Considering residential care
Moving into residential care involves important decisions and a lot of different emotions for all those concerned. If you are thinking about residential care for yourself or someone else, you or that person will have already been through many changes in life - deteriorating health, illness and loss of a caregiver are just some examples - and you may still be learning to cope with these changes.
The decisions to be faced can be overwhelming. None of us really expect to have to look for a rest home for a family member or ourselves. You may try to carry on a little longer, however difficult things are. If this is the case, it is worth looking at what support services there are to help you manage at home. The Needs Assessment and Service Coordination (NASC) can assist by carrying out a Needs Assessment. Even if you find out you need more help than is available, then at least you know you have tried.
Perhaps you have also tried living with family and it hasn't worked out. This is quite common and it is no one's fault. It can be a great relief for everyone when an agreeable alternative is found. There are a number of levels of care available.
Moving into residential care can be a positive decision for both the caregivers and the cared for - they both can now enjoy a relationship that is free from the constraints and burdens of care. Family or caregivers can choose to be involved as much as they wish, and in practical ways. And the emotional support they give is as important as ever.
Nationally, anyone in this situation and needing advice can make use of SeniorLine, a free information service based at Green Lane in Auckland and funded by the Ministry of Health. It is for people aged 65 years and over, their family, whanau or carers who are considering rest home or long stay hospital care, or who need support to stay on in their home. SeniorLine also has specific detailed information on Auckland and Northland residential care options, as well as on home care, retirement villages, rental accommodation and activities for older people. In other areas of the country your own doctor or District Health Board can help you find the local information you need (see our Hospitals and District Health Boards listings).
If you are thinking about residential care, you should begin by having a Needs Assessment. This ensures that:
- You know of any support services that would help you remain in your own home, eg, district nurses, home care, day care
- You have access to specialist medical advice, which may improve your health so you can remain at home
- Admission to hospital for rehabilitation is considered
- You have help with making the decision. (It is difficult to return home once you have left and moved into care.)
A Needs Assessor will visit you at home and talk with you about the choices open to you and how much help you need. For example:
- If you use any aids to walk
- If you need help with things like dressing or showering
- What your memory is like
- What family or social support is available to you, etc.
In order to get anything from public funded services, you have to have a Needs Assessment done by NASC - they are the "gatekeepers" to these services, so to speak.
The Needs Assessment identifies the level of support you require, and need is categorised as 'low,' 'medium,' 'high,' or 'very high. Long-term residential care is only considered for 'high' and 'very high' categories.
To get an assessment you can either contact NASC yourself, or your GP can refer you. If you are in hospital, you can be seen in the ward. NASC contact numbers can be obtained through Seniorline (also see the end of this topic for Auckland and Northland contacts).
Levels of care
Residential care includes rest homes and long stay (private) hospitals. All facilities are required to have a current licence from the Ministry of Health.
Rest homes care for older people who cannot manage at home. They allow some independence and privacy in home-like surroundings. Access in and around the facility is geared towards people who have difficulty with mobility, eg, the person may need to use a walking frame.
Rest homes have some mild to moderately dependent residents who may need help with things like dressing and showering, as well as some who need a lot of help and probably also night care. Most residents are women and are aged over 85 years.
Rest homes have some registered nurse hours and at least one care staff member on duty at all times.
Dementia rest homes
A person with dementia may not require care in a dementia rest home. Rest home, dementia rest home or specialist hospital care may be recommended.
In dementia rest homes, assessment by a psycho-geriatrician is required. Residents may have advanced Alzheimer's disease or age-related dementia. They will usually be mobile but experience confusion requiring specialist care in a secure and safe environment.
Dementia rest homes provide higher staffing levels to ensure close monitoring, and enclosed garden areas with restricted access to the street for those with persistent wandering.
Specialist hospitals are sometimes called ‘psychogeriatric hospitals’. The residents have high dependency needs coupled with challenging or noisy behaviours. The behaviour may be due to dementia, or the combination of an age-related disability and a mental health condition. Staff members are trained to manage this type of behaviour.
Specialist hospitals have two staff on duty at all times, one registered nurse and one caregiver, or more staff according to the number of residents.
