Ken Henry

also addressed the inquiry,expressing similar sentiments.

“The system overall is horribly complex and it contains a very high level of uncertainty for people who are elderly, people who are vulnerable, people who are suffering emotional and psychological stress … and they’re bewildered” he said.

He stated he had long felt the system was underfunded, unsustainable and under resourced and that the baby boomers would not stand for it. He suggested a special levy earmarked to cover the expected increase in demand for aged care leading up to the peak in 2030.

The Association of Aged Service Professionals (AASP)

https://www.aasp.org.au/home/

also made a written submission to the Royal Commission. Their submission was specifically in relation to the MPIR, the Maximum Permissible Interest Rate that can be applied as a daily converted amount (Daily Accommodation Payment – DAP) in relation to the advertised/negotiated cost of accommodation. With the fall in interest rates this amount has reduced from 6.69% in 2014 to 4.89% as at 30th June, 2020. With many residents now deciding to pay daily, the effective reduction in cash flow to facilities is becoming significant.

The Association recommended that the Minister, in order to ensure the viability of the sector, use his authority to review a revision to the current method of calculating the MPIR.

Counsel Assisting

Arising from consultations, has recommended the appointment of an independent “Aged Care Pricing Authority”, responsible for care and other costs.

I am President of the AASP and fully support their submission. I sincerely hope to see effective changes to the current funding arrangements arise from the enquiry. All Australians deserve to be assured of quality and timely aged care support in their later years.

Jillian Slade Consultant in Aged Care Placement

Relationship Centred Dementia Care Online Presentation

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The Dementia Australia National Symposium Series 2020 – Dementia care is quality  was delivered as an online series of six weekly virtual events, commencing 4 August. It had originally been intended to be delivered as an in person event in Sydney.

Dementia Australia CEO Maree McCabe said about the series “Offering the webinar series for free is our contribution to supporting the aged care sector through this difficult time to enable a greater level of engagement than would have been possible with the original event.”

Hospital, hotel or home? What does relationship-centred quality look like and how do you know you’re delivering it? was presented by Dr Lisa Trigg, Assistant Director of Research, Data and Intelligence at Social Care Wales (UK), on 25 August.

“A relationship-centred approach to quality is the best type of quality, where the person needing care is treated as an individual with his or her own personality, regardless of their health issues,” Dr Trigg said.

“It is being cared for by someone in a compassionate and supportive reciprocal relationship – even though someone may be in the late stages of dementia, they are still a person with their own individuality and personality.”

Dr Trigg has studied quality improvement in long-term care and currently supports people working in care in Wales with evidence and research to inform policy and service design. At the symposium she explained the concept of relationship-centred quality and gave delegates the opportunity to reflect upon the quality of care in their own organisation and how well it is being achieved.

Relationship centred care focuses on enhancing the care experience for residents together with family and staff, where relationships between them are built upon and nurtured. Residents feel a sense of security, feeling safe and receiving knowledgeable and sensitive care whilst staff feel safe from threat, working within a supportive culture and families are supported to feel confident in providing good care. A sense of belonging is established, residents are supported to make friends within the setting, family maintain valued relationships and staff feel like they are part of a team.

Residents have the opportunity to develop and meet goals, giving them a sense of achievement, which is shared with family and staff. A sense of continuity is built with residents receiving care from staff they know and staff have consistent work assignments. A shared sense of purpose is also achieved with the help of family in activities where residents have meaningful, purposeful functions and staff help with clear, shared goals. Importantly, residents feel valued and recognised, staff feel like their work matters and family feel valued by staff.

You can tune into the last two webinars in the webinar series:

Tuesday 1 September at 4pm Reconsidering Person-Centred Dementia Care: Can we make this an everyday experience for those living with high dependency needs and dementia? Presented by Professor Dawn Broker

Tuesday 8 September at 11 am Leadership and the Challenge of Change by Ita Buttrose AC OBE and Addressing Leadership Blind Spots to Staff Engagement by Dr James Adonis

Dementia Advocate closing by Keith Davies.

Jillian Slade is a Placement Consultant.

 

Aged Care Minister Colbek’s Response to Covid 19

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On Friday 22nd August the Senate Select Committee on COVID-19 in Aged Care Facilities interviewed the Aged Care Minister, Minister Colbek, for the second time.

He began well by thanking all workers in aged care facilities – personal carers, nurses, cleaners and cooks. He stated that they deal with confronting situations, that they can be scared for their own health but continue to turn up to work.

