Residential care: What you need to know

Thinking about moving into a rest home, or helping somebody else to make the move? Age Concern addresses common questions.

1. How is care provided?

By private companies and not-for-profit organisations. In most cases the cost of care is subsidised by the government Residential Care Subsidy. Care falls into four levels: rest home, long term hospital, dementia, and psycho-geriatric. Not all homes provide all levels (In the following information, ‘rest home’ refers to all levels of care).

2. What determines whether I can move into a rest home?

To be eligible for subsidised care you must be formally assessed as ‘needing care’ by a Needs Assessment and Services Coordination agency (NASC). Your GP can help arrange this. You are likely to be eligible if you have ‘high’ or ‘very high’ needs, and cannot be safely cared for at home.

3. Do I have to move?

Deciding to move to a home is a major decision, and the move can be easier when the decision is yours. The result should be improved quality of life.

4. How can I find a rest home that suits me?

Get a list of rest homes from the District Health Board, Age Concern, or NASC agency. Shop around; visit and compare homes. Checklists to help are available from Consumer NZ and Alzheimers NZ. Start looking as soon as you think you might need a rest home. When you find one you like, ask to be put on the waiting list; you can do this before you have been assessed. If the home of your choice doesn’t have a vacancy when you need it and you have to move to another one, ask to transfer to the preferred home as soon as a suitable place is available. www.eldernet.co.nz lists rest home vacancies.

5. Government funding

Once you have been assessed as needing care, apply for the Residential Care Subsidy. It is means tested. If your assets are equal to or below the threshold, you will qualify for the subsidy for most of the cost of care. The income test determines what you have to contribute. If you don’t qualify for the subsidy, you must pay your own way. You can ask for a review of your means test at any time.

6. I don’t qualify for a subsidy – how much will it cost?

If you have been assessed as needing care, and move into a rest home that has a contract with the DHB, you will pay no more than a maximum weekly amount set by the DHB to cover care required. If you have not been assessed as ‘needing care’, there is no restriction on how much you could be charged and you would not be eligible for the subsidy. Maximum contribution must include: accommodation, food, laundry, nursing and care, GP visits, prescribed health care and medicine; continence products, transport to health services.

7. Can I be charged more than the ‘maximum contribution’?

Yes, if you choose services or facilities over and above the care you have been assessed as needing. Examples may include: a ‘premium’ room, eg, ensuite, specialist visits not publicly funded, transport to other services or events, private phone, personal toiletries, hairdresser, dietician, podiatrist, glasses, hearing aids, dental care. You can refuse extras, or negotiate an arrangement to suit. When visiting rest homes initially, ask them to explain their fee structure, what happens if you change your mind about an extra service and what happens if the fee structure or conditions change after you move in. Take a blank copy of the Admission Agreement home to read. If you decide to receive extra services, the home must specify these in your agreement.

8. Admission Agreement

Information about services the home will provide, and what you have agreed to pay are in your agreement, the contract you sign with the home before moving in. Take your time before signing, as you would any legal document or contract. Have someone you trust read it. Don’t sign up to extra services if you don’t want them.

9. Giving away assets

An annual gifting limit applies for the five years before applying for a subsidy for care. Gifts that exceed the limit are taken into account when subsidy eligibility is assessed. Substantial gifts made before the fiveyear period, may also be added.

10. Monitoring quality of care

Rest homes must meet the Health and Disability Services Standards NZS 8134:2008, be certified to operate by the MOH, and meet requirements set in their DHB contract. The MOH arranges regular and ‘spot’ audits of homes to ensure they meet standards and requirements. Summaries of audits are publicly available.

11. How are complaints made?

If problems arise after you move in, raise your concern or complain. Every home must have a written complaints procedure. First, talk to the manager. If you are dissatisfied, agencies available to help include Age Concern, a Health and Disability Advocate, DHB.

12. Who will make decisions for me if I can’t?

Set up an Enduring Power of Attorney before moving into a home. This appoints the person of your choice to manage your affairs and make decisions on your behalf if necessary. If you do not do this, and you need someone to look after your affairs, the Family Court might appoint someone for you.