Residential Care Frequently Asked
Questions
What is a rest home? 
Rest homes allow you some independence and privacy in home-like
surroundings. Access in and around the facility is geared toward people
who have difficulty with mobility eg may need to use a walking frame.
The majority of rest home residents are women over the age of 85 years, and a
significant number have memory loss. Rest homes employ a registered nurse
some hours per week, and there will be at least one care staff member
on-duty at all times. More staff members are on duty according to the number
of residents.
Further information:
What is a Specialist Dementia Rest Home?
A person with dementia may not necessarily require care in a specialist
dementia rest home, sometimes called a 'dementia unit'. The assessor
consults with others, eg a psycho-geriatrician, and recommends the most
appropriate type of care facility. Residents of dementia rest homes are
mobile and show confusion that requires specialist care in a secure and
safe environment.
Dementia rest homes are small – usually no more than 20 beds. They provide
higher levels of staff trained in dementia care and have enclosed garden
areas with access to the street restricted. Dementia rest homes employ a
registered nurse some hours per week and have one staff member on-duty at
all times, with another readily available on-site.
Further information:
What is a Private Hospital?
These hospitals care for older people
who need nursing due to illness and disability. Although they are called
hospitals, long-term-care hospitals are very different from public
hospitals.
They do not have doctors on duty 24-hours, or specialised rehabilitation.
Hospital residents tend to be immobile and many of them are confused.
Long-term hospitals have two staff on duty at all times, one registered
nurse and one caregiver, more staff depending on numbers of residents.
Further information:
What is a Specialist Private Hospital?
Specialist hospital residents have high dependency needs coupled with
challenging or antisocial 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. Long-term
specialist hospitals have two staff on duty at all times, one registered
nurse and one caregiver, more staff depending on numbers of residents. For
larger facilities with several units on one site, registered nursing cover
can be shared between units for the hours 10pm to 7am .
Further information:
What are the rules around Residential Care?
All rest
homes and hospitals must be certified by Ministry of Health. Any
facility wishing to care for residents recieving public funding must
also have a contract with their local District Health Board and
keep to the terms of this contract. Fees at any level of long-term
care are limited to the Maximum Contribution for contracted care
services. This applies to both private payers and residents
receiving Top Up.
Contracted care services are
detailed in the National Contract for Aged Residential Care
Services.
The section of most interest is often section D - 'Service
Specifications'.
Further information:
Where
do I start?
If you are
thinking about residential care, you should begin by having a Needs
Assessment - this applies even if you are in a public hospital. The
assessment ensures that:
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You know of support services that
would help you to stay in your own home eg district nurses, help with personal care. |
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You have access to specialist
medical advice and/or rehabilitation which may improve your
health. |
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You have help with making this
critical decision. It is difficult to return home once you have
moved into care. |
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You know the assessment criteria for public
funding of residential care. |
A needs assessor can visit you at home or in hospital, to talk with you
about:
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Tasks you find difficult |
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Family / whanau or social support available
to you |
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The kinds of services that would help you
stay at home |
It is a often helpful to have another family / whanau member with you at this
meeting.
Further information:
What happens if I need to go into a rest home?
If the
needs assessment process identifies long term care as the best
choice for you, the assessor will recommend a level of care
appropriate for your care. The options are:
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rest home |
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specialist dementia rest home |
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private hospital and |
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specialist private hospital |
Talk to the needs assessor and your family / whanau about the choices you
face and what might work best for you. Get your family involved – divide
tasks and visit as many places as you can. It is good to have someone
with you when making a visit, you pick up more information and can
compare impressions afterward.
Further information:
How much will it cost for long-stay care?
Residents receiving Subsidy
These are people who have been assessed as eligible for:
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Residential
Care Subsidy: |
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ie. meet asset threshold, pay NZ Super
and pay income contribution to rest home or hospital. |
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Top Up
: |
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ie. do not meet asset threshold, pay maximum
contribution٭ for Dementia or Hospital care, with Top Up
meeting the shortfall for higher care costs. Top Up is
organised by the Needs Assessor. Residents continue to receive
NZ
Super. |
Privately paying residents
These are people who do not meet the asset threshold for
Residential Care Subsidy and are in rest home level care. They pay their own fees.
The
conditions of the contract between the District Health Board and
rest home / hospital apply regardless of whether you are paying
privately or receive public funding. Care facilities cannot charge
for any service that is already part of its contract with a District
Health Board.
If the care
facility in which you live does not have a contract with a District Health Board,
the amount you pay will be governed by the
Admission
Agreement.