He said “We need them. They are at times unfairly scrutinised.” He went on to claim that the government …” can always do better.We will continue to work to be prepared to have resources as best we can, particularly to support the Victorian government to get the community transition under control.”

Then he stumbled. As he was being questioned about whether his department was doing its job protecting the elderly from COVID-19 in federally funded and regulated nursing homes the Senator was unable to answer how many residents had died in Victorian aged care facilities and how many current active cases there were.

Eventually a staff member told the inquiry that as of 8:00am on Thursday, 20 August 254 residents in aged care facilities had died due to Covid-19, there were 1811 active cases, with 239 recovered.

According to Anne Connelly of the ABC in her report today the Prime Minister claimed in Parliament Question Time on Monday (24th August) that of the 126 nursing homes affected by Corona Virus in Victoria only 16 have experienced a “significant” impact from COVID-19; four have had a “severe” impact and, as of yesterday morning, the number that have been “significantly impacted has been reduced to three”.

She also reported that Prime Minister Morrison and Aged Care Minister Colbeck spent yesterday’s Question Time arguing that the many plans, emails, guidelines and webinars which were sent to the aged care sector equated to effective preparation and that high levels of community transmission were to blame.

This was obviously in response to the question on Friday in the Senate Hearing where Minister Colbeck was quizzed about what support the federal government gave the aged care sector to help it prepare prior to the community spread of the Corona Virus outbreak.

Minister Colbeck mentioned at the hearing that the federal government were spending $171M for the aged care response to Covid-19 and they had set up a Disability Response centre in Victoria with $15M in funding split between the federal government and Victorian government.

The lives of those most vulnerable in aged care facilities must be given the respect and care they deserve. Ensuring the aged care providers have sufficient information, easy to follow guidelines, staffing support and adequate protective equipment is the job of the government. Both State and Federal governments have a critical role to play and they must work together in harmony to protect the elderly under their umbrella of care.

Jillian Slade is a Placement Consultant for aged care.

 

 

 

 

 

Extra Support For Aged Care Homes

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With 500 Covid-19 cases in aged care facilities in Victoria as of 29th June, 2020 the government has stepped up support to aged care providers to help cope with the crisis. The Australian Medical Assistance Team will be helping Defence Force personnel and health workers. This Team is usually sent into disaster zones to work on humanitarian aid overseas.

Five AUSMAT senior expert nurse leaders are also being deployed to Victoria from other states, and two Victorian-based specialist logisticians will be deployed in support of the nurse deployment and Aged Care Response Centre.

A Federal Department of Health spokesperson said more than 450 temporary workforce surge staff have been deployed to aged care providers experiencing a COVID-19 outbreak in Victoria to date.

Non-essential surgery will be suspended in public and private hospitals in Melbourne and Mitchell Shire to free up hospital beds for residents in aged care facilities requiring a transfer and to enable nurses to help care for aged care residents.

New Leave Entitlement for Aged Care Workers

Staff working in residential aged care under the Aged Care Award, the Nurses Award and the Health Professionals Award will be entitled to paid pandemic leave as of today (29th June, 2020), following a ruling by the Fair Work Commission. The Fair Work Commission said pandemic leave will support the needs of low-paid workers who are exposed to elevated levels of risk during COVID-19.

Staff will be entitled to two weeks’ paid pandemic leave if they are required to self isolate due to being a close contact of a confirmed case, or if they are showing symptoms of COVID-19. The entitlement extends to casual employees who are employed on a “regular and systemic” basis.

However, this pandemic leave does not cover workers who test positive to COVID-19 during their self-isolation. They will instead be entitled to workers compensation leave.

This will mainly affect workers employed by the smaller aged care providers as they tend to have a higher percentage of workers on awards, whereas the larger aged care providers more often employ staff on enterprise agreements. Those staff will not be entitled to the pandemic leave payments.

Communicating With Loved Ones in Aged Care

With the increased number of cases in aged care facilities and higher level of community transmission, most aged care homes are only providing family visits under exceptional circumstances across all Victorian residences. Most homes will allow compassionate exceptions for residents who are palliating, or where regular care is provided by a visitor and the absence of this would have adverse effect on the resident’s wellbeing.

To keep residents connected to their loved ones homes are facilitating phone calls and video calls. Read more about technologies in Aged Care here.

Unfortunately, these technologies don’t work for some residents, such as my friend Don. I placed Don into care 5 years ago and he is suffering more than most in care, as he has been deaf since birth and has no relatives. He is unable to take advantage of video chats with friends like me, he cannot converse with other residents and does not leave his room, so he has been isolated for several months. He is now having even more difficulty because he cannot see staff members’ mouths as they are all wearing face masks.

