Choosing between growing old in their own home and moving into an RACF is a complex decision for older people.3 Many older people would prefer to stay in their homes as they age; 4,5 however, physical disabilities and cognitive impairment may force them to face a housing decision. The advice that GPs give to the older person and their families can be an important deciding factor on whether the older person moves into an RACF.
Older people who choose to stay in their own home but require assistance to live independently can access support from the government through the Commonwealth Home Support Programme (CHSP) for basic assistance or the Home Care Packages Program (HCPP) for those who require greater assistance. However, it is important to note that the government does not always cover the full cost of the services required. Additionally, depending on the older person’s income, an out-of-pocket contribution may be required. Local councils and some charities may also offer in-home services (eg transport, social support, home maintenance) to older people.
In Australia, there are currently around 2700 RACFs in operation that cater to the different needs and interests of older people (eg specific cultural and linguistic group, dementia care). RACFs that are government funded must provide a certain level of service to receive accreditation, including:
- continuing availability of staff to provide emergency assistance
- assistance with personal care (eg toileting, showering, eating, dressing)
- support with mobility and communication
- help to access specialised therapy services or a health practitioner service
- support for people with cognitive impairment (eg dementia).
However, the range of social and recreational activities available for older people in RACFs can vary significantly, and is significantly dependent on the provider. Out-of-pocket expenses above general fees may be required for access to these activities.
The complexities of housing decision often faced by older people are illustrated in Figure 1.
Reproduced with permission from Roy N, Dube R, Despres C, Freitas A, Legare F. Choosing between staying at home or moving: A systematic review of factors influencing housing decisions among frail older adults. PLoS One 2018;13(1):e0189266.
Factors influencing the housing decision of older adults, classified by the meaning and experience of home dimensions
Providing support and care for an older person is valuable and rewarding; however, it can be easy for the carer to forget about their own health and wellbeing (refer to Part B. Families and carers). Providing carers with a break from the caring role can help to relieve stress, which will undoubtedly benefit the older person too. Respite care gives both the older person and their carers relief for a period of time (eg a few hours, days or weeks).
There is never a ‘best time’ for respite care, and it is important to emphasise that carers should not wait until they are too overwhelmed with the responsibilities of caring before considering respite care. It is vital that the carer look after themselves so they can continue to provide care for the older person.
There are several types of respite care available to older people and their carers:
- In-home respite – the care worker comes to the older person’s home to provide care (requires assessment by the Regional Assessment Service [RAS]).
- Overnight or weekend respite – the care worker comes to the older person’s home to stay overnight or several days.
- Community access respite – the care worker assists the older person to attend social activities for a couple of hours during the day.
- Residential respite – the older person moves into an RACF for a short stay (requires assessment by the Aged Care Assessment Team [ACAT]).
- Emergency respite – Commonwealth Respite and Carelink Centre
- 1800 052 222 during business hours
- 1800 059 059 for emergency respite after hours.