Extra costs
Any resident can be asked to pay for items or
services outside of the contract by negotiation. See ‘What
Residential Care Subsidy Covers’ for
a summary of the contract. There should be no
compulsion to purchase. All extra charges should be written in the Admission
Agreement and be agreed and signed by both parties. The resident
and/or family / whanau are responsible for meeting extra costs.
٭ Maximum Contribution
Maximum contribution is based on the latest nationally agreed price
for contracted care services, as set out in the
National Contract for Aged Residential Care Services. It is
notified in the NZ Gazette.
Maximum contribution is GST inclusive and rates vary. Areas with
high land values have a higher rate. New rates for maximum
contribution were set July 1, 2006. Rates are listed on the
Ministry of Health website.
Further information:
What if there is a change in my financial circumstances?
You should notify Work and Income of
any change in financial status. Phone the Residential Care Subsidy
Unit to discuss, see contact below.
Further information:
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Residential Care Subsidy Unit phone 0800 999 727 |
Can I put myself into a rest home?
Yes.
However, if you enter care without a needs assessment you do not
automatically qualify for public funding once you have used all your
assets. Any appication for subsidy must show you have been needs
assessed as requiring long-term care.
It can be
financially risky to enter care without assessment. If you pay all the costs of your care privately, the rest home or
hospital must
notify you in writing of the financial risks involved. This is a
requirement of the
National Contract for Aged Residential Care Services.
Further information:
What is an Admission Agreement?
This is an
important and often large legal document setting out the
responsibilities of both the resident and rest home / hospital. Care
providers are required to provide you with an Admission Agreement.
Ask to take the agreement away with
you and read it carefully. If there is anything you are not clear
about, seek advice.
If there
are terms you are not happy with, try to negotiate a different
arrangement, and change the agreement to reflect this. You initial changes just as you would any other legal document. For
example, you might negotiate a reduced period of notice required -
two weeks is often considered a reasonable time frame for both
parties.
The
Agreement should specify any extra charges, and by signing it you
undertake to pay these costs if you use the services listed. You may
be asked to supply a guarantor. There should be no extra costs
for any resident, unless these have been agreed to in the Admission Agreement.
Your care provider cannot charge you for any service you receive
that is already part of its contract with the District Health Board.
Contracted
care services can be checked in the Ministry of Health booklet
'Looking at Long-term care in a Rest Home or Hospital', or the National Contract for Aged Residential Care
Services.
Further information:
What is Top Up?
Top Up is the difference between Maximum Contribution
and the contract rate paid by the District Health Board. It is paid
direct to providers of Dementia and Hospital level care.
You do not have to apply for Top Up. The needs assessor does the
necessary paperwork to ensure that Top Up is paid on behalf of
eligible clients living in facilities contracted to the District Health Board.
Can I move to a rest home closer to my family?
Yes you can. You will require a needs assessment before moving - this is to ensure that any move you make is to an appropriate level
of care. If you change District Health Board area you will need authorisation from the Needs
Assessment and Service Co-ordination service of the new area before making the move.
It should
not take long to organise.
Further information:
Can I
change my rest home if I want to?
You can. The National Contract for Aged Residential Care Services
requires care providers to make it easy for you to leave or transfer to
another place. Check the Admission Agreement to see how much notice you
have to give.
Contact your needs assessor and tell them what you want to do - you may require
another assessment. The needs assessor will also do the paperwork to ensure
that funding transfers with you.
Further information:
Should I have to keep paying for my room if I go into hospital or away on
holiday?
If you are paying privately, you will have to meet this cost
yourself. Often you don’t know how long you will be in hospital, but you
may need a different level of care after your hospital stay.
For a planned holiday, see if you can negotiate a lower rate for the
period you will be away.
For residents who are on a subsidy, payment continues if you are away for
a short time: two lots of two weeks a year for holidays, or up to three
weeks a year if you are admitted to a public hospital. Payment for time
in public hospital can be extended by recomendation from Needs
Assessment.
Further information:
Do rest homes and hospitals have to supply mobility equipment?
Providers of rest home and hospital care must supply communal
mobility equipment for subsidised residents eg. wheelchairs for outings. Equipment
required for exclusive individual use is the responsibiltiy of the
resident.
Further information:
Do I have to pay for toiletries?
All residents must provide their own toiletries.
Further information:
Will I be charged for bandages?
Bandages
are part of contracted care services, so there
should not be any charge.Your care provider cannot charge you for any service you
receive that is already part of its contract with the District
Health Board. Your Admission Agreement must specify any extra
charges.
Further information:
Do I have to pay for podiatry?
