Accommodation Bonds

[bakermaj]

I am particularly concerned about the lack of transparency in terms of variable accommodation bonds and entry into resiential aged care. It would seem that those individuals who cannot offer a large bond are compromised in terms of their equitable access to residential aged care as facilities are creaming potential residents. That is they are selecting individuals based on the size of the bond that they are able to pay not on a needs basis. I am also concerned that the amount of money exempt from the bond, that is the amount that facilites are required to leave the older person with, does not allow the older person to have any sense of financial security if they happen to "live too long". I have witnessed a number of older people who have moved into low care and paid a bond many years ago, be turned away when they needed high care because the facility had only extra service beds available and the older person could not meet the costs of the new bond. So much for ageing in place. Do others share my concerns?

[Administrator]

Hi there bakermaj - good question, unfortunately, there are no easy answers. Providers seem to be able to charge whatever they want with regards to accommodation bonds. The reason for this is that a lot of nursing homes have been farmed out to "private" corporations. Providers are not bound to a pricing scale - basically, they can charge whatever they like - and do. Often people have written to us highlighting the fact that paying more money, does not neccessarily mean better care. It's a lucrative way for providers to charge top dollar, and sometimes for very little.

We would recommend getting legal advice prior to signing any contracts with any nursing home provider - not having someone professional go over the "small print" for you is risky. We know of bonds being paid in the hundreds of thousands of dollars - just what separates someone from paying, for example, $120,000 to $450,000, we are at pains to explain.

I have copied and started a new topic here, as well as copying your topic from Feedback, Suggestions, etc. under the now dedicated topic Accommodation Bonds

Please use the new location to post any replies or comments - good to have you on board!

[industrystandard]

I have witnessed a number of older people who have moved into low care and paid a bond many years ago, be turned away when they needed high care because the facility had only extra service beds available and the older person could not meet the costs of the new bond.

Just stopped in to say that this isn't quite correct. Residents can be charged only one bond to enter aged care. If a resident should transfer from low care to an extra services high care facility, the bond transfers with them. What may be an issue is the amount already drawn down. Providers are allowed to draw down a certain amount per year for a maximum of five years. However the five year rule applies even when the resident transfers between facilities, including between low and high care. So if a resident has already been in low care for a number of years, the incentive to accept them into a high care extra services facility may not be there. There can be exceptions though, such as when the low care bond is substantially higher than the high care extra services bond (as is usually the case). According to the rules, the entire bond is transferred to the new provider (regardless of wether the high care bond amount is less) and sometimes the interest earned on the difference can offset any loss of draw down.

Of course, you could just choose a non-extra services facility, have your bond refunded and buy your own cheap wine.

[Administrator]

As residential beds are scarce, private providers are in a position to 'cherry pick' those residents with the greatest capacity to pay.

For example, if a 'concessional' bed becomes available and there is the choice between two people both with the same residential classification scores, the person with few support needs, minimal or no behavioural issues and strong family support, is likely to be accepted.

A commercially-driven facility, and even a number of not-for-profit facilities would accept the former person. That is, unless the facility is underpinned by a mission that expressly 'favours the poor'....

[At Wits End]

Does this mean that if a person is at home and being cared for by family - but is designated by an ACAT as High Care - that it may be almost impossible to get into High Care. That is if they have complex needs and High Care at that. Because I had heard that those entering High Care do not pay a bond. I know they do have to pay the daily costs. And it is not hard to have high dollars invested - so invariably man widowed or single pensioners who own their own home will be 'over' the financial threshhold and thus have to pay the highest daily charges/rate etc.

And it says that if your assets are over a certain level you will have to pay the highest rate to be in High care.
And the rules say that you do not 'have to' fill out the 28 page Assets test questionaire.

So with all that in mind why do so many high care nursing homes still insist that they do want to see the 28 page Assets test questionaire filled out and accompanying the application for High Care permanent care. Why would they also need it if they are assured of being paid the maximum daily rate/cost per day.

Is it because they have some hidden charges to allow a person to enter permanent high care?

