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.

 

 

 

 

 

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.

 

 

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!

 

 

How Aged Care Facilities Respond to COVID-19

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With the corona virus pandemic now in Australia there are changes to how aged care facilities are able to operate.

Trinity Manor Greensborough front

In my role as Placement Consultant I help clients find suitable accommodation in aged care facilities in Melbourne. I’m currently getting frequent updates from aged care facilities on changes to their protocols. Fortunately most aged care facilities still currently taking new residents and, in some cases, respite residents. There seems to be a general requirement for new residents to self isolate for 14 days when they move into their new home. However, the need for this varies from facility to facility, with some making it mandatory for all new intakes, whilst others have made it only for those who answer positively to questions about their symptoms and/or exposure to COVID-19 or carefully check on resident’s health upon intake.

I had a client recently who I had trouble placing into a facility as she was unable to do the 14 day isolation due to memory loss. Fortunately I was able to find another suitable facility whose policy is if a new resident comes from home they will have their temperature taken and be monitored. As my client was coming from home she was accepted. However, this facility requires new residents to self isolate for 14 days If coming directly from hospital. Some facilities can no longer accept people living with dementia or people that wander as they are unable to provide care for them with the social distancing restrictions now in place.

Restrictions around visitors also vary between aged care facilities with some putting in place a total ban for visitors, with some allowance when residents are in palliative care, and others allowing minimal visitors as per the government guidelines of no more than two at a time, once a day.

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Most visits to inspect facilities are now virtual with a range of sophistication there; some have film crews do a professional video tour whilst others film the facility themselves. Some facilities will meet with you and show photos and some will even allow a personal tour but with strict cleanliness and health protocols in place.

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It is challenging keeping up with all the different protocols in the various facilities and another reason my clients find my services so helpful  as I sift through these frequent updates to keep them informed.

 

 

 

 

Aged Care Placement During The Corona Virus Pandemic

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As we all face the effects of the COVID-19 virus in our community, it is of particular concern in aged care facilities, where the most vulnerable people reside. Ever more draconian restrictions are being put in place in the wider community to try to control the spread of the virus. Aged care facilities are particularly at risk and so they have to be even more restrictive. The government has introduced a two person only visit limit to each resident and have restricted gathering in communal areas. Some facilities have put in even stricter limits, such as only allowing family to visit or completely locking down, allowing no visitors.

Despite the new regulations, social distancing and self isolation in the wider community, there will still be those elderly people who have a fall or get very ill with heart attacks, strokes, dementia and other health problems who end up needing to go into an aged care facility. Also, due to the self isolating or lockdown situations now being enforced there are elderly people, particularly those living with dementia, who will no longer have the level of care they need. I had three such cases last week that all required emergency placement in an aged care facility.

The first was an ‘at risk 93 year old woman’, living with dementia, alone in an apartment in Docklands,. Her son lives in the USA and her sister in law in Albury, NSW. As she now needed to move into a facility the family wanted accommodation in Albury so she could be near her sister in law. They asked me to find a suitable facility and organize the transfer. I found a suitable facility and the son had to make the decision sight unseen, trusting my judgment. With the help of a case manager and a private carer I arranged for transportation. Due to the changing directions coming from the government, the facility was changing its protocols daily which delayed her being admitted and resulted in her staying a night in Albury and the private carer taking her to the facility, where she had to start a 14 day isolation. Very difficult circumstances for an elderly lady living with dementia. Happily, she is settled and doing well.

The second was a gent with dementia living with his wife who had serious health issues. His behaviour had exacerbated and she was concerned about keeping him locked in the house if the lock-down got worse, which it has. This was a difficult process as her children thought she should keep him at home as she had signed up for ‘better or worse’.  He also had to go in without her looking at the room and undergo social isolation for 14 days.

The third was another woman living with dementia in a fully independent, serviced apartment in Carlton.  This was also an urgent situation as there is no one to go in and check on her and she is living alone and isolated with dementia. Fortunately I have been able to place her as well.

There has definitely been a rise in demand for help in finding suitable aged care.The service I provide means I source a facility that is suitable in terms of location, programmes, affordability, staffing levels, type of accommodation, services offered and outings. Because I research the facilities, visit most of them and know many of the managers I have an inside knowledge about how they operate and how suitable they will be for my clients.

These are challenging times for us all, and for an elderly person living with dementia having to move from their home it is extremely stressful. . I am grateful that now, more than ever, I can be of assistanceto ease this distress, fear and anxiety as I have a counselling qualification, which gives me the skills to really help people going through this transition.

 

Bereavement Can Be A Risk Factor

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We know Shakespeare’s tragic story of two young lovers who both lost their lives through bereavement. Romeo and Juliet are the quintessential lovers, forever in love. In their tale they took their own lives due to the grief of losing their loved one, but studies have found that a bereaved person is actually at a higher risk of dying due to health problems. Following the loss of a loved one it has been found that often a person will experience increased heart rate, blood pressure and blood clotting, as well as increases in symptoms of anxiety and depression. The expression dying from a broken heart takes on a clinical meaning.

A randomised clinical trial at the University of Sydney lead by Professor Geoffrey Tofler looked at a total of 85 people and showed that it is possible to reduce several cardiac risk factors during this time, without adversely affecting the grieving process. The oldest person in the study was 85 years of age with the average age of all subjects in the study being 66.

Following on from previous studies on cardiac health risks, increased depression and anxiety after bereavement Professor Tofler noted “However, there have been no interventions to address this with the goal of lowering cardiac risk, so we aimed to provide this with an approach that does not adversely affect the grief process.”

Forty-two subjects received low daily doses of a beta blocker and aspirin for six weeks, whilst the control group of 43 were given placebos. Heart rate and blood pressure were carefully monitored, and blood tests assessed blood clotting changes.

“The main finding was that the active medication, used in a low dose once a day, successfully reduced spikes in blood pressure and heart rate, as well as demonstrating some positive change in blood clotting tendency,” Tofler said.

The investigators also carefully monitored the grief reaction of participants.

“We were reassured that the medication had no adverse effect on the psychological responses, and indeed lessened symptoms of anxiety and depression.”

Professor Tofler advocates the use of this therapy as a risk prevention strategy in those recently bereaved. He also encouraged the medical profession to give extra attention to the health of recently bereaved people,rRobson-and-Jeromeeople, as well as family and friends, who should provide social support and report any health symptoms to medical practitioners.