The aged care journey is often composed of phases; points in time when care needs step up a pace, when domestic assistance may start to extend to more intimate or higher-level care, and when the level of home help available is just no longer enough.
Recognising when the next phase is beginning for your own parents or family members, though, can be difficult because these changes may happen gradually over a considerable period. This is especially true of the transition between ageing at home and requiring residential aged care.
Ken Chauhan, an aged care concierge with Anglicare Southern Queensland, spends his days helping families manage these transitions and says that there are common signs to look out for that a home care package may no longer be suitable for your loved one – and these signs differ depending on whether they live with a family member who cares for them, or live alone.
Signs of carer stress
Chauhan says a red flag that it may be time to consider residential aged care for your parent or relative is when the person doing the lion’s share of caring for your loved one (whether that is their partner, another adult child or yourself) isn’t able to continue supporting them without compromising their own health or wellbeing.
He notes that acting as a family carer can be an exhausting, 24/7 task that can exacerbate an older carer’s existing health problems.
“If that carer is the person’s partner, the majority of times I would say they would be facing their own health issues, even while playing the role of a carer, so there comes a time where the carer is no longer capable of continuing the care that they have been providing,” he says.
“So that the carer can take a break or at least regain strength and look after themselves better, it’s important that the person, and their family, starts thinking about residential aged care at this stage.”
Increasingly frequent emergency episodes
Chauhan says another common sign that ageing in place may no longer be an option is that your parent or family member is experiencing an increasing number of health emergencies or the time period between such emergencies is decreasing.
Noticing that you’re having to call an ambulance more frequently or that your loved one is suffering repeated falls should trigger a discussion about residential aged care, he advises.
“[If their] mobility has declined and they’ve experienced minor falls, that’s another sign, because you don’t want that to turn into a major fall,” Chauhan says. “As we age, any injuries can change your life dramatically, and recovery can take longer.”
Increasingly frequent need for respite care
Respite care facilities provide temporary care and accommodation to people who need care, to allow their carer time to leave the home for an extended period or simply attend to their own needs.
Respite care can range from a single day to overnight stays and even stays of a week or more, either on a regular, planned basis or in emergency circumstances where the carer is unexpectedly incapacitated.
Chauhan says, though, that a pattern of increasing use of respite care can indicate that the family carer’s health or wellbeing is being seriously impacted by their caring role, or that the needs of the person receiving care are becoming unmanageable.
“When you see this frequent use of respite, that’s another big sign that a family needs to start considering permanent residential care,” he says.
Increasingly challenging or unpredictable behaviours
If your relative is living with dementia or another condition that impacts cognitive functions, their behaviour can change substantially from what it was prior to their illness.
When those behaviour changes become difficult for a family carer to manage or impact the carer’s health – for example, where the person being cared for has sleep patterns that prevent their carer from sleeping or involve physical outbursts – that often prompts families to look into a residential care home for their loved one, Chauhan says.
“In some cases, dementia can progress to the point where it’s hard to predict how a person is going to react to certain situations, and for one person doing the caring alone, that can become no longer viable,” he adds. “With residential care, care is available instantly, at any time.”
If your parent or family member lives alone but receives home assistance of some form, the changes that flag that home care is no longer sufficient are often subtle and take a different form to those you may spot in someone who lives with a carer.
Regular mismanagement of medication
“Even though a nurse may be visiting once a week to do a health check, it’s often at this time that they notice the person they’re caring for has been skipping or forgetting to take important medication,” Chauhan explains, noting that a key aspect of residential aged care is ongoing assistance with medication.
If your loved one is no longer able to manage their own medication without mishaps, residential care may be the best way to ensure their wellbeing, he says.
Signs of social isolation
A decline in your relative’s mobility, hearing, sight or other abilities can take a heavy toll on their motivation to go out or interact with others. Sadly, being socially isolated then poses a risk to their mental health and can even further undermine their ability to live independently.