Long term care/private hospitals
Long term care hospitals, also known as private hospitals, have two staff members on duty at all times, one of whom is a registered nurse. They care for older people who need nursing because of illness and disability. Although they are called hospitals, long term care hospitals are very different from public hospitals. They do not have emergency services or doctors on duty 24 hours a day or specialised rehabilitation services.
There are no particular facilities for convalescent care, though some people choose to stay in a rest home for a short time. An example of someone doing this might be an older person who normally lives alone but is recovering from a replacement hip or knee operation. You have to pay your own fees for this as there are no subsidies available.
Other accommodation - Retirement villages
Residential care does not include retirement villages. There is no legal definition of a retirement village. They are housing developments designed specifically for older people and consist of self-contained units and some have communal amenities. Residents need to be independent. People in their 50s are often also allowed to buy or rent in these villages.
Some retirement villages have a rest home or hospital on site as well, and this may be a factor in your decision-making, if you are thinking about possiblities that lie further ahead.
Dealing with the change
The loss of your home, neighbours, and independence may seem a very high price to pay for 24-hour professional care. You may feel anger, disappointment or a sense of failure. Give it time and allow yourself to grieve or adjust.
On the positive side, lots of things will go with you into a rest home - your memories, photographs, knick-knacks and perhaps your favourite armchair. Many people carry on living their own life within a rest home. Your family and friends can still visit, you can still go to the same shops and clubs and maybe keep your own doctor. Moving into a rest home can be a huge relief. You know you will receive the care you need to remain as independent as possible. You will not have to worry about house maintenance, bills or your personal safety.
For family and caregivers the move will bring mixed feelings of relief and guilt. Worrying about a loved one's wellbeing and safety can be almost as exhausting as physically caring for someone. It can be a relief to know they are cared for safely.
For caregivers of those with dementia (who may or may not have an insight into their own condition and the demands it places on others) the decision to seek residential care can be especially difficult. You are making a decision on behalf of that person. This can be made easier by discussing it with family/friends and/or a Needs Assessor to agree on what action is in the best interests of the person with dementia.
Settling in is easier when you are involved in the decision-making and you can make an informed choice about your future. Moving into residential care should be a planned process with time taken to discuss with family and work through the different feelings it brings.
Once there you can also talk freely about how you are feeling. Rest home staff members are quite familiar with the settling in process and the other residents have been through it themselves.
For people with dementia, day care or short stays can provide a gradual transition to long term care. This way the confused person is not suddenly moving to a totally new environment and it provides time to get to know staff and residents.
Your quality of life is very important. In a rest home there will be the chance to make friends, go on outings and join in activities. Instead of worrying about managing day to day, you can start concentrating on what you would like to do.
Getting used to living in a rest home takes time. Hopefully, you will have the chance to visit several and choose the most suitable. Some people find a short trial stay, if it can be arranged, is helpful.
If you do not settle in, you have the right to move to another facility, whatever the reason. If you have been in a rest home for a while, or if your health has changed, it is best to have another Needs Assessment to check the level of care you need.
Checklist for moving into residential care
- Organise GP referral for a Needs Assessment.
- Assessment by Needs Assessment and Service Coordination (NASC).
- Level of residential care recommended.
- Discuss options and plan of action with NASC.
- Visit a number of rest homes/hospitals.
- Request a copy of the Admission Agreement to take away and study. Contract details can be checked on the Ministry of Health website.
- Choose a rest home/hospital.
- Negotiate and sign Admission Agreement.
- Apply for a Residential Care Subsidy or Loan, if appropriate.
for further information about a range of topics, including accommodation, home support services, financial considerations, and legal issues such as an enduring power of attorney.
Needs Assessment Service Coordination (NASC)
Auckland NASC phone numbers:
Central Auckland (09) 631 1234
North Shore and Rodney (09) 442 7171
Waitakere (09) 442 7171
Counties Manukau (09) 276 0040
Northland NASC phone numbers:
Whangarei 430 4131 or 0800 888 890
Dargaville 430 4131 or 0800 888 890
Kaitaia 430 4131 or 0800 888 890
Bay of Islands 404 2858 or 0800 888 890
Hokianga 405 7709.
For other areas talk to your GP, local District Health Board (DHB), or contact SeniorLine.
Other internet resources
Original material provided by the Auckland District Health Board. Reviewed and edited by everybody, July 2012.