If the
podiatry has been prescribed by your doctor there should be no charge. Rest
homes and hospitals often arrange for a podiatrist to visit the home
on a regular basis, so even if you do have to pay, charges may be
less than if you were to visit a podiatrist out in the community.
Further information:
Who is responsible for transport to my public hospital specialist?
Residential care providers generally try to get family members to
take residents to local hospital appointments. If this is not
possible, you should not be charged. Public
funding does not cover the cost of travel to a private specialist.
Further information:
Who should pay for incontinence products?
The National Contract for Aged Residential Care Services requires that care providers supply incontinence
products that meet the needs of the resident. If you choose or are offered a more expensive product than that
normally provided by the facility, you can expect to pay the
difference in cost. An example would be if you chose to use
"pull-ups" rather than a pad system.
Further information:
Do I pay for medications?
There should be no charge
for any medications prescribed by your doctor from the official
Pharmac list. Drugs not on the list may incur extra charges, this should be specified in the
Admission Agreement, which you sign on entry to the care
facility.
Further information:
How many staff should there be on-duty?
The Aged Residential Care contract requires that all contracted
rest homes and hospitals ‘provide sufficient staff to meet the
health and personal care needs of all subsidised residents at all
times.’ The following information is taken from the contract.
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For rest homes: |
| 10 or fewer subsidised
residents: |
1 care staff member on duty
at all times |
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| More than 30
subsidised residents: |
at least 2 care staff
members on duty at all times |
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| Up to and
including 30 subsidised residents: |
1 care staff member on duty
and 1 care staff member on-call at all times |
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| More than 60
subsidised residents: |
at least 3 care staff
members on duty at all times |
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For specialist dementia rest homes: |
| 1 care staff member on duty
at all times, with another readily available. |
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For private hospitals: |
| 1 registered nurse and 1
caregiver on duty at all times, extra staff according to
numbers of residents. |
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|
For specialist private hospitals: |
| Staffing is the same as for
ordinary hospitals above, although for larger facilities
with several units on one site, registered nursing cover can
be shared between units for the hours 10pm to 7am. |
Further information:
What do I do if I have a complaint?
It is okay
to talk about some aspect of care which concerns you or your family. It is always best to first talk or write
directly to the manager / owner. If you are uncomfortable with
this, you may want to enlist the help of a friend, family member
or Health Advocate. Dealing with a small issue early can prevent a larger problem.
All rest homes and hospitals must meet the requirements of:
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Code of Health and Disability
Services Consumers’ Rights |
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Health and Disability sector
standards |
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National Contract for Aged Residential Care Services
for contracted care
services |
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|
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| If you feel the
care is not up to standard, you can make a complaint to the
provider - all rest homes and hospitals are required to have a
complaints process. |
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If you are not
satisfied after speaking to the provider, then:
For concerns about quality of care, contact the
Health and Disability Commissioner.
For concerns around what services the facility
is required to provide for a resident receiving subsidy,
contact Residential Care Line or your local District Health
Board.
For concerns about costs when you are paying,
go back to the Admission Agreement with the facility, this
should specify all charges.
For financial issues that you are not able to
resolve with a facility, you can seek redress through the
Disputes Tribunal, a process that does not involve lawyers.
Another option is the
Consumers’ Institute. Note you must be a paid up member to
get advice from the Institute.
Contacts: |
| Health Advocates |
0800 555 050 |
| Residential Care Line |
09 375 4395 or 0800 725 463 |
| Health & Disability Commissioner |
0800 11 22 33 |
| Consumers’ Institute |
04 384 7963 |
| Disputes Tribunal |
local District Court |
| Ministry of Health |
0800 113 813 |
Further
information:
Can I
keep my own doctor?
If you wish to retain your own doctor, you may need to pay the cost difference between
fees for the doctor contracted to the rest home and what your doctor
charges. The
rest home will be concerned with out-of-hours service and will want
some assurance that if necessary, your doctor could visit you, for
example on evenings and weekends. This could be difficult for your doctor, if s/he attends only one patient at the home.
Further information:
Do rest homes have to offer an activities programme?
There is no prescribed number of hours required for occupational or
diversional therapy programmes, although there is an expectation
that there will be one as part of the care plan for each resident.
The National Contract for Aged Residential Care requires that the
programme is evaluated every six months when care plans are
reviewed, or sooner if a resident's needs and abilities change.
Ask about the hours of employment for specialist staff in this
area - higher numbers of hours indicate a greater commitment by the facility
to this area of resident care.
Further information:
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Ministry of Health
