Home Care vs Residential Aged Care

It’s totally understandable that most older people wish to stay at home for as long as they can.

Many have lived in their homes for decades and raised families there. Homes, and the comfort and independence that they bring, hold deep emotional attachments for many older people.

As Australia’s population ages, the trend is that people are remaining at home longer. Some are not moving into aged care until their late 80s or even 90s, if at all. The demand for home care and aged care will continue to increase; by 2050 the number of Australians aged 85 and over is expected to more than triple, to 1.8 million.

The government has seen the sense in people staying at home as long as possible. It costs on average $250 a day for each resident in Residential Aged Care, and many Australians only pay $54.69 per day of that (85% of the daily full pension). The Government must make up the shortfall. For the government, home care packages are much less expensive.

When it comes to home care, people can choose a service provider that is right for them. The government then pays the provider a subsidy to arrange a package of care services to meet the needs of a client or consumer.

Government-funded home-care packages come in four different care levels: $9,179 per annum for level basic care (level 1); $16,147 per annum low-level care (level 2); $35,138 per annum for intermediate care (level 3); and $53,138 per annum for high-level care (level 4).

My Aged Care organizes assessments of a person’s need, which are carried out by an Aged Care Assessment Service (ACAS) nurse, who visits them at home. This assessment determines what level home care package a person is eligible for. The waiting period for a home care package is typically six months but is now closer to three months for high care packages.

Self-funded retirees or part pensioners will be asked to contribute some of the value of their home care packages. The government pays the rest. This is called an Income Tested Fee and is determined by the Department of Health and Human Services. Full pensioners are not asked to pay this contribution.

Barbara Ould, CEO of care and support provider Absolute Care & Health – which administers home care packages – says that an important principle of Home Care Packages is that the consumer has a lot of flexibility over what their funds can be spent on, to ensure they receive the supports that is right for them.

“For many people, a Level 1 package will be used to cover basic home assistance like cleaning and gardening; a level 2 package can also provide support for shopping, assistance with attending appointments, and assistance with cooking; by a level 3, many recipients also require some personal care support, especially if their mobility has declined; a level 4 package is for people who require a greater level of support and recipients will generally have more hours of personal care,” Ould said.

“Nursing and other Allied Health services such as physiotherapy or occupational therapy services can also be covered by a Home Care Package. These are often required by recipients no matter what their level.

“Package funds can also be used for home modifications such as grab rails or making a shower safe as well as aids to promote safety in their home like shower chairs or rise-recline chairs. It’s important to understand that home care packages do not cover, accommodation, entertainment, full-time nursing, security, or food costs (although they can be used to pay for the preparation and delivery component of pre-prepared meals).”

Despite the excellent care that people can receive at home, eventually, the practicalities of remaining at home can outweigh the emotions and even a Level 4 Package will not provide for around-the-clock support. Often children are the ones who must make the decision to move a parent into a form of residential aged care, which range from retirement villages to independent living in a community, to high-care residences.

Reasons why older people could consider a transition into aged-care include:

1. Cost As people age, the level of help required at home will generally increase. Some older people are happy getting, say, assistance for four or five hours a day, generally in the morning or getting help with evening meals. However, when help is required 24-hour-a-day home care becomes hugely expensive and a home care package will only cover a small portion of this. Often there is little change from $5,000 per week or $260,000 per annum for full-time care. By contrast, aged care costs less than $55 a day for many Australians, which equates to around $20,000 per annum. There can be other incidental fees, such as the extra services fee and a Centrelink means-tested fee. The Refundable Accommodation Deposit (RAD, formerly known as a bond) must be paid but that is fully refundable. Falling property prices should mean that RADs are lowering, or at least not increasing. Empty beds in a facility usually mean you can negotiate hard on a RAD.

2. Difficulty of finding/managing quality carers Although there are many carers who genuinely care for older people for a lengthy time, demand is currently higher than supply, and finding the right person can be a challenge. When more than one carer is needed (24-hour-a-day care requires four or five carers), the problem becomes even greater. Although a care provider such as Absolute Care & Health can manage much of this, multiple carers can be a challenge for some elderly people who want consistency and as few different people as possible.

3. Loneliness As much as older people value the independence of remaining at home, an empty house can be a lonely place, despite carers visiting during the day, particularly if a husband/wife has died. By contrast, modern aged-care residences have good and varied social calendars and try hard to include new residents. Security, too, is often better in aged-care residences.

4. Strain and stress on family Managing home-care rosters can be time-consuming and can in some instances breed resentment among family members who end up doing most of the work. When parents transfer into aged care, their children and grandchildren can spend quality time with them without having to play the roles of principal carers at home.

5. New modern aged-care residences Modern aged-care residences are often bright, clean, vibrant, and often far more modern and pleasant than a tired family home. Many have libraries and meeting areas, restaurants and cinemas, and even swimming pools.

6. Medical staff and facilities Quality aged care residences all have medical staff and medical facilities available either within the premises or on call in retirement villages. As people age, their reliance on medical services generally increases. Having medically-trained people on hand leads to great peace of mind.

To apply for a Home Care Package through the government’s My Aged Care Services, phone 1800 200 422 or visit myagedcare.gov.au