This is a mine field for me and there is so much I do not know

[At Wits End]

Hi bakermaj
I am still mystified about all this Bond business. Why, if there are no bonds for high care, - and high care was being considered at the time - was I subjected to all sorts of inquisitions? I informed the facility that the person, if it was agreed that they would come to the facility, would be paying the extra services charge and the highest daily care fee. So would be paying the maximum per day. Yet still they wanted to know all manner of what exactly were the assets, in whose name was the home property etc. They were concerned that a grandchild often stayed in the family home (to help care for the grandparent) and asked if the home was solely in the name of the elderly person or was it jointly in the name of the grandchild and the elderly person. The answer was that it was the sole property of the elderly person.
In the end I would not fill out the extensive 28 page grilling document to ascertain financial assets. Why did I have to? So with that I was told I had ruined my chances of being considered for that facility as all intending occupants had to complete the 28 page document.

And another party later told me that the facility preferred only widowed or single persons, with substantial assets and whose assets were entirely and solely only in their own name. And, it was claimed, that the facility preferred people who still had capacity. (Capacity to make a new Will?). This was a Church run place. And I have since been told that a high proportion of people who enter that facility also choose to leave some or much of their assets to the place in their Will, in recognition of the care they receive. But I have to wonder what coercion proceeds that decision? Surely no HCF would ever stoop to being so manipulative with their residents?

In the end the decision not to choose this place (nor any other HCF) was the right decision.
All is NOT well in the Aged Care High care area in Australia.

[industrystandard]

Bonds are payable in high care only if the facility is an 'extra services' place. There are some complicated rules about bonds; essentially there is a rule which means that the resident must be left with a certain amount of assets after paying the bond. Extra services facilities don't advertise this as they aren't allowed to deny any-one entrance on the inability to pay the entire bond.

As for the daily fee at facilities which aren't 'extra services': it is means tested for non-pensioners.

[Heather]

This is shocking info. So an elderly person just over the threshold of assets could have to pay the maximum rate of daily care/accommodation and still have to pay a bond on top of that? As a first time entry into care at the High care level? No wonder these fancy suits who run these places can afford fancy buildings and quality soft furnishings. But I am not convinced that the staffing levels in all of them is up to standard, after what I have seen. How is it the fault of the carers if they have to manage an impossible workload? A woman at work told me her Uncle died on gangrene of the foot in a nursing home. In the 21st century a man can die of gangrene of the foot despite his care being overseen by a Registered Nurse? How can this happen? Maybe in the Crimean war or left out on a battlefield to die. But gangrene of the foot in a nursing home? And why was he still in the nursing home when he died and not in hospital? His nieces are now asking questions as they are disgusted. And she says no one rang the family until he was dead.

[industrystandard]

This is shocking info. So an elderly person just over the threshold of assets could have to pay the maximum rate of daily care/accommodation and still have to pay a bond on top of that? As a first time entry into care at the High care level?

Bonds are only payable in high care for 'extra services' facilities.

[paulinek]

"Bonds are only payable in high care for 'extra services' facilities."

What are extra services facilities?

[Administrator]

Hey there Pauline, the provision of "extra service" only applies in some homes with places approved by the Australian Government. It provides an additional element of choice for people entering residential aged care who wish to choose and pay for a higher than average level of 'hotel' type services, including accommodation, the range and quality of food and the provision of non-care services such as recreational/personal interest activities.

Extra services facilities charge more. "Extra services" may vary and may be a bigger room, a glass of wine with an evening meal, greater choice of meals and/or nicer decoration in a room, for example.

From the health.gov.au website:

Extra Service In Residential Aged Care
The Aged Care Act 1997 allows the Department of Health and Ageing to approve 'Extra Service' status for a residential aged care home, or a distinct part of a home.

Extra Service involves the provision of additional 'hotel' type services or lifestyle extras, including higher standards of accommodation and increased entertainment and food choices. However, aged care homes are only approved to offer Extra Service if their level of provision of these extras is significantly higher than average.

Extra Service offers increased choice and diversity in the aged care sector by giving residents the option of making additional payments to receive additional services. Residents are required to pay an additional fee for these services and may be requested to pay an accommodation bond for either high care or low care accommodation.

