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The Canberra Times
The Canberra Times
Steve Evans

How to stay in your own home when old age really takes over

Valerie Brown is 95 and living in her own home.

"It's absolutely essential. It's all my memories," she said in the luxuriant garden at the back. She's lived in the house for decades so its warm red-brick walls glow with memories.

She knows the nooks and crannies - where the light switches are. The furniture and ornaments trigger reminders of her husband, who died 20 years ago.

"It's where I'm totally familiar. It's where I've had a garden for 30 years. How could I leave that?"

She can't, and through the government's Support at Home programme, she hasn't.

It offers means-tested financial help for some things but not others. It includes help for everyday living like, in the government's words, "domestic assistance such as general house-cleaning or laundry, basic home maintenance, meal preparation or deliveries"

But it does not fund "professional cleaning or maintenance such as carpet steaming, pest control, pet care, costs of groceries or food for other household members".

And the program offers "clinical support" delivered by health professionals like nurses to help people "maintain or regain capabilities", but that doesn't include "services more appropriately funded through the primary health care system such as ambulance and hospital costs, medical diagnosis and treatment, medicine dispensing, psychiatry, dental care".

The third element of support is there to help people remain independent. This includes money for "personal care such as showering and using the toilet, accessing social activities, transport, respite care, assistive technology or home modifications to help you stay independent". The government guide says it excludes "hairdressing and beauty services, tickets for attractions, personal vehicle running costs".

Valerie Brown values the program greatly because it lets her choose how to spend the money she gets (within the set constraints). "They give you a piece of money - the government does, taxpayers," she said, "And it's very sensible because you can choose how you spend it. I can spend it on gardeners because I like my garden. And someone comes and fixes the house."

And she says she's lucky enough to have a daughter. "Then you've got someone who cares about you and helps you with all the odd things".

Her daughter Bina Brown has set up her business office in the garage so she's near at hand during the day, and not that far away in her own home at other times.

Valerie and Bina (right) Brown. Picture by Karleen Minney

She founded Third Age Matters to advise people on what the options were as people aged beyond a time of independence.

Two immediate choices for many are: living at home like her mother has done or moving to a residential care home as, on the latest figures, 198,000 people have done.

About 835,000 people were assisted under the Commonwealth Home Support Programme, according to the Australian Institute of Health and Welfare.

So demand is likely to sky-rocket. The Productivity Commission estimated that "one quarter of Australians will be aged 65 years or more by 2044-45, roughly double the present proportion. The proportion of the 'oldest old' will increase even more".

Bina, who advises baffled people already wrestling with the emotionally-challenging problem of looming age, said: "Because different services are now charged at different rates and everybody's income is different and everybody's care requirements are different, that really means that there's a different formula for every single person.

"Anybody ageing, particularly with health issues, would want to look at what the potential costs of staying in their home or moving into residential aged care could look like.

"Sixty-five is relatively young to move into aged care. Increasingly people are leaving it to their 80s, 90s, unless they've got underlying health issues which mean that they do need that 24/7 care. For the bulk of people, they want to stay in their home."

But independence eventually becomes dependence. It's one of those inevitabilities.

The residential home looms when care in a person's own home becomes unsustainable, perhaps after a fall or a loss of mental faculty.

Valerie and Bina Brown. Picture by Karleen Minney

The system changed on November 1 last year, and people already in care homes saw no change in funding arrangements.

But for new residents, the move meant residents with savings or other assets contributed more.

The way Australians pay for residential aged care comes under four main areas:

Clinical care is fully paid for by the government (the taxpayer).

But the rest is means-tested. The government may pay some but the resident picks up what burden he or she can (as the government calculates it).

Everybody in a care home has to pay a basic daily fee which is set by the government at 85 per cent of the basic age pension. This contribution partially funds services like meals, cleaning and laundry.

People without assets pay only this fee.

"Residents who have more than $238,000 in assets, more than $95,400 in income or a combination of the two, will make additional contributions towards their everyday living costs," the government said.

On top of the basic daily fee, residents pay a "hotelling supplement".

The third component of the charge for staying in a care home is the "Non-Clinical Care Contribution":

"Residents with sufficient means would contribute 7.8 per cent of their assets over $502,981 or 50 per cent of their income over $131,279 (or a combination of both) up to a daily limit of $101.16."

So the system is complicated, probably beyond everyday understanding. The government's My Aged Care website may help.

"My starting point would be find the right place first because one of the costs is the market price of a room," Bina Brown said.

"The most expensive place isn't necessarily going to be the best place for an individual," she said. Some places don't, for example, cater for residents with dementia.

A resident would pay either a regular daily payment or a deposit which would be refundable to the family when the resident leaves the home (usually in the inevitable event). This is called the Refundable Accommodation Deposit, and the home would take a portion as payment daily for however long the resident was there.

"So when you're thinking about where, it's important to look at what the market price of the room is, which is the refundable accommodation deposit.

"You could go to the Centrelink, or go to a financial information officer, or you could use the government calculator, which is on their My Aged Care website to give you an indication of what those costs could be.

"Or you could go to a professional like myself or a financial advisor."

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