Living well at home, or in residential aged care
Living well at home, or in residential care
One of many important goals when caring for someone with dementia is to prevent causing them extra distress. Studies have shown that people living with dementia have a significantly higher quality of life if they remain in their own home, compared to living in a nursing home. They have more social contact, higher levels of activity, more exposure to daylight, and less use of psychotropic medications.
However, sometimes dementia specific care is the best — or the only — option for your situation. It’s important you don’t feel guilty about that decision, as caring for someone is a full time job, and we can only do our best.
Below you’ll find more information about both options.
Living well at home
There are three government funded programs that can support people living with dementia to continue living at home (note that these services are not only for people who are living with dementia). These are the Commonwealth Home Support Programme, a Home Care Package, and the NDIS. Information about each of these programs is provided below.
✔️The Commonwealth Home Support Programme can assist people with basic support such as cleaning, showering, shopping, meals, transport, podiatry, physiotherapy, home maintenance such as lawn mowing, transport, and other aids to stay independent.
To be eligible for the program, you must be 65 years or older (50 years or older for Aboriginal or Torres Strait Islander people). If you are on a low income and homeless, or at risk of being homeless, the age criteria is lowered to 50 years or older (45 years or older for Aboriginal and Torres Strait Islander people).
The cost of the Commonwealth Support Programme depends on what you can afford, the type of support, and the provider. According to MyAged Care, “Simple services like house cleaning and meals might cost a few dollars. More complex services like renovation work will cost much more.”
You can find out more about the Commonwealth Support Programme online, or contact MyAged Care on 1800 200 422.
✔️A Home Care Package is an option for people who have more intensive, long-term needs. These packages are ‘Consumer Directed’, meaning that you and the person you care for have a say in what is included in the package and how support is delivered. Services include (but are not limited to) what is offered under the Commonwealth Home Support Programme.
Eligibility for a Home Care Package determined through an assessment, but you must also be: an older person who needs coordinated services to help them stay at home (this of course may be due to dementia, but it could also be due to various other factors), or a younger person with a disability, dementia or other care needs not met through other specialist services.
According to My Aged Care, your financial situation won’t affect your eligibility for a Home Care Package. But you may also need an income assessment through Services Australia to work out exactly how much you may be asked to contribute. More information is available on the Home Care Package costs and fees page, or call My Aged Care on 1800 200 422.
You can check online if you’re eligible for the Commonwealth Support Programme or for a Home Care Package, or call My Aged Care on 1800 200 422.
✔️NDIS is the best option if you don’t meet the criteria for the Commonwealth Home Support Programme or the Home Care Package. Some people may also consider using providers who are not government-funded.
Living well in residential care
Sometimes dementia specific care is the best option for your situation. If full time residential care is needed, the first step is to contact My Aged Care for an assessment from ACAT (Aged Care Assessment Team). They will visit your family member at home, with you present, and ask questions to determine eligibility. If they agree that you or your loved one is ready to live in an aged care home, they will provide a referral number you will need before you start the search.
When visiting aged care facilities, if possible, bring your loved one with you so they can give feedback on which facilities they liked best, and consider the following factors:
1. Is there a dementia specific unit?
These units are usually more secure than a general unit, and since 60% of people living with dementia are prone to wander, security is an important factor.
2. Does the facility have a home-style layout?
Does the facility have a home-like feel, or does it feel like a hospital? Do the residents seem relaxed and comfortable? Are the noise levels low to respect the residents? Other factors to consider include how much privacy your loved one will have. In most facilities, residents will have their own room with a lockable door (although staff have keys). However, there are facilities where residents are required to share a room.
3. Does the facility provide meaningful activities to enhance quality of life?
When you visit the facility, you can check the activities schedule for yourself (you’ll usually find it pinned up in a common area) and get a feel for what activities are routinely offered. Look for facilities will prioritise activities that increase socialisation and improve well-being, such as cooking, craft, art therapy, singing and dancing.
4. Does the facility prioritise movement?
Health professionals have known for quite a while now how important regular physical activity is for maintaining good mental health, which should be a priority at any aged care facility. Exercise may also slow disease progression. For that reason, the best facilities will have regular physiotherapy for people in the dementia unit, and it won’t be held at a time that conflicts with other activities (people living with dementia shouldn’t have to choose between social engagement and physical health). You can often check this for yourself on the activities schedule. Some aged care facilities also schedule regular walks with residents which is highly beneficial – especially when it’s in green spaces.
5. Does the facility have well-designed outdoor spaces?
These should be easily accessible, interesting, safe and secure. Residents should be free to come and go from these spaces (check that they are not routinely kept locked). There should be fixed seating, and residents should have the ability to easily return indoors.
6. Are there quiet spaces? Are staff respectful of the space as people’s ‘home’ rather than their workplace?
A comfortable environment is very important for a sense of well-being. Research shows that sundowning — where people with dementia become more anxious and confused in the late afternoon and evening — is not only due to impairments with circadian rhythm, but also due to environmental and social factors. These factors include afternoon fatigue, caregiver fatigue, lack of sunlight, and excessive noise. When you visit, pay attention to whether staff are conversing with each other quietly, and if there are quiet spaces so that sundowning is minimised.
7. Can your loved one afford the facility?
It’s important to understand what fees your loved one will have to pay when moving into an aged care home, and whether they are eligible for government assistance with accommodation costs. Speak to the facility and My Aged Care about this.
8. Will your loved one be seen by their regular G.P? What is the aged care facility’s communication strategy?
There are many different ways a facility can operate. There are some where resident doctors attended the facility (that is, people who have graduated medical school and are in the process of completing a post-graduate training program). Others require residents to have their own GP, as long as the GP was willing to visit the facility. It’s also important to ask about the facility’s communication strategy. How will they communicate any changes in your loved one’s condition?
9. Other factors that are beneficial
There are other factors that are considered best practice for aged care. These include:
Unit sizes: Having smaller units with a maximum of 8 residents may be more beneficial for people living with dementia to reduce overwhelm and increase quality of life. Dementia units in Orange are typically around 20 residents.
Regular staff: Having consistent staff in the dementia unit, with the majority of employees being full time or part time, is also beneficial. Regular staff are more likely to understand your loved one’s specific needs. A consistent care team also fosters a feeling of safety for a person with dementia, and facilitates improved communications between staff and families.
Dementia-specific training: Aged care providers are required to adhere to regulations and standards to ensure the care they deliver is appropriate, however they are currently not required by law to educate their staff in dementia. Facilities ensuring the majority of staff members had dementia-specific training would certainly result in better outcomes for people living with dementia in aged care facilities.
10. Keep in mind the waiting lists
It would be best to have the dignity of choice by putting your name down in a few places, since wait lists can be many months.
11. Additional Resources
Dementia Australia has this checklist for choosing dementia specific residential aged care.
This information is collated by volunteers. If any of this information has changed, please help us stay up-to-date by getting in touch.
What factors do you find important in an aged care setting that supports people to live well with dementia? Please let us know.