Choosing a nursing home guide

Plan ahead for when you can no longer look after yourself.
 
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  • Updated:22 Aug 2006
 

01 .Planning ahead

Man with nurse

Planning ahead

Most of us don’t want to think about nursing home care while we’re still relatively healthy and independent; we tend to leave it until an emergency forces us to face the issue, utterly unprepared. But planning ahead for the later years of your retirement means you — or your family — won’t have to make important decisions on the run.

  • Talk things over with your family while you’re still able to.
  • Involve yourself in the decision about where and how you’d like to live if you can no longer look after yourself.
  • Visit a number of different types of home: some are church or community-based, others are operated for profit.
  • Once you have your Aged Care Assessment Team assessment (ACAT) that confirms your eligibility for subsidised nursing care, put your name on as many waiting lists as you wish and then, when you’re happy with a place offered, let the other homes know.

Please note: this information was current as of August 2006 but is still a useful guide today.


Checklist

These points should help you focus on your needs when checking out nursing homes. Make sure you ask lots of questions and take notes.

The home

  • While it’s important to choose a location you’ll enjoy, don’t forget friends and relatives, who’ll be less likely to visit if it involves a long trip.
  • Are the common areas clean, well maintained and easy to access? Is there a laundry service, a good outdoor area, a pool? Are the corridors wide enough for trolleys, wheelchairs or a mobility scooter?
  • Is there a nurse on call 24 hours? How are medical emergencies handled? Can your own doctor visit or will you have to rely on the home’s contracted medical professionals? Can you get help seeing your own health providers?
  • Can you ‘age in place’? If your care needs increase over time, it’s good if you can move from low-level to high-level care within the same facility.
  • Does the home provide palliative care (when people become close to death) or does a resident in this situation have to move?
  • Is the home welcoming to visitors? Are visiting times restricted? Was the manager prepared and helpful when dealing with your inquiries?
  • Can you get ‘extra service’ if you want to? What’s provided and how much does it cost?  

The rooms

  • Are there single or shared rooms? Could you get a shared room for yourself and your spouse? (While some homes provide facilities for couples, others frown on it, especially in high-care nursing homes.)
  • Is there a kitchenette and ensuite bathroom or do you share these facilities?
  • Are the rooms airy? Are they completely furnished or can you add personal soft furnishings? Do they have verandahs, balconies or large windows?
  • Is there a phone, a TV, a computer, internet access? How are you charged for this?
  • If the rooms are small, are there other areas where you can meet visitors in relative privacy?

The residents

  • Observe the residents. Are they dressed in clean clothes, or can you smell urine? Do they have clean teeth and clean, combed hair?
  • Are their fingernails clipped? If you spot many bandaged arms or legs, bruises or bedsores, these could be — but don’t have to be — signs of neglect. Management should be able to tell you how prevalent bedsores are, and how they’re treated.
  • Talk to the residents. Do they appear content? Ask them about their daily routines. Can they have input into making choices about their daily routine or some aspects of it? Is there a residents’ committee and/or a similar organisation for relatives?

The staff

  • Observe how many staff are around. Do they appear compassionate, caring and gentle with the older people, or rushed and impatient, which could point to staff shortages. More staff are needed if many residents are bedridden, need help getting around or with feeding, or have problems sleeping through the night.
  • Ask the management how many staff are on duty during the night, how they’re replaced when sick and about the proportion of casual staff.
  • What's the Director of Nursing like? What are their care values, and how do they fit with yours? 

Activities

  • If you’re visiting mid-morning or afternoon, observe whether the residents have something to do, or are just sitting around.
  • Is there a qualified diversional therapist on staff who facilitates the leisure and lifestyle needs of residents?
  • Are outings organised, facilities provided for craft, choir, dancing or theatre activities? Are pets allowed (to stay or visit)?
  • What fitness routines are in place?

Special needs

  • Are there in-house church services and/or visiting clergy?
  • Are there people who come from your language or cultural background or share your religious beliefs?
  • Are staff specially trained to cater for residents with dementia?
  • Are there activities for people who aren’t mobile?  

