Nov 08, 2017

The “Lucky” Son: My Parents’ Journey to Aged Care

I am a very lucky person – I am nearing 60 and still have both of my parents alive and in reasonably good health.  Mum is 87 and Dad 88 this year.  Looking back through my family history I’m fairly sure none of my ancestors have been this lucky.  In fact all of them had lost at least one parent by the time they reached 45, in many cases it was MUCH earlier.

That’s the great news, they are both alive and kicking – with that comes the need to look after them in their latter years.  Mum has had some health issues with a pacemaker installed a few years back and she has dementia.  It is not as bad as others we know, she still recognises people and remembers names and people quite well but her short term memory is poor.  Dad has been doing fantastically well until late last year when he hurt his back pruning trees.

In December 2016 we decided to look at Aged Care facilities in Perth for Mum and Dad.  We were given lots of advice, one of the best pieces of advice was from the family GP.  Dr Mariam Bahemia has been their family doctor for many years and told us of a great middleman service.  She recommended we talk to a Perth company called Relacs.  They are an offshoot of Chalice financial services.  They charge an initial fee of around $3750 and then a final fee on placement of the same amount.  A total of around $7500 seems a bit expensive but it was well worth every dollar.  More on this later.

Our next learning was to ensure that they both had a ACAT assessment.  This is a government assessment that gives them a ‘care required’ rating.  With people in their 80’s the natural inclination is to ‘pass the test’, show the assessor that they are really fit and well.  After a little coaching and a dose of honesty, they were both assessed as high care.  The main triggers for that ‘high’ assessment was Mum’s incontinence, and Dad’s back meaning he needed help showering.  High level is good and means strong government support.

This assessment means, amongst other things, that they had some immediate safety things fixed around the house.  Hand rails, smoothing steps etc.  They also get an ‘allowance’ to fund in-home care, this can be cleaning, gardening or serious nursing care.

When we started the process to aged care, we thought we had plenty of time, but as the weeks ticked over, Mum had a couple of minor falls and Dad’s back was not improving.  After one fall the hospital was reluctant to allow her home unless we had able bodies at home.  We found an organisation that provided 7*24 care but it was very expensive.

I spent some time as live in carer with support from an external nursing organisation.  I thought I could do a fair chunk of the caring and knowing it would keep costs down.  The two breaks of 2 hours per day would ensure a professional did the showering in the morning and the meals in the later afternoon.

It worked well for a few weeks but was tough fitting in everything in the two hour slots.  We had trips to the optometrist, heart specialist, geriatrician….  Sustainable in the short term, just.  My brother John came down to take over and felt the same, it’s only just sustainable.  Then Mum had a mini-stroke.

This basically meant we needed to ramp up the hunt for the long term Aged Care placement.  That meant a lot of paperwork to complete for Centrelink – the value of Relacs started, they did all that for us.  They allocated two people to help us, Jenny to find a suitable facility and Amanda to crunch the numbers.  Both were fabulous professionals.

We then had a reality check – few facilities offer rooms for couples, most are only for singles.  One place we visited told us that they have a few married couples but they all preferred separate rooms.  That would not work for Mum and Dad.  Then another reality check – most rooms become available on the death of a patient, not many check out for any other reason.  So double rooms are rare and even rarer to find an empty one!!

Jenny from Relacs also made us aware that we should select a facility that has a secure dementia ward.  That means that if Mum or Dad was to need that level of care, then they would not have to move again.  They’d have to move rooms but that is all.

The work Jenny did was very similar to a relocation person that we have used on many of our moves.  Jenny took our requirements and short listed a few, I also believe that Relacs have considerably more sway than someone off the street.  Again similar to relocation people, Relacs place people in homes all the time and so an Aged Care facility needs to ‘look after them’.

We eventually settled on a facility called Aegis Balmoral – they were building a new wing on to an existing facility.  It has a secure dementia area on the same floor.  As we were one of the first to agree to move in, we (with help from Jenny) managed to get a great room with a balcony and city glimpses.  The fact they can see the BHPB building seems appropriate!!  As always on this journey, more learnings – you must have 2 single beds…..hmm I’ll come back to that.

While all of this was happening we had changed the home care situation to 7*24 hour care from a company called Home Instead.  As they assessed Mum and Dad as being ‘not too high’ care, they said they could provide someone on a 24 hour shift, so long as they only did about 8 hours per day.  Getting up a couple of times per night was OK, more than that was not.  Cost was much more reasonable at around $600 per day.  The service offered by these carers was fabulous – they all really cared for Mum and Dad.  The basic service was ….try to avoid all falls, ensure that they had their medications, feed them 3 meals a day, showers for both every day….and if you have time, do any housework (especially washing).   Good value and meant I could do all the running around.

