Choosing Residential Care
Selecting the right Residential Aged Care Facility (RACF) can be daunting and this can be exacerbated if you are needing to do it under duress. For example … and we see this a lot … you can’t return home due to a fall and the hospital is applying pressure on you and your family to move you somewhere else. While this pressure will significantly increase the stress experienced - the following information will assist you and your family regardless of the situation. Finally, whilst moving is always an upheaval regardless of where you are in life, it is always an option - so don’t feel that this is an irreversible decision.
Choosing the right RACF is a very personal decision, and while there are some logical and practical decisions that you and your family need to work through, it often comes down to where you feel most comfortable. Family Aged Care Advocates recommends that, where possible, you visit a selection of places, even ones that may not be on your radar, to get a feel for what is right for you. Most facilities have a cafe now, or you may arrive early for a scheduled meeting and just sit and observe.
**NOTE** In covid times - this is not as easy and your access may be restricted
While you are there, observe the following:
• Do the residents look happy and engaged?
• Do the staff look happy? They will no doubt be busy, but how much?
• How are staff interacting with the residents?
• Is management visible? Is the door open?
• Is there any odour?
• What are the finishes like? In public areas and less visible areas?
Depending on your timeframe, this step may be an early part of your proactive planning process that you and your family can take your time with … or … it may be condensed into your visit schedule with facilities that you are meeting with that have already met some criteria.
Let’s step through that process now
Where do you want to live?
In your current community or close to your family and/or significant others?
Tip: When thinking about this, try and be realistic about what you can, and want to, commit to. It is not unusual for people to move from their local community to be close to family but then find that over a period of time those family visits get less frequent and they are then in a community that they do not know, increasing the sense of isolation. This will depend on the degree of frailty in the person at the time of the move.
What is your budget?
The prices listed on the My Aged Care website are the maximum prices that a RACF provider can sell that type of room for. You might be able to negotiate something different. There are different ways you can set up the agreement that may mean you don’t need to pay the full price of the room, known variously as RAD’s, DAP’s, RAC’s and DAC’s. / over What is included in these costs and what might be provided to you as “additional” services and the cost for that?
Tip: A fundamental level of service provision is mandated through the Aged Care Act and the Quality of Care Principles, however, you increasingly see Extra and Additional services offered by facilities. This can be useful for increasing the comfort of care … but is it within your budget? Can you opt in or out of them? For example, how often do you need to travel to appointments? A facility is not required to provide travel to appointments, some may charge for the service. You may find that community transport services you previously used are no longer available to you once in care.
Finances, Legal and Life
• Have you talked to an aged care specialist who understands your affordability options and what you may have to pay for your care and accommodation?
• Have you done the Centrelink paperwork? This can take a while.
• Have you sorted out your legal documents such as your Will, Enduring Power of Attorney, Enduring Guardian? When were these reviewed and do they reflect your current wishes?
• Have you had a clear conversation with the significant others in your life who are affected by this process? Be clear about what are your needs, expectations and fears.
The Residential Aged Care Facility
Things to consider:
• Often facilities are selected by the family and they select based on what is relevant to them … and not necessarily what’s relevant and important to you. For instance, are you a sociable person who likes to mingle with others? Then maybe a smaller room but a better community / lifestyle engagement and well used communal areas is going to be better than a spacious room with little going on in the facility.
• Currently staffing ratios are not mandated in Australia, nor are minimum staff qualifications. However, the vast majority of facilities would have a minimum expectation that care staff are qualified to a Certificate III level. The presence, or absence, of a 24/7 registered nurse is usually dependent on size of the facility. It is more likely to be the number of frontline care staff that will have a greater impact on your day-to-day quality of life. These are the people who will be assisting you with your daily care needs - going to the toilet, showering, eating etc. Ask how many direct care staff are on shift at different times of the day.
• What are your ongoing care or medical needs? Do you still need to attend lots of appointments or have specialised procedures. If so, talk to the facility about how they will be able to support that and if there might be additional costs.
• Do you feel comfortable with the staff you meet there? Were you able to meet management or did you speak with the placement coordinator (or similar) only?
Good luck with your search. There are a lot of fantastic facilities out there providing beautiful care to our elders. Ask around your network of friends and colleagues for their resident facility experiences. You can also jump online - My Aged Care has a non-compliance checker at www.myagedcare.gov.au/non-compliance-checker, which is about as close as possible regarding an independent review of different facilities compliance with the aged care standards. There is also now a new star rating system based on accreditation https://www.health.gov.au/our-work/star-ratings-for-residential-aged-care results and consumer feedback. If all this sounds a challenge or you and your family want some guidance, Family Aged Care Advocates are here to help.