- Julie Cheney RN
“I don’t need that yet” – sure about that?
We in LYS have been at a lot of events specifically for seniors lately. There are always a lot of providers, both community and residential, as well as equipment and medical or pharmaceutical representatives. One of the most common statements we all hear from people is “I don’t need that yet”. Now this is often very true regarding people being independent in their self-care and their ability to get around within their own and outside environments. But how many of those confident people have made real changes to their environment and their lifestyles so that their confidence, independence and safety are maintained well into their future? How many have thought about the contingencies of what if this were to happen? Not enough, I can assure you.
I have also heard a lot of professionals speak over the years and I have been in the aged care, community care and health industries for over 30 years. The themes and processes I am hearing about now are very different to what they were only a decade ago. One of the speakers I have heard and admired is Brain Herd. Brian specialises in Elder Law in Queensland and all things to do with supporting older people and their care needs. He was one of the first people to alert me and my colleagues to the pit falls of having no legal processes in place for the contingencies of unconsciousness or dementia, and of appointing people who will only have self interest in mind.
A recent article by Brian was about ‘bed blockers’. An unfortunate title given to older people who have a crisis in health and are not safe enough to be allowed home and not ill enough to be in acute hospitals. It’s a common occurrence, more common than the older generation likes to think and completely under the radar in the offspring/carer generation. The comments we hear from carers or other family members are along the themes of: “I had no idea how hard it would be”, or “I was not prepared for what would happen in the future if Mum couldn’t look after herself”.
Now, none of us want to think about this. We all want to believe that its just like the movies. A beautifully coiffed older person gently touches your hand, tells you how wonderful life has been, goes up to bed and falls asleep amongst a gauzy haze of soft music and profound last words. Sometimes this happens, but mostly, it doesn’t. Sorry to be harsh, but we have to be real about what’s coming. And the reason I am being so harsh is because reality is getting harsher.
There was a time when a nurse could attend a person’s home based on their family calling or a person calling themselves. We would attend, do extensive assessments, offer 20 service options and solutions for care needs and set them on their way for years of support at home. Now that process is more complex and with far longer waiting times. Now, you will have to either make a call or go on the internet to access My Aged Care. You need an ID number and must be assessed. You will wait for your assessment anywhere up to 12 months, depending on your level of priority. You will then, maybe, be approved for a community package at a level relevant to your needs at the time of the assessment. You will then wait … and wait … and wait… for the package to become available. 9 – 12 months again is increasingly common. You might not be able to get a higher package and have to take an entry level one just to get a bit of help.
So, what do you think happens during the time that you’re waiting? If you have come to a point where you are struggling to cope and have need for support right now, you will find it increasingly hard and, if you don’t get the help you need, this will become worse quicker.
You might even start to withdraw, reduce your social activities, limit your access to services and other health activities. This is not good for you, for families or for the health system, because then your health deteriorates and you end up in a health crisis in the hospital, maybe even at the point where you can’t be safe at home.
I know – sorry – such doom and gloom. It’s just that the world of aged care and community services has changed so much and so fast that I am trying to get people to start thinking ahead a bit further, so that they don’t feel out of their own loop when it comes to being forced to make hard decisions in crisis. I’m tyring to get across that the choices are changing, the responses are changing, and the processes have certainly changed. This means family or close friends, or worse the older person on their own, find themselves in a position to need rapid action on health, on the home, on living arrangements and on basic care. Much of this costs money, and you can be guaranteed it costs time. In Brian Herd’s words this is being an ‘event manager’ for a parent rather than being realistic about the future.
So, are there options? For a start, be aware. Realise that any form of aged care in the future will cost money. All services are assessed for income and assets, unless they are wholly private. If you want subsidised care you will need to give great detail about all income, all assets, pensions, super, the lot. This is assessed, and a determination made about the level of subsidy. You will still have a fee to pay for your services, some very little, some a bit higher, unless you have very little in the way of income and assets. Be prepared for these facts. Realise that care is no longer free. And then, once you’ve expressed the indignation, like I have for years, think about what it is you are receiving – care – help – support – those things that keep you independent and feeling in control, that you have worked at all your life, and have earned money to enable to continue on into your very old age. You’re paying for yourself, for what you need, you’re own wellbeing, and you’re worth it.
Then there’s the practical stuff. First, talk within the family. Talk about your needs and wishes. Anticipate that if you were to need more help with …, e.g. shopping or driving, yard work, washing or anything else, where could it come from? What could you pay? Who would you call on in a crisis? What would they be able to do, commit to? Who would be safe and ethical when you are vulnerable? Plan for the worst when you really want to hope for the best, then you are prepared and more in control.
More practical stuff. Get the legal documents sorted early. Look at your living environment and either fix it, declutter it, reduce it or move somewhere easier. Keep sight of what you like to do and how you could sustain it, withdrawing will make you less well. Use aids to make things safer or easier so that you are less likely to fall or stop doing things. Don’t let your diet fall into an instant noodles hole because this too will send you into poor health. If you’re a likely carer, get ready, listen to friends who are carers, find out the legal situation for your parents, anticipate a long life, or a life with some level of disability and what would need to change. Get services in when you can to prepare well to make the transitions easier and the processes less time consuming. Get ready, you might never need it but, boy if you do, you will be glad you prepared.
And for all of us, work together as a family and as an older person. We know you don’t want to be burdensome or time consuming or dependent or an effort. But we also know you can do a lot to minimise the impacts upon your life and this is where your responsibilities are still calling you to action in your later years. You don’t stop learning in your third act, you just learn about different things. Be open to it, be prepared, keep more control where you can for when life sends you lemons.