Chauhan says that residential aged care can be a big help for older people who are missing out on vital social interaction while living in their own home, so much so that Anglicare has clients at its residential aged care homes who’ve elected to live at the home with the aim of living “longer, happier and healthier” lives.
“Some of our residents have been in our homes for many years – they’ve chosen to come here and they enjoy the lifestyle,” he adds.
Care is increasingly unwelcome
If a loved one who previously accepted home help shows a marked change of attitude, that can be a trigger for a family to talk about future care, Chauhan says, because an increased resistance to assistance may mean your parent or family member is self-conscious about what they recognise is their own decreasing ability to live independently.
“I’ve noticed that when clients start to resent their carers coming to visit, that’s a big sign,” he notes.
Home care funding is no longer sufficient to meet care needs
When the highest level of Home Care Package is insufficient to cover your loved one’s care needs, and if they are unable to privately finance the extra care they require, residential care should be considered, Chauhan says.
“Home Care Packages aren’t infinite budgets, there’s a limit to how much the government is prepared to spend for a person’s care,” he explains. “Anglicare’s client liaison officers review our clients’ care plans regularly and if they see that a person’s care needs are exceeding the amount of funding that’s available on their package, the first option is to ask the client if they’re financially able to cover the gap in funding.
“If they can’t, the second option is to consider residential care, where the additional care can be provided.”
It’s important to plan any transition from home care to residential aged care carefully and without immediate pressure, rather than leaving the consideration phase until a crisis event forces you to act hastily on behalf of your parent or relative.
There are range of key factors to weigh up, including:
The right to age in place
The Australian Human Rights Commission is emphatic in noting that all Australians have the right to choose where they live, but adds that it’s important for everyone to know their specific rights depending on their choice of housing situation in older age.
The ‘consumer-directed care’ model was introduced in Australia in 2015 to give Australians more control over the funded assistance they are entitled to receive in order to age in their own home.
However, as Chauhan notes, this funding has limits and if you or your family are unable to privately cover the cost of the level of home care required, you or your family member’s residential options may be dictated by what My Aged Care is willing to fund.
It’s also important to remember that unless some form of formal guardianship is in place because a person no longer has the capacity to make decisions for themselves, Australians also have a right not to seek help, unless they are at risk of harming themselves or others.
The financial situation
“Generally, people are worried about their family homes,” Chauhan explains, “That’s why I strongly recommend seeing a financial advisor or an aged care consultant who can give you some tips on the financial contribution side of residential aged care, because this may inform of the best options for your financial circumstances.”
The federal government’s one-stop-shop for aged care funding, My Aged Care, sets out how its contribution to the cost of residential aged care is determined, including the role that means testing plays in the process.
Lifestyle preferences
“A lot of times I’ve seen that moving into residential aged care is not a choice, it’s just a necessity,” Chauhan says. “An individual sometimes stretches [the decision-making process] out so far that living safely at home becomes problematic and an episode or diagnosis means that it’s no longer safe for them to live at home on their own.”
This situation can often be avoided if you or your loved one plan well ahead of time for where you wish to live in later life – even if the actual move isn’t likely to happen until well down the track. He recommends visiting several aged care homes before settling on one that best suits your needs.
“Never assume things,” Chauhan adds. “Ask questions when visiting the residence, ask staff any questions on your mind and, at Anglicare, if we don’t have the answer, we will always go and find it out. It’s always good to raise any of your concerns and have a detailed discussion before making a choice.”
“If you don’t leave it until that last moment, and you choose a place that you’ve looked around, you like the landscapes, you like the surroundings, you like the management, you like the workers, the philosophy and everything, then you’ll be able to really enjoy your retirement there, compared to if you’re forced to go there.”
Anglicare Southern Queensland are here to support you at all stages; whether you’re on the path to retirement, in need of some help at home or are looking into residential aged care, we have a range of support services to help you or your loved one with the transition.
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