Mindfulways Case Studies

Mr Smith - 83 yr old widowed man who had a stroke and was in hospital. He suffered with dysphagia (loss of swallow) global aphasia (inability to speak)and was no longer able to transfer in and out of bed or walk. After many weeks in hospital it was decided that he would need 24 hour residential care.

Mr Smith's daughter contacted us as she was working long days and was under enormous stress and felt very sad regarding her Father's situation. We discussed her situation and explained our services and arranged to meet at the hospital for the initial meeting.

Living situation:
He rented a homes west unit with his only daughter. He had a sister in Northam. All of his friends had passed away. Finances: He was receiving the full aged pension (single - $883.30 fn) and he had $41,000.00 in a savings account. This meant that Mr Smith income was under the income threshold of $26,176.80 and savings /assets were under $47,500.00 which meant that he was considered a "Low means resident" and would only need to pay $49.07 basic daily care fee per day which amounts to 85% of his pension.

Legal:
He did not have an EPA (Enduring Power of Attorney)or EPG (Enduring Power of Guardian) in place.

Plan:
Firstly we notified Homes west that Mr Smith would be vacating his home and arranged for his daughter to liaise with Homes west. She would need to find other accommodation. Secondly since Mr Smith did not have an EPA or EPG in place an application to the State Administration Tribunal was necessary to ensure that Mr Smiths health and lifestyle along with financial needs were managed. His daughter was the applicant. They needed a medical report and a service provider (social worker report). This was necessary due to the fact that Mr Smith was not able to communicate his needs regarding his lifestyle or financial needs. Mr Smiths daughter was not able to access his bank accounts as she did not know his pin. This meant that she couldn't complete the Income and Assets Forms (SR554) that is submitted to Centerlink that everyone needs to complete (you can decline to complete and pay maximum payments to nursing homes) to find out how much money one needs to pay for accommodation.

ACAT:
Mr Smith had no previous aged care assessment. AGED CARE ASSESSMENT - SUPPORT PLAN) He required one of these to either enter residential care or go to TCP. The hospital arranged the acat to be completed whilst an inpatient. He was approved for residential care (doesn't expire), residential care respite (high) (doesn't expire)and TCP (expires 28 days).

Initial Meeting:
An initial meeting was held with Mr Smith and his daughter at the hospital to discuss his care needs. Mr Smiths daughter stated that she wanted her dad to go into a residential care facility close to where she was going to live in Manning or on her route to and from work in Welshpool.

She felt proximity was important as she worked and wanted to be able to visit as often as possible. We collected the following information: health/medical conditions and needs (secure - non-secure residential care), functional abilities, equipment needs, interests and hobbies, any available financial details (centerlink numbers, medicare details, religious and cultural needs, dietary needs, allied health (speech, physio, and OT needs).

Outcome:
After this meeting we provided a list of 4 recommended residential care places and organised times for Mr Smiths daughter to visit. We then lodged the applications to the preferred residences. We continued to follow-up vacancies and when one was available we notified the family. Mr Smith had been transferred to TCP when the room became available. Average wait time in TCP is between 6 and 7 weeks on average. We contacted the TCP facility and arranged for transport at a suitable time.

Mrs Jones was a 78 year old lady who was living at home with her husband. They owned there own home. Mr Jones was Mrs Jones carer due to dementia which she was diagnosed with 6 years ago. They had one child who lived overseas.

Mrs Jones had recently become increasingly confused in the afternoons. She was agitated and hallucinating. She believed that her husband was trying to kill her and often tried to leave the home and run down the street calling out. She had been reviewed by a Geriatrician. Mr Jones could no longer provide a safe environment for his wife int he home and due to his own health conditions was not able to continue to care for her at home. Mr Jones GP had referred Mrs Jones for an aged care assessment (ACAT) and he did know how long it would be before they could complete the assessment.

Finances:
Mr and Mrs Jones were on a combined aged pension. They owned there own home valued at $780,000. They had $14,000.00 in the bank. Initial telephone call: Mr Jones was extremely upset and felt that he could not care for his wife safely and wanted some immediate options. I suggested possible urgent respite in residential care whilst waiting on the acat assessment so that he could find a suitable residential care facility.

Even though he did not have approvals for residential care respite from the acat as yet, Mrs Jones was able to access urgent respite immediately. I found a secure residential care facility close to Mr Jones home and we arranged for Mr Jones to take her to the residential care facility.

ACAT:
We notified the local ACAT team that she required an urgent acat (which is within 7 days of entering respite). The ACAT met Mr Jones at the facility and completed an acat. She was approved for Residential care and Residential respite (high care). I met Mr Jones and we completed our initial assessment where we gathered all necessary information.

Financial considerations:
Assets and Income forms were completed with our help and sent to Centerlink. Mr Jones would be able to stay in his own home and this was not counted as an asset as he is a protected person. We advised Mr Jones to contact Centerlink and arrange for separate pensions due to illness (separated due to illness). Mrs Jones would be eligible to receive a consessional bed in residential care.

Outcome:
We found 5 residential care facilities that Mr Jones could afford (paying 85% of the pension - $49.07 - per day). Mr Jones visited the care homes and I completed with all of the paperwork. We liaised with the care homes on a regular basis and when a bed was available in a secure care home we arranged for transport.

Mr Williams is a 95 year old gentleman who was living alone in his own home. He had become ill with cardiac failure, he had poor sight and hearing and was a very high falls risk. He did not want to leave his home but was not coping with a Home care Package 4 visiting twice a day. He was barely getting out of bed and was at risk of getting pressure area sores.

His son called and we discussed Mr Williams needs. We completed the initial assessment at Mr Williams home with his son. We gathered all of the necessary information for admission and we advised the family to speak to a financial advisor about the home. They had a couple of options.

Sell the home and pay a RAD
Finances:
Own home: Valued at $780,000 (No protected person living in the home) so this is included in the Assets and Income Form. The home is capped at $162,815.20. He is receiving the full aged pension and had assets valued at 120,000.00.

Income Test:
Total assessable income is Pension is $23,254.00 and the income Free area is $26,327.60 this means Mr Williams does pay an income tested amount. We did some basic calculation : Mr Williams is single Income estimate: $26,401.00 p.a. This includes $3,147.00 as deemed income from your financial assets

Net asset estimate: $282,815.20 This includes the value of your home capped at $162,815.20 Mr Williams is required to pay the Basic Daily care Fee = $49.42 plus a means tested care fee of $3.39 per day. He can choose himself what he can afford in regards to paying the Refundable Accommodation Deposit. He chose to sell his home and pay the $450,000.00 RAD in full along with the basic daily fee and his means tested care fee.