June video phone 2

Pictured an aged care resident uses a communication device designed specifically for elderly people.

I am hoping that the extra support and focus now being given to help aged care providers manage this crisis will see a dramatic drop in cases within aged care facilities.

Jillian Slade is an Aged Care Placement Consultant.

 

Roller Coaster Ride Placement in Aged Care

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Since earlier in the year when Covid-19 made its way to Australia it’s been a roller coaster ride in my job as a Placement Consultant for Aged Care Accommodation. In Melbourne all went quiet with families tending to keep their loved ones at home during the original lockdown in March and April and then it got very busy when restrictions were lifted in mid May. I was suddenly fielding multiple enquiries and arranging tours again as most aged care facilities had recommenced showing their homes to potential residents. They had also relaxed the isolation period for residents entering care on either a permanent or respite basis. Then lockdown restrictions were again enforced on 9th July.

Up To Date Information

Gathering information for my clients about care and fees for each aged care facility and arranging tours (when available) has became more labour intensive as each facility has different procedures for touring and admissions during these restrictions.  As the health restrictions change so do the facilities’ procedures, making it an ongoing task. For prospective residents it is very difficult to navigate and they rely on my gathering the correct information and providing advice.

Of course they wonder if the different procedures will guarantee that they will be safer and less likely to catch Covid-19. It is very difficult to assess the likely outcome between the different procedures in each facility. One can only make an educated guess based on the Health Experts’ advice.

More Seeking Aged Care Accommodation

During this second lockdown I am finding there is a big difference in the number of enquiries I am receiving from families needing to place their loved ones in aged care. I think families held off from having their loved ones admitted to an aged care home during the first wave, and now that we have a second wave they can’t continue to hold out until we are Covid-free, as there is no knowing how long it will be.

However, with such a large developing number of aged care homes in Victoria reporting cases of Covid-19, clients who had chosen their new home last week are now questioning whether it is safer to stay at home until aged care homes are clear of the virus.

Screening Process 

All aged care homes have a similar screening process for residents before entering a home. Everyone must show evidence of a current flu vaccination, submit to a temperature check and answer questions relating to general health and whether they’ve had contact with someone who might have Covid-19.

Restrictions on Touring Aged Care Faciilties

As Victoria is now in Stage 3 restrictions, most aged care homes have suspended all ‘meet & greet’ appointments for tours. Meetings can be arranged so that a client can speak to the staff over the phone, via Skype, Zoom or Face Time. Intending residents can view photos of the home’s interiors and suites and have virtual tours. There are still some aged care homes that provide restricted tours allowing viewing only of the resident’s proposed new bedroom with no interaction with other residents in the home.

Professional Help

I’m finding that now, more than ever, people are seeking my help as a Placement Consultant to find the most suitable aged care facility for their loved one or a client. With so many variables to consider now and a changing landscape it is a comfort to many to be able to use a professional to assist them.

 

 

 

 

Sudden and Complex Decisions in Aged Care

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For people either planning for their future or who are at a stage where they need the support of an aged care facility in my role as a Placement Consultant I am often able to help with complex decisions and finding the right place that suits their particular needs.

For example, a couple I helped a few years back were planning for their future as they aged. They were selling their current home and considering moving into a retirement village, using the funds from the sale of their home. However, they were concerned that in the future one or both of them may need the higher level of care afforded in an aged care home and that they would not have enough funds left to buy into an aged care home that has the standard of living they enjoy.

They needed my servicesas they were confused by the vastly differing fees and charges, with inclusions that varied from village to village. I helped them by researching the different price ranges, exit strategies and cost of entering the next level of care. I felt the best solution whereby they could transition into aged care from retirement with the least disruption and loss of capital would be a retirement complex with aged care on site. I found the few facilities that offered this arrangement and set up visits for the couple to choose the option that suited them best geographically, cost wise and to their standard.

When a new aged care facility opened in Templestowe, Melbourne in April, 2019 I placed four of my clients there that year. They were all very happy with the single storey residence, and its lovely, large suites including double suites for couples. As a Placement Consultant, it has often been a challenge to meet my clients’ requests for a double suite as not many facilities catered to couples with shared room accommodation. Thankfully the new aged care facilities being built have rooms with couples’ accommodation, opening up the options.

Moving into aged care accommodation is often an emotional and stressful time for a person and their family, as they are suddenly in a situation where there has been a fall or deterioration to the point that immediate accommodation with high-level care must be found. They are often in hospital, waiting to be discharged and their needs are such high care they can only be supported safely in an aged care facility.

