Residential ‘road-test’ costing respite places
The royal commission has heard “significant” concerns about respite care and the effect of the “try before you buy” approach on the availability of residential respite.
The royal commission has heard “significant” concerns about respite care and the effect of the “try before you buy” approach on the availability of residential respite.
Carers Australia National Policy Manager Susan Elderton told the Royal Commission into Aged Care Quality and Safety last week that it is becoming increasingly difficult to find residential respite care.
“We wondered why, because according to the Department of Health’s data the incidence of people taking respite beds in residential care facilities has kept rising,” she said in evidence.
“So one thing we posited – and this came out of conversations with providers and people in the sector – was that actually those beds weren’t being used for people who wanted short-term respite.
“They’re increasingly being used by people who wanted to have a ‘try before you buy’ experience – go into a respite bed, see if you like the facility, ‘road test’ it, and then if you like, you go straight into permanent care.”
As reported by Community Care Review last October, the Aged Care Financial Authority said in a report that in the number of people going straight from respite to permanent care was increasing partly as a result of people using a respite stay to try out a facility before they moved in.
This approach tends to be more attractive to providers, Ms Elderton told the commission.
“There are many reasons why residential care providers may not want to provide respite,” she said.
Ms Elderton said there was a significant administrative load involved in taking someone in even for a short time, and subsidies for respite were low compared to permanent care.
“Disruption to the facility is high, too,” she added. “You take in a new person, you don’t know their needs. You’ve got to adapt to them. It takes much more effort than someone who’s a familiar presence.”
Respite as a home care service
In other evidence, Ms Elderton called for respite to be included as a service under the home care package program.
“Under home care packages (respite) is not a service, so if you’re on a home care package you can get access to subsidised respite, but only when all the other funds have been expended from the package and if there’s some left over that can be used to pay for the cost of respite,” she said.
“We think it should be factored in as a service. “
Another issue, Ms Elderton said, is that respite is not officially a service for carers, but a service for the person being cared for.
“We do acknowledge that there are people without carers who will benefit from a period of rest that they need for themselves. But for the most part it is so carers can take a rest,” she said.
Informal care at a tipping point
Australia’s declining population of informal carers has left the nation at a tipping point, Ms Elderton said.
There are 2.7 million carers of which 860,000 are primary carers. Forty-nine per cent of those care for the aged. A Deloitte Access Economics report, tendered in evidence to the commission, puts the value of unpaid care at $60.3 billion of paid care, up from $40.9 million in 2010.
However the population of informal carers, primarily family and friends, is declining, Ms Elderston said. This was a result of baby boomers having fewer children, the need for families to have two incomes and to work for longer to survive, women having children later in life, increased divorce rates and increased rate of mobility of families.
Asked by Counsel Assisting Timothy McEvoy if the looming depletion of informal carers was “cataclysmic” for the provision of care Ms Elderton replied:
“Cataclysmic is a big word but, yes, it’s certainly extremely worrying and – and theoretically they’re going to have to be replaced by paid workers, care workers, or they will have to go into residential care. (Older people) won’t be able to age at home as they want to.”
Having more flexible and carer-friendly workplaces would help address the problem, she said, as could reducing the home care waiting time to a maximum of three months and making more high-level care packages available.
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Unfortunately aged care “gurus” otherwise known as private providers push the try before you buy concept quite openly, providing aged care facilities with a ready consumer market.
Older people who then require emergency respite face presenting to their nearest hospital in the absence of a respite bed.
If you need an aged care specialist see an independent assessment or financial counselling service.
There is a need for the provision of more “cottage style ” respite, where a person can have a short stay (say 4 to 7days). There used to be such a facility in the Illawarra area but because of a change in providers it no longer exists. Carers need a break (often just to get some sleep over a few days) and the person with dementia may benefit from a change . In the latter case respite may be difficult for the carer to manage but if those providing respite are properly trained , difficulties may be minimised.
I have been told by one facility that they will not provide respite for less than 2 weeks because of the paper work involved. I do know of facilities which will offer a respite person with a permanent placement but if the individual has been hard to care for, then such an offer is not made.
There are also providers who refuse to admit clients to a permanent bed until they have completed and received their income assessment. These providers are putting undue pressure on clients and their families, demanding they accept a respite bed instead of a permanent bed. The same providers are also pressuring ACAS/ACAT to complete respite extensions because the income assessment has not been received.