Food

  • Try to arrange at least one of your visits to coincide with meal time. Is enough help provided?
  • Is the food nutritious, appetising and sufficient?
  • Is it freshly cooked on the premises, or brought in? Can you prepare some yourself? Do you have a choice of meal? Perhaps you can see a meal plan.
  • Are fruit and snacks freely available? Is fresh water provided in rooms?
  • Discuss any special dietary needs.
 
 

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02.Aged care facilities and standards

 

Types of care

  • A retirement village or independent living unit caters for those who can still live fairly independently. Various support services — like laundry, cleaning or meals — are available at a cost.
  • A number of services can be provided in your home, ranging from basic help with shopping or cooking right down to tailor-made extended care.
  • Residential aged care facilities provide low-level care (assistance with everyday tasks and occasional nursing care) and/or high-level care (for people who require continuous nursing care) — they used to be called nursing homes or hostels. Many homes provide both levels of care, which means you can stay in the same home if your care needs change over time — you can ‘age in place’.
  • Residential aged care is provided on a permanent basis or short-term (respite, to give carers a break) and includes all essential services (like accommodation, meals and assistance from staff).
  • Some homes provide ‘extra services’: a higher standard of accommodation or services (such as a bigger room, or wine with dinner). The quality of nursing care must be the same for all residents.

ACAT assessment

To qualify for government-subsidised residential aged care, you’ll need to be assessed by an Aged Care Assessment Team (ACAT, or Aged Care Assessment Service, ACAS, in Victoria) — health professionals who’ll help you work out what kind of care will suit you best when you’re no longer able to manage at home without help. An ACAT assessment is funded by the government; it’s valid for 12 months.

Accreditation and standards

Aged care homes must be accredited by the Aged Care Standards and Accreditation Agency (ACSAA) to receive Federal Government subsidies. Homes that fail to meet standards are put on a ‘timetable for improvement’, their progress is monitored and, if warranted, their accreditation shortened or revoked. The latest accreditation reports are published on the ACSAA website (www.accreditation.org.au/ReportsOnHomes, or phone the agency in your state or territory for a copy).

The Commonwealth Department of Health and Ageing (DHA) is ultimately responsible for imposing sanctions if the non-compliance is considered serious, has occurred before or threatens the health, welfare or interests of residents. Information about sanctions imposed on homes (current and archived sanctions) is published on the DHA website (go to www.health.gov.au and type sanctions in the search box).

The accreditation and monitoring arrangements in place should ensure our elderly receive quality aged care. However, earlier in 2006 several incidents of sexual abuse in accredited nursing homes came to light that seriously undermined confidence in the system and challenged its effectiveness. Elder abuse includes things such as verbal abuse, withholding of pain relief, neglect, rough handling, being left unattended and helpless — the list goes on.

Preventing elder abuse

Following the widely reported cases of elder abuse cases earlier in 2006, the Federal Government has repeatedly pledged its commitment to introduce legislation aimed at preventing abuse in aged care facilities. The measures introduced so far include:

  • More frequent unannounced inspections (spot checks with less than 30 minutes’ notice) to ensure providers comply with care and security standards.
  • Police background checks for all aged care workers, including volunteer visitors.
  • A regime of compulsory reporting of abuse — including sanctions for non-compliance and legislative protection for whistleblowers.
  • Reform of the Complaints Resolution Scheme to give it more investigative power.
  • Increased funding for staff training and aged care nursing scholarships.

Useful resources

  • Commonwealth Department of Health and Ageing DHA
    www.health.gov.au
    Phone: 1800 500 853
  • Commonwealth Carelink Centre
    www.commcarelink.health.gov.au
    Phone: 1800 052 222
  • The Aged Care Crisis Team
    www.agedcarecrisis.com
    PO Box 1082
    Ivanhoe 3079
  • Your doctor, hospital or health or community centre
    A local telephone directory (with an Aged page) may also be of help.
  • Your financial adviser, legal representative or a Centrelink Financial Information Officer
    Phone: 132 300