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Aged Care – the process

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What are the first steps that need to be taken to ensure that our loved ones, or in this example, my widowed mum, can effectively enter a residential aged care facility without too many dramas.

1. Complete an ACAT assessment
You can’t drive mum to the closest nursing home and ask if they have a room available for her. Your mum needs to have an ACAT assessment to say that she is eligible from a health perspective to enter residential aged care.

 What is an ACAT assessment?
ACAT stands for Aged Care Assessment Team. This is a team of medically qualified people who can assess your mum’s health and decide on a suitable plan to ensure your mum is cared for and receives the necessary medical care.

 How do I find my local Aged Care Assessment Team?

A very good government website myagedcare.gov.au will provide you with direction on applying for an assessment. After the assessment is completed, a letter will be forwarded to you or your mum in this example, outlining the level of care that she is entitled to receive.

It is important that the letter provides the necessary residential aged care approval to ensure mum can enter a residential aged care facility.

Once you have the correct ACAT Assessment letter, mum can now consider entering a nursing home.

 2. Figure out how much you need to pay?

There are forms that need to be completed and there are a couple of different forms which are relevant to a person’s circumstances.

In mums’ case, as she is a widow and in receipt of an age pension who owns her home, she will need to complete an SA485 which will ask questions concerning her home, its’ value and whether she is planning to rent the home or sell the property. They will not necessarily ask her about her other assets and income because Centrelink already has these details.

If mum was not in receipt of an age pension, she would need to complete a far more detailed and comprehensive SA457 form as Centrelink does not have any income or asset details.

If you are confident in using the internet, there is also a dynamic SA486 form that you can complete online which changes the questions on an ongoing basis depending on the answers you have provided to the previous question.

These forms are all available on myagedcare.gov.au, which provide a good explanation of who should be completing what form.

These forms can be completed before mum needs to enter the home so that mum and you, in this example are aware of the fees, but do not panic if you are not able to do so as they certainly can be completed after mum has entered the aged care facility.

A few weeks after completing and lodging the forms, mum will receive a letter from Services Australia outlining her fees and whether she needs to pay a Refundable Accommodation Deposit.

 3. You can now relax!

After mum enters the aged care facility her fees are reviewed on a quarterly basis in January, March, July, and September. The aged care facility will receive notification of the review and any possible change in the fees, with necessary adjustments being made for the fees which have been paid in the last three months.

So, even though mum is now safely residing in the aged care facility you still need to be diligent to ensure that mum’s fees are correct, and her financial circumstances are reviewed and kept up to date on a regular basis.

If you still are unsure of the process and have questions speak to an expert who can fully explain the issues you and your mum may face when it does come time for her to enter residential aged care.

 

 

Source:  Mark Teale | Centrepoint Alliance

Aged Care – it’s complicated, and emotional

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This story highlights the complexities of aged care and the financial and emotional stress that can arise for not just one person, but in this case, two.

Here is a brief outline of the circumstances.

  • Mum, Anne is 87 years of age and not in very good health. For the last 6 years she has been cared for by her daughter, Jayne who is now 61 years of age.
  • Anne is in receipt of a full age pension; her only assets are her home which she has lived in for over 50 years (because of its location is worth over $1 million) and $43,000 in a bank account.
  • Her daughter Jayne, is single, a qualified nurse and has not worked for the last 6 years while she has cared for her mum. She is in receipt of a Carer Payment and a Carer Allowance. Jayne does not own a house and has lived at home with her mum since her father passed away 20 years ago.
  • Anne’s health has been in continuous decline, and she now needs to enter residential aged care.

What happens next?

Anne enters residential aged care as a low means resident, meaning she does not have to pay a Refundable Accommodation Deposit (RAD). Her only cost is the basic daily fee of $52.25 per day or $731.50 per fortnight. Anne is in receipt of the full age pension $944.30 per fortnight, so there does not appear to an issue.

At the time of her entering aged care, Anne’s home is exempt because Jayne is still residing in the home, has done so for many years, and is receiving an income support payment – the Carer Payment. Under the legislation Jayne is classified as a “protected person”.

After a period of 14 weeks the Carer Payment ceases as Jayne is no longer caring for her mum and is therefore no longer entitled this payment. Jayne then decides she is going to return to nursing and commences work at her local hospital, continuing to reside in her mum’s house.

Unfortunately for everyone, life is about to become a little more stressful.

As Jayne is no longer in receipt of an income support payment, mum’s home becomes an asset for the purpose of calculating the aged care fees.

Anne’s status as a low means resident remains and she does not need to pay a RAD, however she now is required to pay a Daily Accommodation Charge (DAC) of $58.19 per day or $814.66 per fortnight on top of the basic fee. Mum’s total fees now are the Basic Daily Fee of $52.25 per day plus the DAC of $58.19 or $1,546.16 per fortnight. Mum’s only source of income is the full age pension $944.30 per fortnight, therefore she is just over $600 a fortnight short of being able to pay her fees.