This is where I can offer my services as a Placement Consultant, helping on several levels. Firstly, I interview the client to find out what is important to them and what are priorities and, as I have a good knowledge of the accommodation available, can recommend a short list of the most suitable options. Secondly, I can help with negotiating fees, often saving my clients considerable amounts. Thirdly, I can fill out all the paper work and fourthly, I have counselling qualifications and can help ease the transition for all involved.

If you have a client or family member who needs help finding suitable aged care accommodation please contact me.

 

 

 

 

A New Approach To Design of Aged Care Facilities

Aged Care Facility

An Aged Care Facility

A group of design professionals, innovators, planners and seniors came together in a charrette (a workshop devoted to planning a design or solving a problem) to look at a new way of creating aged care facilities. Rather than design just for comfort, or looks, the group aim was to design to aid longevity. Hosted by The University of Queensland and DMA Engineers, the 120 assembled experts considered this a rare opportunity for teams of people from different fields to collaborate in some blue sky thinking.

DMA Engineers managing director Russell Lamb discussed the current dischotomy.

“It’s quite restrictive. In fact, it’s probably one of the most restrictive. I think that’s one of the struggles that the industry’s dealing with at the moment, where we hear terms about ageing in place, but if you go from a retirement living facility, where it’s in most regards an apartment that younger people in their twenties, thirties, forties may be happy to live in, to when you’re actually going to an aged care Class 9C patient room. The amount of services and facilities within that room are fundamentally different.

“One of the challenges the industry is really faced with is how we can have a space which transforms over a matter of years and transforms in a way that maintains the character of the place and doesn’t become too clinical, too quickly.”

The group was challenged to create visionary, innovative and highly connected designs to meet the needs of an intergenerational community in 2050. It was noted that too often aged care facilities are cut off from the wider community by virtue of cheaper land forcing providers to the outskirts of town.

The University of Queensland’s Director of the Healthy Ageing Initiative, Professor Laurie Buys, said

“Older people are thinking and acting very differently than ever before, and we know that future generations of older people will have very high expectations about maintaining their engaged lifestyles.”

The experts gathered into groups and took part in a design competition. The chance to throw the rule book out of the window was appealing for many of the designers who were able to think more generally about how the needs of older people can be met in a hypothetical way, rather than designing to a client’s brief. A common thread emerged of physical and social connectedness, key to promoting increased choice, economic development and job creation. Designs visualized spaces that enabled older people to be creative and productive rather than just existing in places with activities to pass the time away.

 

Thanks to Aged Care Insite for information used in this blog.

 

 

Taking a Break From Aged Care Homes

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If a resident wants to have a break from their aged care accommodation, until very recently, the legislation only permitted permanent residents to be away from their aged care residence for up to 52 days a year for non-hospital related reasons. This is known as social leave. If they took more than the 52 days the Government did not provide its subsidy to cover the extra days and the cost was usually passed on to the resident.

The legislation has now changed in the wake of the COVID-19 pandemic. New emergency leave legislation amendments have now been adopted by the Federal Government, which are to be activated in volatile situations, including natural disasters or health epidemics.

The Minister for Aged Care and Senior Australians, Richard Colbeck, said the recent bushfires and the virus pandemic had highlighted the need to protect leave entitlements of aged care residents.

“During the COVID-19 pandemic, some aged care residents have temporarily relocated to live with family, to reduce their risk of exposure to the virus,” Minister Colbeck said.

“Most of these residents are likely to exhaust their 52 days before the pandemic passes, leading to extra costs on them or their families.”

The eligibility for emergency leave will be backdated to 1 April this year, so people impacted by the current COVID-19 crisis are not disadvantaged.

With so many changes being made by the governments during this pandemic, clients are finding my services as a Placement Consultant to be even more helpful than ever. I can advise clients as I am kept up to date with all the latest legislative changes and procedures being adopted by each of the aged care facilities within Victoria.

 

 

 

 

 

Extra Funding and Visitor Code for Aged Care Facilities

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The dedication and commitment of staff at aged care facilities is to be commended. There has been some bad publicity about staff unknowingly spreading COVID-19 within a couple of facilities, and that is tragic, but generally staff across Australia have done a great job with a lot more pressure than they normally carry. Many have gone beyond the call of duty with extra challenges to their already demanding roles.

In my last blog I discussed the call for an increase in visitation rights for families to aged care facilities and the extra burden that would place on staffing levels in an already strained situation. Fortunately there has been a positive response to helping families visit residents in aged care homes whilst keeping them safe. Firstly a nationally consistent code for aged care visits, The Visitor Access Code for Aged Care, was finalised and released as a guide for facilities. It was contributed to by thirteen aged care peak bodies and consumer advocacy organisations.

