Care home or more home support? Considerations & scenarios.

These decisions can be complex so, after you've thought through what some acceptable options are for you, we advise that you obtain professional financial and legal advice.

• If you stay at home, are all the support services you require available?
• If you intend to pass on some inheritance, some of the following options have greater financial implications than others. This article by New Zealand Society of Actuaries (Inc) helps you understand what type of financial arrangements might suit you and your circumstances. Remember inheritance issues are also affected if you are in residential care. Our articles on Financial testing give further information.
• For those with no assets other than a home (that you want to continue living in), Equity release may be a means of funding private home support services. You need get legal and financial advice before committing to this as once it’s arranged you reduce other options. Further information may be found in our Equity Release article.
• Similarly, homeowners may be able to borrow from family using their home as security, so that in a sense the children are standing in for the bank. Again, see your lawyer and financial advisor before proceeding.
• If you choose a private service provider, you need to be able to manage all the arrangements, agreements and payments with them. A reputable and professional service provider will have all the necessary policies and procedures in place to make this easier.
• If you decide to stay at home, make use of the wide range of assistive equipment that may be available, and which is suitable for your needs. A specialised equipment assessment is required if you want to access loan equipment. While it may seem a dauting process to go through there is usually a health professional who can assist you. If the waiting list for assessments is long you may choose to visit a mobility equipment retailer and buy the required equipment. In the long term you will find the right sort of equipment makes life so much easier.

So, back to your options.

These need to be considered carefully and the financial implications of each fully explored and understood. The costs also need to be compared to residential care costs so that you can make a more informed choice. We know the cost of residential care ranges from about $70,200 (for care and a standard room) to $100,000 + per year (for care and a premium room fee of approx. $120 per day), so, how much in the way of home support services can be purchased for similar amounts?

Your options may include:

1. Where the assessment shows there are considerable family/whanau and/or community supports, sufficient, appropriately skilled caregivers available, and where there is a commitment by all parties to support such an arrangement, subsidised higher packages of care may be able to be arranged and provided.

Pros:

• Individualised care may be possible.
• This is likely to be a fully subsidised service so, no additional cost to you.

Cons:    

• Depending on the type of arrangement, significant organisational and management skills may be required.
• The needs of supporting whanau/family can be overlooked. Carer stress needs to be recognised and mitigated.

2. You may be able to get publicly funded home/domestic and personal care services (which you may have previously received) and top them up with private services. This of course is only an option for those who have the financial resources to be able to pay for this or are able to access these through a financial arrangement such as Equity Release (as above).

Pros:

• Personal care is currently not subject to financial assessment, so is likely to be subsidised.
• You may be able to get some subsidised domestic assistance (however this may be subject to a type of financial assessment – i.e., being a Community Services card holder).

Cons:

• You may have to receive your services from several providers and several support workers.

3. Entirely private paying. Again, this is only an option for those who have the financial resources to be able to pay for this. (See the previous point about Equity Release.)

Pros:

• It’s probable that you can arrange more flexible and tailored services to suit yourself and your situation.
• It’s likely that you can have more choice as to who your support workers are.

Cons:

• These services may not be available in all areas.
• Costs can be high where extensive services are needed.

Let’s look at some scenarios

Scenario 1 CHRIS – Continuity of care and living alone bring their own problems.

Chris, a homeowner with some savings, had no immediate family and lived alone in a medium sized New Zealand town. Mobility problems had led to an interRAI assessment and subsequent recommendation for residential care (Chris would have been a private payer.) Getting in and out of bed and showering were the major issues but once up for the day Chris could move about the home with a walker. Chris had a personal medical alarm, and luckily the neighbours were great. Most days someone came in to check things were ok at mid-morning and afternoon. Chris didn’t want to leave home, so arrangements were made for daily home support services.

Home support services were arranged. Chris didn’t have a community services card and paid privately for domestic services. Personal care was subsidised. These services were provided for about 3 months however Chris found the following proved to be a problem:

• The support workers changed frequently, and some got on better with Chris than others
• They often came at variable times and couldn’t come after 9.30 pm when Chris was ready for bed.

As a result, Chris decided to pay for private personal care. Assurance was given that there was a choice of support worker, they wouldn’t change (unless absolutely necessary) and they would fit around Chris’s timetable. For a year Chris really enjoyed services at home, had contact with the neighbours and occasionally the local community, while paying about the same rate as residential care.

When a sleepover was required, Chris said the price ‘skyrocketed’. Not long after that service began, Chris’s needs increased, and the decision was made to go into a care home.

Note: The cost of home support services is variable as the services provided need to be tailored to individual needs.

Scenario 2 PAT and ALEX –Broken nights. The difference the right sort of help can make.

Pat and Alex desperately wanted to stay together. Although Pat needed quite a lot of support Alex was able to provide most of it. A support worker came in and helped Pat with showering (which, following an assessment, was subsidised) and they paid for extra help around the home when it was needed. It was the broken nights however that became a problem. Alex wondered how long it could go on for. That’s where regular subsidised respite care breaks and privately paying a support worker to sleepover 3 nights a week (the private agency could provide the same support person each night where the subsidised could not) made all the difference. For about the cost of residential care Alex got 3 unbroken night’s sleep a week and Pat got used to having another person in the house at night. This made both Pat and Alex feel more reassured that their arrangement could be sustained for some time yet.