4. Respite and Residential Aged Care
Topic 2 of 4
How to access respite care
Residential Respite Care is either for when you, as carer, need a break (for other demands on your time, holiday, fatigue etc.) or for when your loved one needs more help for a limited amount of time.
Care2Serve, the Tasmanian provider of Carer Gateway, can assist you in accessing Residential Respite Care. Your elder will need to have an assessment with an Aged Care Assessment Service (ACAS). Eligibility for an assessment requires the person be over 65 years old or over 50 if they are Aboriginal or Torres Strait Islander – can be an Australian citizen, permanent resident or on another visa (but not on a holiday visa). If your elder has not yet had an assessment and you’re unsure what to do, Carer Gateway can provide the information you need. Contact Care2Serve for support for the next steps.
The following sections will explain what to expect from respite care, how to choose what’s best with your elder, and what to do once a decision is made.
Where to start
There is a lot involved in arranging Respite Care for your elder. Here are some steps to help you.
Select each step to learn more.
You and your elder call My Aged Care (1800 200 422) and tell them you wish to get approval for Residential Respite.
Your elder will be assessed for and asked if they would like ‘approval’ for Residential Respite. If possible note down who has done the assessment.
Note: ‘Approval’ for Residential Respite means that although there is still an out-of-pocket daily fee*, a large percentage is subsidised by the Australian Government.
*Out of pocket fees:
- Residential Respite fee: there is a daily fee charged by nursing homes for respite. As this fee increases twice a year with Consumer Price Indexing (CPI) we recommend you speak to Carer Gateway for an up-to-date price.
Carer Gateway can help eligible carers with fees (call 1800 422 737 and press 1 at the menu). Some people may be eligible for DVA subsidised respite for up to 28 days if they have a DVA Gold Card.
When your elder has had the assessment and Residential Respite has been ‘approved’, you then have the option of 63 days of subsidised respite per financial year.
This can be the most challenging task. You need to find Residential Aged Care that not only meets your elder’s needs but is of a standard you are confident about. In other words, you need to find a place your elder likes and you both trust.
To see which residential aged care homes are near you, go to either the Aged Care Guide or call Carer Gateway for a copy to be sent to you. Alternatively, go to the My Aged Care website and click on or search ‘find a provider’. Then do your research. It is highly recommended that you visit these places and ask questions before you decide.
The best way to decide is to visit the home and ask people living there about their experience. Also, ask the management about how they are meeting their compliance obligations. Then ask a lot more questions. There are Standards (see the next page) to be met. There is a list of suggested ‘Questions to ask Aged Care Homes’ in the resources menu.
The Government provides a star ratings system which is available on the My Aged Care website. The star ratings should cover information such as:
- Residents experience – residents are asked questions such as ‘do you like the food?’
- Compliance – is the home meeting obligations to provide safe and quality care?
- Staffing – how much actual care time do residents receive from care and nursing staff?
- Quality measures – what are the instances of falls, pressure injuries, unplanned weight loss, use of physical restraints and medications?
This is important information but the most reliable information comes from visiting the facility, observing what is happening and asking questions yourself.
What are the Aged Care Standards?
All Australian government-funded aged care services are bound by the Aged Care Quality Standards. Standards exist so that we know what to expect about how services are delivered, and services have guidance on what they need to do to be a ‘quality’ service. See Strengthened Aged Care Quality Standards in the Resources Section for details on each Standard.
What to expect from Residential Aged Care
Whether you are deciding on respite or permanent care, there are services and supports that Residential Aged Care should provide. The quality of these services and supports is based on the Aged Care Quality Standards. For a deep dive into these Standards, click on this link to the Aged Care Quality and Safety Commission.
Move through the slides to learn more.
1. Support
Your elder should expect support to be put in place that caters for their individual needs. This might be help with personal care, mobility, eating, communication and working any gadgets.
There must be an alert system for assistance next to the bed and in the bathroom. There should always be a Registered Nurse to dispense medication at the required times.
2. Communications
Aged care facilities are required to support people with their communication. Staff should be aware of any special communication needs and make sure they are assisted appropriately. This includes hearing aids, verbal communication, and English as a second language. Your elder should be able to access Wi-Fi and use a device to stay connected with family and friends.
3. Food
Nursing homes are required to ensure that people get the nutrition and hydration they need to maintain good health. They should cater for any dietary intolerances, allergies, cultural and religious preferences and provide modified meals and physical support if that is needed to eat or drink.
There should be many opportunities to eat and drink; breakfast, lunch, dinner, morning and afternoon tea – and supper! There should be the choice of having meals in your room but remember that the dining room is often very sociable and a great place to connect with others.
4. Illness and emergencies
If your elder becomes unwell in the nursing home, there are protocols and procedures that they must follow including calling you, the carer, to discuss the next steps. Most facilities will want your elder’s GP to visit if needed. This is often a requirement on admission.
In an emergency, the nursing homes will call an ambulance who will treat your elder according to their wishes as stated in their Advanced Care Directive or take directions from a substitute decision-maker (Guardian or Enduring Guardian). See Module 5 about Advanced Care Directive and substitute decision makers.