Jayne, who is now working, decides she will pay the difference from her salary, which solves the problem in the short term.

However, two years after mum entered residential aged care, she loses her pension because of her assets, her one-million-dollar home has become an asset for the purpose of calculating her age pension entitlement.

Mum’s cash in the bank has reduced to just over $20,000 and even though Jayne is still working, her salary will not cover her own living expenses and Anne’s total aged care fees. Anne’s fees are no longer around $600 a fortnight short in paying her fees, she is now short $1,546.16 per fortnight.

The options available are not many.

They could sell the home, which is incredibly stressful for Jayne. Even though she has an enduring power of attorney and could sell her mum’s home, she is reluctant. It’s not the financial perspective, but the emotional and sentimental impact of selling the family home. After all, this is her mum’s home and she has also lived in the home for over 20 years.

Jayne considers borrowing against the value of the home and paying a Refundable Accommodation Charge (RAC) of $433,500 to the aged care facility to ensure mum no longer has to pay the DAC. The money borrowed and secured against the value of the home will reduce the value of Anne’s assets to below the threshold and she could then be entitled to an age pension of $591 per fortnight.

Mum’s aged care fees will change to the Basic Daily Fee of $52.25 per day, with a Means Tested Care Fee of $18.27 per day, making the total fee payable $987.28 per fortnight.

Jayne would then be responsible for both the short fall in her mum’s aged care fees as well as the mortgage repayments on mum’s home.

In this particular scenario, Jayne had not spoken to anyone before mum had to enter aged care and so she had no idea of the decisions she would have to make. As such, she was not prepared either financially or emotionally with the issues she had to face.

The aged care legislation is complicated but more than that, it is exceedingly emotional, and people should be prepared for and aware of the decisions that they may need to be make before they have to make them.

Talk to an expert who understands what is required so that you are prepared, and nothing comes as a shock. Don’t leave it until the last moment, decisions made under emotional stress are generally not made with the clearest of heads.

 

Source:  Mark Teale | Centrepoint Alliance

10 things to consider when looking at Aged Care

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In October 2018 the government established a Royal Commission into Aged Care Quality and Safety. It commenced hearings in January 2019, provided an Interim report in October 2019, and is scheduled to provide its final report in November 2020.

During the last 12 months the media has reported on several very disturbing issues of neglect, understaffing and abuse which has occurred in a number of aged care facilities in Australia. This no doubt has led to a certain amount of apprehension for elderly people and their families who are about to enter residential aged care.

I can understand this feeling and I do sympathise with people in this situation. However, not all aged care facilities are like those which have grabbed the headlines.

My mum has been in a residential aged care home for the last 16 months. She entered her home just prior to the announcement of the Royal Commission. Over this period, I can assure you that mum has been well looked after, she has put on weight, and she has developed new friendships in the home, not only with the residents but also the staff. Neither my brother, sister or myself have witnessed any actions which have caused us concerns.

People have asked me how we decided which home was best for mum. The following are some of the things we considered when we were choosing her aged care.

 1. Affordability – what could mum afford to pay to enter the home and what would her ongoing fees be? Some homes charge an Extra Service Fee which covers internet usage, streaming services, choice of meals or even wine, extra outings, etc. The list is endless. Remember, if you do choose a home which charges this fee you cannot opt out of the fee in the future, even if mum or dad stop using those extra facilities.

2. Location – how close is the home to the people who will visit on a regular basis? What if someone needs to accompany them to see a doctor or to be taken to hospital?. I live 10 minutes from mum which is handy – she has broken her bottom dentures three times and I am able to get them fixed a lot quicker than the facility staff as I am able to pick them up and take them to the closest dental technician.

3. Accreditation– does the home have the necessary government accreditation? Has there been any issues of non-compliance in the past which has resulted in sanctions? You can ask the home, however you should also visit the My Aged Care website which is a government site that provides details of any past compliance issues.

4. Health and Safety– you can ask the home for the latest Health and Safety report which will outline any incidents that have taken place against residents or even residents against staff.

5. Staff to Patient Ratio– these are not consistent across the different states and depending on the level of care – high or low– the ratio will vary. However, it is worth asking the question. I understand that minimum staff to patient ratio recommendations will be part of the final Royal Commission report in November 2020.

6. Bedroom– are you being shown the actual room that mum or dad will move into or is it a show room? Is the room light and airy? Is it a reasonable size? Are you able to fit a table or at least a comfortable chair for a person to sit and watch television or read? Is the room clean? How often is the room cleaned and do they change the bed linen regularly? Is there a panic alarm within reach for a person lying in bed? And is there a private bathroom?

7. Furnishing– is the bed new or at least sturdy and damage free? Is there a wardrobe for mum or dad’s clothes? Is there a lockable draw for valuables? Are the curtains covering the windows clean and fresh? Is there air conditioning? Importantly, is there a television? If so, how old is it? Finally, is there a phone connection to the room?