Secondly, the federal government has responded to the need for more financial support to assist aged care facilities stay safe with the ‘COVID-19 Aged Care Support Program’.

The government is seeking to achieve the following outcomes through this program:

  • Consumers of aged care services directly impacted by COVID-19 receive safe, quality care; and
  • The financial costs of managing direct impacts of COVID-19 are reduced for eligible aged care services.

The total funding package is $52.9 million delivered over two years. $26.45m is to be delivered in 2019-20 and $26.45m in 2020-21 to residential aged care providers (RAC), National Aboriginal and Torres Strait Islander (NATSI) providers and Home Care providers whose services are directly impacted.

The program will reimburse approved aged care providers for eligible expenditure incurred due to the direct impact of COVID-19. The grant will cover 100 per cent of eligible expenditure up to the maximum grant value.

For RAC and NATSI providers, there will be two components of funding:

  1. A base funding allocation of $20,000 plus; and
  2. An additional $2,000 for each operational bed/place.

Any expenditure which exceeds the maximum amount and other ineligible expenditure remain the responsibility of the provider.

The funding is to cover eligible activities associated with managing direct impacts of COVID-19, including the following:

  • providing additional staff to manage care in a service with residents who are either infected or isolated due to COVID-19
  • replacing existing staff who are infected or isolated due to COVID-19
  • training staff and residents/clients in infection control, and
  • accessing equipment and resources required to manage a service in an infection control environment, including linen and bedding, paper products, PPE, disinfection and cleaning agents.

Increased or replaced staff may include registered nurses, direct care staff, hotel services staff (catering and cleaning), diversional therapy and activities staff, allied health staff, maintenance staff and administrative staff.

With this swift response to and recognition of the needs of residents, their families and staffing within aged care facilities, in my role as a Placement Consultant, I hope my clients and all other residents in these facilities are now able to see their families, feel supported, safe and, above all, stay well.

 

 

Visitors to Aged Care Homes

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The Prime Minister went on national television last Tuesday to tell aged care facilities in Australia to go easy on their lockdown measures. He said the recommendation from the national cabinet was for a maximum of two visits per resident per day in the resident’s room. He was concerned for the welfare and health of residents in aged care if they were not receiving regular visits from their families.

Several things have come to my notice as an Aged Care Placement Consultant about the situation. Aged Care Facilities seem to vary from one to another with how they are dealing with COVID-19, as mentioned in my last blog. When it comes to visitors some are in strict lockdown, others are following the government recommendations. Staff are busier than ever, as they don’t have the help of volunteers and other support services; for example, they are having to conduct all the activities to keep residents occupied.

General Secretary of the NSW Nurses and Midwives Associations, Brett Holmes, said the government needed to provide additional staff to aged care facilities so they could screen visitors before allowing them in. I agree with this and can understand the difficulties aged care homes will face in monitoring visitors, I’m aware that even at the moment where families are allowed to visit their loved ones in palliative care, in some facilities it is only for 15 minutes, yet when asked to leave they ask for another 5 minutes, then another 5 – this all takes up staff time, adding an extra burden. There will be further calls on staff time when the directive starting in May that visitors must have the up to date flu immunisation comes into effect, as this will need policing.

Brett Holmes went on to say “There are qualified nurses out there looking for work and if the Commonwealth Government wants to open up the aged care facilities, then that should be done in the safest possible way.That should also mean of course the additional resources of PPE to allow that screening to be undertaken in the same way that our public health system is responding to this risk of people from outside the facility bringing in the COVID-19.”

I have noticed when that some aged care facilities are contacting families and asking them if they are content with the precautions the facility is taking and, to my knowledge, most families are generally understanding why the facilities have taken those precautions and that it is for the protection of residents.

Last week I placed a gentleman in an aged care facility and his wife was upset that she couldn’t visit him over the weekend. As I have said before, each facility is dealing with the situation differently. The same goes for retirement villages. I am helping a client to find a suitable retirement village and one place we were interested in would not allow a site visit but also won’t allow a resident to move in unless they have seen the facility in person. Another retirement village will allow a site visit, but only one person at a time.

I am finding that only people in an emergency are now seeking aged care accommodation as they don’t want to self isolate within the facility for 14 days once they move in, they don’t like the idea of no visitors and don’t want to spend the money and make a monumental move to a home site-unseen. Trying times indeed!