5. Social groups and activities
This might be a very good opportunity to meet new people and participate in activities (new or familiar). Every residential aged care facility has a ‘Lifestyle’ coordinator sometimes known as a ‘Diversional Therapist’. Their job is to organise interesting and entertaining activities, outings and events. They will meet your elder and ask about their hobbies and interests and hopefully make sure there are activities that will be of interest to them. Expect a calendar of activities.
6. Physical environment
Homes are built with paths wide enough for walkers and wheelchairs. They must be very clean even in hard to reach places. Hygiene is enormously important. There should be plenty of light and opportunity for fresh air.
Most homes have ensuite bathrooms with non-slip floors, handheld showers, and lots of room for walkers or any other mobility aids that might be required. Toilets are raised with rails. The room itself may already have a lifter recliner chair or at least a comfy armchair, a TV, and a ‘hi-lo’ bed with a pressure care mattress. There is usually a wardrobe, a cupboard for storage, and somewhere to put your favourite photos. If your elder is immobile, the room may be the main consideration. You may want to make sure that there are surfaces within reach of the bed for all bits and pieces, that there is a window to look out of, and that there is an extra chair for visitors.
7. Staff
Staff are trained and police checked. They should be kind, empathetic and skilled. They should do a very good job of getting to know your loved one, understanding them, and their story, and being a trusted person to provide a high level of care and support.
8. Pets
Most facilities allow pets to visit (calm and friendly dogs, perhaps not the goat or hamster but do ask) and some are happy for your elder to bring their cat.
The Aged Care Guide has a small picture of a pet next to the homes that allow this – but please double check. Contact the homes to find out.
9.Try before you buy
Residential Aged Care can be a very positive experience for many people. It can improve health and wellbeing by ensuring regular meals are provided, medications and treatments are taken appropriately, the likelihood of social and physical isolation is reduced, there is more engagement with other interests, more safety and security, and more regular care and support.
If the place you and your elder have chosen does not work out or is not suitable, try another place. Keep in mind that a short-term respite is a good way to try before you buy.
How to choose
Always visit a residential aged care home before you decide.
Choosing the right place for your elder is going to be a combination of fact checking against measurable standards (see Star Ratings for aged care homes | My Aged Care) and ticking off important practical questions (see Questions to ask in the Resources section). It is also personal preference and gut feeling.
Some people are guided by ‘First impressions’ but be careful that the fancy entrance foyer with the nice chairs, the water feature and the roses growing in pots do not lead you down the garden path. These may look attractive and feel like a fancy hotel but in residential aged care, the number one consideration is the care itself. You can get a very good sense of the suitability of place if you spend some time there.
Here is a guide to using senses, including common sense, when checking out a home.
Select ‘Play’ to view
Your senses will play a role when deciding if the residential aged care home fits the bill for your elder. Here are some examples.
Smell. The best-case scenario for your elder will be the smell of hot cinnamon toast, a Sunday roast, or even fresh coffee. Smell is important for a sense of wellbeing. Clean and fresh is the baseline.
Sight. A priority might be cleanliness, tidiness, and order, but equally important is a cheerful atmosphere. Do the staff have name tags? Are there homely settings that look comfy, like a warm fire, armchairs, sunny spots to sit in, and some flowers? Can you see staff and residents talking to each other, laughing, or sitting together with a cup of tea? Is there a menu to see what food is being served and stimulate the appetite? Can you find your way around easily, or do you need to leave a trail of breadcrumbs?
Hear. Can you hear pleasant chatting, laughter, and staff speaking respectfully to residents? Is there a singalong going on or people enjoying music? Or is there a cacophony of TVs at full blast? Are there opportunities for quiet places?
Feel. Often, our sense of comfort and safety is based on less quantifiable qualities. Often, it is a feeling of familiarity: a chair that looks like your own, furniture that reminds you of home, or windows with a view you’ve always wanted.
Our elders deserve to feel safe, respected, and valued. They should have their needs met, feel welcomed, and receive kindness and assistance when required.
What to do after the decision is made?
Whether the choice is to try Residential Respite or move in to permanent care, it will be complex and fraught. Even if it is only for respite, your elder may be fearful that going into respite is the thin edge of the wedge and that they won’t be ‘allowed’ to come home.
Most people have also heard distressing stories about Residential Aged Care homes and elder abuse and that possibility is frightening. If you have been through the process of choosing a place as suggested by this Module, you should both feel much more confident that nothing awful is going to happen and that if your elder is not happy, they don’t have to stay. You will have a plan B. An alternative home to try. Remember that in some cases respite is necessary after surgery to provide 24/7 care during recovery. In this case it may all happen very quickly and your main job will be to listen to your elders fears and try to put them at ease.
If the respite is so that you as a carer can get a break, it can often come with deep feelings of guilt. Please see Module 6 ‘Caring for the carer’ to understand how necessary it is that you remain well and strong.
Select each heading to explore some steps for organising respite care for your elder.
MODULE 4