8. Activities– do they have a regular program of outings, activities and exercise? This was very important from my perspective, my mum does have a short attention span and needs regular activities to keep her brain active and to avoid boredom, loneliness and depression

9. Laundry – how often are mum and dad’s clothes washed? Will the home put name tags on the clothes and if so, who covers this cost?

10. Low Care to High Care– last but by no means least if required will mum or dad be able to move to high care in the same home without the need to move them to another facility?

This is by no means an exhaustive list, but it is a start.

I always think that the best way to approach this process is to look at facility and the room from a personal perspective – if I was moving in what would I want and what would make me happy?

 

Source:  Mark Teale | Centrepoint Alliance

Federal Budget Overview – 2019

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On 2 April 2019, The Hon Josh Frydenberg delivered his first Budget as Federal Treasurer.

The good news is that the Budget has forecasted a return to surplus of around $7.1bn in 2019-20. Australian will earn more than it spends!

Ten million low and middle-income earners are the winners as they will receive an immediate tax cut, which is being delivered by way of an increase in the Low and Middle-Income Tax Offset (LMITO). The increase will be available for the next three years and will see the LIMITO more than double. An amount of $1,080 for Australians with taxable income of between $48,000 and $90,000. A more modest offset is available for those on lower incomes, and the offset cuts out when taxable income reaches $126,000.

It has been estimated that by 2024, 94% of Australians will have a marginal tax rate of 30% or less.

By contrast, the top 5% of income earners will pay a third of all taxes collected.

Australians who receive a range of government income support benefits will receive a one-off payment of $75 for singles, and $125 for couples, to help with their energy bills. This payment is planned to be made before 30 June 2019.

Superannuation was largely untouched in this year’s Budget, however, from 1 July 2020, people aged 65 and 66 will be able to make super contributions without having to meet the work test and the maximum age spouse contributions can be made is to be extended from 69 to 74.

Infrastructure and health received injections of cash.

Expect to see the skyline silhouetted with cranes. The Government has announced further significant spending on roads, rails, airports and the like.

Included in the Budget was an allocation of $500m to get cars off the roads by building more commuter car parks, therefore encouraging people to travel by train. For anyone who tries to navigate capital city peak hour traffic, this will be welcome news.

Small to medium businesses will benefit from the planned increase in the instant asset write-off for purchases of up to $30,000.

Older Australians have not been ignored with an additional 10,000 aged care home care packages being announced and a further 13,500 residential aged care places being made available. With the aged care system being strained with the increasing demand for services and support this is welcome news but sadly is nowhere near enough.

Additional funding has also been directed towards the delivery of primary and frontline health care.

Legislation will need to be passed in order for the changes to be implemented.

 

Source:  Peter Kelly | Centrepoint Alliance

Royal Commission – do we need another?

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I have been in Vietnam for the last few weeks, and when I left the country the “Royal Commission into Misconduct in the Banking, Superannuation and Financial Services” was in its last days of public hearings. On my return home I have been greeted with the Royal Commissions’ interim report.

From my perspective, the more interesting news story was the Prime Ministers announcement of a “Royal Commission into Aged Care Quality and Safety”. At present, we do not know the exact terms of reference as these will be developed after public consultations, which will include residents and their families.

Based on the Prime Ministers announcement, we broadly expect the Royal Commission into Aged Care will look at:

• The quality of care provided to older Australians, and the extent of substandard care
• The challenge of providing care to Australians with disabilities living in residential aged care, particularly younger people with disabilities
• The challenge of supporting the increasing number of Australians suffering dementia and addressing their care needs as they age
• The future challenges and opportunities for delivering aged care services in the context of changing demographics, including in remote, rural and
regional Australia
• Any other matters that the Royal Commission considers necessary

We do not know at this stage who will preside over the Royal Commission however this job would normally be assigned to a judge.

What is the difference between a Royal Commission and a normal court of law?
There are several very important differences;

1. Royal Commissions are established by the Governor General on advice from the Government, whereas courts are standing institutions
2. Royal Commissions are not bound by the rules of evidence that the courts are. These rules encompass the legal principles that govern the proof of facts in a legal proceeding
3. For witnesses there is no difference – they may be examined and cross-examined by legal counsel
4. Royal Commissions can make recommendations but cannot determine a person’s guilt or negligence. Whereas a court does not make recommendations but will make a final determination of guilt and impose a penalty
5. Witnesses may be compelled to answer questions in a Royal Commission and a court, but can only claim privilege against self-incrimination in a court

These are not the full detailed outline of the legal differences between the two, that would take far too much time and certainly too much paper.

The important principle to remember is that the Royal Commission will look at a wide range of issues, depending on the terms of reference. The community, residents, their families and providers will all get a chance to present a submission outlining their concerns and vision of the future for the aged care industry.

If a person does have a concern or an issue with an aged care facility or provider right now, you should be talking to the Aged Care Complaints Commissioner who provides a free service for anyone to raise their concerns about the quality of care and service. They can be contacted on 1800 550 552.

 

Source: Mark Teale | Centrepoint Alliance