Home Vs residential care

Would you or your ageing parents, given the choice, prefer to grow old at home rather than moving into residential aged care? Whether it’s complex nursing, palliative care or help with daily chores that’s needed, leaving home is no longer always necessary for those requiring assistance.

Not only are there growing numbers of government-subsidised home-care packages and private operators offering home-help services, the subsidies are not means tested – so even wealthy seniors can use them to fund these services.

As with many things, how quickly you can get the help that’s needed may come down to what you or your parents can pay for. “While no one will be denied care based on their capacity to pay, those who can afford to will be asked to contribute, ensuring the system is equitable,” says Senator Mitch Fifield, the Assistant Minister for Social Services.

Home (and residential) care for the elderly is heavily subsidised by the government. To keep a lid on its spending, the government allocates home-care packages.

Provided someone is assessed by a government-approved Aged Care Assessment Team (ACAT, known as the Aged Care Assessment Service in Victoria) as being eligible for government-subsidised aged-care services, such as a home-care package, they can apply for care which is then tailored to meet their needs. The application has to be made to an approved provider, rather than a government agency.

The packages are not means-tested so everyone is entitled to one. Those that can pay will be asked to do so, but no more than $10,139.68 a year or about $60,000 over their lifetime.
What services cost

Those with the means to do so can bypass the government home-care packages and secure any services they need privately with a home-care provider. It is also possible to get a government package and top it up with privately funded care.

Private home-care service providers may charge between $45 and $55 an hour for a personal carer, according to industry figures given to AFR Weekend. This generally covers GST, carer wages, insurances and a police check.

The care will vary depending on the individual’s needs but may include home-care duties such as cooking, cleaning and personal care. Where a private home-care provider uses their own car to provide a client transport, such as to a medical appointment or on an outing, they may charge additional fees.

Registered nurse (at home) rates within the industry are $70 to $90 an hour.

Dial-An-Angel is one national private care provider that offers different grades of care, depending on an individual’s needs. The cost of its high-level care service on the Sunshine Coast, which incorporates companion and personal care, is a minimum of $165 for three hours and $55 for each additional hour. It also provides overnight and long-term daily care in 12- or 24-hour shifts, which cost $660 and $915 respectively.

According to one provider, who did not wish to be named, the decision on what to pay to keep someone at home often comes down to how long they are likely to live and their care needs.

At about $1000 a day, the cost of a live-in carer – on top of other care needs and services, including modifications to the house – could quickly add up. By comparison, the maximum cost of care within government-subsidised residential aged care is about $250 a day, capped at about $25,500 a year.

“It is very much a personal decision as to how someone wants to spend their end of life and, for some people, any amount of money spent on staying in their own home is better than residential care,” the provider says.


Where full-time nursing care isn’t needed, a cheaper option would be to engage professional carers and nurses only when needed. A spare room could be made available to a privately sourced live-in minder or relative for added security and peace of mind.

For stroke victim Frank Miles* and his daughter Julie, being able to access home help to move home from an aged care facility was life changing. Frank, 66, had suffered a stroke while in his 50s and had been cared for at home by his wife until her death four years ago. He was then placed in an aged care facility where he felt unhappy and out of place. Thanks to help at home with food preparation (he does not have much movement down his right side), he has been able to move back home and is much happier.
Consumers ready to pay

Virginia Bullock, founder and managing director of Home Support Services, a 25-year-old, Adelaide-based home healthcare service that offers a mix of government packages and private help, says the traditional view was that if you were ill you needed to go to hospital, or if you were getting old you needed to go into residential care. This has changed.

“If you look at the government home-care packages from July 1 this year, all home-care providers will be driven by the consumer. Providers will have to negotiate with the consumer about what their real need is and work with them to meet their needs,” Bullock says.

Under consumer-directed care, providers will receive the allocated government funds but it will be up to the client as to how the money is spent.

“Clients will have a menu where they can choose where their needs sit and, according to the budget, ask for the services. They will do that in consultation with the provider and the experts that are with them,” she adds.

Bullock says government funded home-care packages won’t always be a solution for someone’s entire remaining life due to funding limits. There may come a time when a person’s health has deteriorated to the point where, if they want to remain in their home, they will have to pay for the extra care themselves, she says.

Bullock says people are now more prepared to self-fund some of these costs if it means staying in their own home. Years ago, people assumed the government should pay their health costs, “no matter what”. Now they are much more independent and recognise the benefit of paying for themselves.

There are about 72,000 care packages on offer around the country, with the number expected to reach 144,000 by 2021, according to the government.

Rod Young, government relations consultant for IRT Group, one of the largest care providers, says the government’s aim is to increase package numbers by an average 10,000 a year to match the growth in the number of people older than 65 – Australia’s fastest-growing age group.

He says the demand for the 72,000 available packages is extremely high, with waiting lists the norm among many of the country’s 550 providers.
Levels of care

There are four levels of home-care package – ranging from low care (levels one and two) up to high-level care (levels three and four). Different government subsidies are available for each level, ranging from $8500 to $45,000.

Not all providers will offer all levels of home-care packages, which means some people may have to change providers when their care needs change. A provider who is licensed only to provide low care cannot claim a high-care subsidy when a client’s needs increase. The low-care provider must transfer the client to a high-care provider with a suitable vacancy.

While demand is greatest for the high-level packages which includes dementia care, Young says, providers can only accept clients to fill the number of places they hold licences for, which often mean clients looking for high-care places are put on a waiting list.

IRT has 650 community care packages across all levels. “We are big enough to carry the cost across all levels, Young says. “If we have a client on a level-two package who needs level-three or level-four services but we have no high-care packages available, we will carry the cost of providing the higher-level service until we do have one.”

A difficulty for smaller providers is that they cannot afford to cross-subsidise a higher level of service until a high-care place becomes available. Often the only option available to a person who needs high-level home care but cannot obtain it is to enter residential care.

Council of the Ageing chief executive Ian Yates would like to see levels one and two scrapped and the resources put into levels three and four, where the greatest demand is.

Further, he says, anyone assessed by the government as being eligible for a home-care package should receive one, rather than being told they have to wait. “It is affecting people’s quality of life. If they assessed as needing help at home then they should get it,” Yates says.
What to do

The first step for anyone wanting a home-care package is to get an ACAT assessment. These teams of health professionals determine whether a person needs support and at what level.

Consumers are referred to the providers operating in their region until July 1, after which they will be directed to the government’s myagedcare.com.au website.

The government provides full funding to home-care providers for people with incomes of less than $19,276.40 a year. An income test conducted by the Department of Human Services will determine whether a consumer needs to make a contribution towards their care.

Once a person has income of more than $19,276.40 a year, they can be asked to pay up to $10,139.68 a year (up to the $60,000 lifetime cap).

Self-funded retirees earning well in excess of the income threshold are advised to seek an income assessment before starting any package to avoid being asked to pay the maximum fees and charges.

Ipac Financial Care senior adviser Paul Intagliata says one benefit of completing the income forms is that any income-tested amount paid by someone receiving home care is counted towards the lifetime cap for home care and residential care in the event they eventually go into residential care.

The cap for residential care is about $25,500 a year, or $60,000 over a lifetime. Provided someone pays the maximum yearly charge when they enter residential care and they’ve received home care for three years before entering residential care, they would potentially meet their lifetime cap in about a year.

“Home-care packages give people another option. It may mean going into residential care later or not at all,” Intagliata says. “It probably also allows people to think about the move into care and may make any eventual transition easier.”