Dad knew all along what was happening but we didn’t want to tell Mum too early for fear it would scare her.  Essentially it was like one of those complex change management projects I had run so many times at BHPB.  I nearly called Prue Flower in to help.

With the numbers that Amanda from Relacs had run for me, it was quickly obvious that we could move Mum and Dad without selling the house.  This fundamentally affected how we dealt with the change – we continually focused on making the move happen successfully / happily.  We knew that any discussions on selling stuff would bring sadness and grief.  All conversations were on the future – a safe, secure, happy future.  The only ‘past’ discussions was around how well they had both done to get to this point together.

Amanda at Relacs helped with lots of scenarios – a good example was around the house.  We had decided that we didn’t need or want to sell it immediately, so why not rent it out?  I asked Amanda to run the scenario of renting the house for say $25K pa ($500 pw).  She quickly came back and said that we’d lose around $17K pa in lower pensions and higher care fees.  That shut that option down very quickly and illustrates some of the value we received from Relacs.

We built a detailed plan of people to tell and back room stuff to organise – things like getting access to bank accounts, finding out who provided gas and electricity, setting up online access to government systems.  Upgrade home security system.  Also we needed to make sure we were ready for Day zero….photos for the walls, treasures for room, new doonas, some new clothes, heavy vase…  Notices to send out, mailing list of people.

Luckily my brother Todd had paid a visit and he measured the room for a new set of drawers, this became important!

Dates for building completion slipped by a couple of weeks and again Relacs helped.  They were the ones hassling the facility each day.  Eventually the call came – Friday at 3pm  – you can move in on Wednesday at 10am and Monday is a public holiday.  The plan kicked in to action and we headed to Freedom for the chest of drawers….must be delivered Tuesday to allow setup before Mum and Dad’s arrival.  Tight but OK.


Two of my left field ideas also kicked in – I had been watching the Oscars with Mum and she had made the comment, “I’ve never been on a red carpet”.  That quickly developed into, let’s take them from the old house to the new facility in a limo with red carpet.  A quick call to the Queen of Perth Parties (Jasmine) and she quickly told me of a company called Bling Limos that have red carpet and a wide door (usually important for brides but also great for elderly people with limited mobility).  The direct route would have been 15 minutes and so we agreed on  a scenic route, the one hour trip cost $225.  Good value, no great value…there was no goodbye to the old house, they were both so excited to see the limo that they forgot they were leaving.

The second idea has worked but not quite as well.  I had a concern that once we told their friends that they had moved, we may get everyone wanting to come in the first week or two.  We needed to space people out.  We also didn’t want visitors to come when Dad was out at physio or too early in the day.  We needed an Executive Assistant and a diary we could all see.  We signed up with Up Close and Virtual and Emma has been very understanding.  They have a Perth number that people call and make appointments.  Cost after first couple of weeks is $29 per week.  When I say, it hasn’t been a raging success, we have not had very many calls – the great news is that we have not had to take the calls.  Emma and her team have done it all.

Back to the learnings – Amanda also told me a couple of valuable things.  A simple one that we would have discovered in time is that their pension increases after they move into Aged Care.   It increases for each of them from around $660 per fortnight to $870 per fortnight.

The other one is that you maximise your options if you pay a lower accommodation fee (called a RAD).  This increases your daily payments but you can increase your RAD at your leisure.  Balmoral asked…the minimum deposit is $10K each, how much will you pay.  I said $20K, they weren’t happy but accepted it.  Another couple thought they had to pay $400K up front and so sold their house first.  This dramatically increases the grief of the change.  What was the advice on paying low RAD worth?  Made the change easier, so worth heaps.

I must also say that my favourite sister, Sue has done a great job over many years.  Being the only daughter plus being the only child of Mum and Dad’s kids that lives in Perth, she has done so much of the heavy lifting…thanks Sue.  It was also great to have my brothers, John and Todd, make the long flights to Perth to help with this transition…thanks guys.  Of course I must also thank my wife Sandy for her fabulous support…thanks xx

So has it been a success?

So far so good.  Both of them are quite happy and agree the move was right.  The single beds caused grief on the first night, trying to share one bed, Dad fell on to the floor.  I tried again to get ‘approval’ to push them together, after much debate, I simply pushed them together and locked them in place.  For staff making the beds or to get to a patient in an emergency the staff need to unlock the beds…adding ten seconds but reducing the fall risk.

The entire complex is like a five star hotel and like a hotel, there are lots of facilities.  Like hairdresser, physio, men’s shed, movie theatre…  They’ve been a bit slow on the uptake but slowly, slowly has worked well to date, lets keep that mantra going.

I have tried to document things I learnt from the last couple of months – worked for us and factually right for us, may not be 100% right for you.

This content was originally published on Nancy and Bill

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