Extra service status enables the residents to enjoy a superior level of comfort and choice, through:

- a physical environment that offers high quality personal accommodation and furnishings, and enhanced choices of recreational and communal spaces;
- food and meal services that offer a wide range of choice and enhanced enjoyment of the dining experience;
- variety and choice in lifestyle, recreational and personal services that are responsive to the changing interests and needs of residents;
- a culture of service.

Extra services does not mean that a higher standard of care is offered, or there are more staff allocated to extra services paying residents.

This article was written by an aged care staff member working for a very well-to-do nursing home – part of a chain. It provides an “insight” from their perspective into working in an “extra services” facility.

Results of Extra Service status Approval Rounds

[paulinek]

Hi Linda,

Your reply made me cry again! Just the sheer frustration of this whole system. After our experience of "extra services" I would advise people not to fall for it. It is all smoke and mirrors with absolutely no substance behind it. I once spoke to the Director of my mum's nursing home and she asked me how to spell haemorrhoid. I was appalled. How could you work in Aged Care and not know a simple, basic word that many elderly people, particularly those non-ambulant ones in high care, suffer. No preventative medicine practiced. My mum screamed in pain for months with faecal pain. She used to say that it felt like there was an army in her faeces, each one armed with a shard of glass cutting its way out. The staff thought my mother was a very funny person rather than realising that she was in terrible pain and ultimately developed a very painful haemorrhoid. When you are confined to bed for 18-20 hours per day, there should be preventative medicine provided to avoid developing a haemorrhoid. A member of staff told me that my mum was "really lucky" as she only had one. She told me I should see some of the bottoms at the nursing home, they had many, many haemorrhoids. It made me physically sick.

Rather than promises of additional services - ask for the proof of those services. I thought a private nursing home would be better than a public nursing home. The best carers ended up leaving. Staff who knew them told me they had gone down the road to the public Aged Care facility as they had better staff to patient ratios and the work was less stressful. With a high care patient, I now know - it is critical that the staff to patient ratios are high. There is no choice of food as it is too time consuming for staff to go through and work out the menu with my mum for the week. It only happened once when they gave me the paper work to fill in. I was never asked again.

It doesn't matter how fancy the carpet is or the furnishings, if you are constantly sitting in your own faeces and urine, unable to get help, to get a drink, with a television blaring at you - I am sure you would give up all the "luxury" and sit on bare boards if you could just be cared for in a humane way.

[Administrator]

I must admit, I am somewhat bemused when i read reports in the media (and of course, the aged care providers love pushing this - $$$) purporting that baby boomers expectations will be higher than ever - they will demand more choice, etc, etc.

Well - that may well be ok for people who may be healthy enough to enjoy "extra services". But i hardly see how baby boomers will be able to exercise their "higher expectations" or "demanding more choices" when they are confined to bed, perhaps suffered a stroke (or at the very least, has multiple gerentological based health issues) - lost the ability to speak, totally reliant on someone helping them toilet or totally dependent on pads and someone wiping their bottom, walk, etc. etc.

Instead of fancy carpet and furnishings, they'll probably be thinking more along the lines of ..... "... why aren't there enough staff members to respond to my buzzer.... I need someone to help me to toilet (or shower)... I need assistance with my meals (still not enough staff).... how come I'm restricted to 3 pad changes per day.... my teeth are really sore - when can i see a dentist...." and the list goes on.

Another way of looking at "extra services" - at least when your visitors arrive, they'll be able to appreciate all those lovely fancy carpets and furnishings!

[lipari]

Well my problem re Accommodation Bonds is somewhat different & hope that there is some avenue for a positive outcome. My mother went into low care in a facility just over 2 years ago & a bond figure was set and agreed upon with the facility. When the residential agreement had not arrrived 6 months later, I again queried this alongside the bond and was informed that it would be organised. Am still waiting?????
6 months ago, my mother needed to be placed in high care in the same facility. My issue has now become that due to the fact that there was no bond paid, I have now been advised by Centrelink that my mother will lose most of her pension (she still has her family home with a grandchild living there). I consider that the failure for not pursueing with the agreement/bond rests with the facility in question. What avenue or process is available in order for this to be persued further and my mother not lose her pension.