Thank you Matthew ( Prof Tonts )                                                               

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I am here today to share with you  my experience both as a worker in the aged care field and a daughter of aging parents. I am in no way an expert in this area and do not profess to have all the answers. Many of my comments will be of a personal nature and from my observations.Through out my talk I will make reference to parent or parents, but this is a also applicable for partners or other elderly or frail loved ones

Judging ( looking around ) from the audience here today I would guess that a number of you are in the Sandwich generation
 
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That is, you have dependent children and you are involved in the care of your parents (cooking, cleaning, taking them to appointments , etc etc) hence you are in the middle. I am one of these,  I have 2 daughters at uni and 1 still at school and I am very involved in the care of my 88 yo father, who still lives at home.


So what should we do when we see that our  parents  need more care?  I will try to take you through, step by step what you might do to access help. There are numerous services to assist a person to live independently at home. Remember this option is the cheapest one for the government as it is cheaper to keep a person at home than  in an aged care facility. Despite what we may think it is only a minority of older people who live in an aged care facility.                                                      
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You could start by accessing a HACC  service. This is only a phone call and is self  referral to the Commonwealth Respite  and Carelink  Centre 1800 652  222. This can help with social support, domestic assistance or personal care. Unfortunately these are few in number .However often our parents need more help or you need to start thinking about some form of care.                           
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This is were I see the biggest  mistake. We don't do this early enough and it means we may find our selves in a crisis  situation. I hear time and time again. " Oh no Mum is not ready yet " However there are many services out in the community that are available and designed to keep our parents at home for longer. It seems to me that people think that there is only one step from home to care, this could not be further from the truth.
                   
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The first thing to do is visit the GP and ask / suggest for an A.C.A.T. ( aged Care Assessment Team) assessment. ( remember that not all GP's are necessarily familiar with this system and you may need to convince them that your parent does  need  more help because the person the GP sees  may be quite different to the one you know. This should  mean that they visit in approx 1 week. you will be seen by either a social worker, a nurse, or an occupational therapist In follow up visits a geriatrician might be involved. When  the  meeting takes  place make sure you are there, so that the assessor gets an accurate picture of what the  real needs are. Otherwise when asked do you need help with meal prep, washing you or your clothes, or housework, they will answer that all is fine.                                                       
They will complete an A.C.C.R ( aged care client record )
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The ACAT assessor will do a mini mental test, assess depression  and assess needs of ADLs  including domestic help, medication, cooking, shopping needs.
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They will then make one of the following recommendations
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 If your parent is managing their  medicines and doing all their own ADLs,( safely ) and still driving the recommendation may be to do nothing, or at least try and direct them to a senior citizen  centre, to reduce social isolation.
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However, in many cases a  recommendation to either low level or high level care may be made. Once you have this ACAT completed and recommendation  made , you will be given this package and believe me it will take you some time to complete as it requires all property to be valued, it is then  sent to Center Link . The ACAT  does allow you to put your parents name down at a facility of your choice. When a place becomes  available you will get a phone call. Some facilities will ring you to see if you still  need the name on the list others only keep the name in for 6 months, so find out and if need, keep  ringing. RACF's must have so many concessional people and so having a name at the top of the list may not mean you get in next.
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A recommendation to a low level of care   also allows you to access a Community Aged Care package. This is up to 6 hours a week of help, 24 hours a day, 7 days a week, in the home.It can include, laundry, dressing, transport, showering, cleaning, cooking, shopping. This is the step that I see missing so often. This package is  means tested and well subsidized  by the government. It means that when you visit your parent, you can spend quality time with them and go to coffee or  a movie or picnic, because you are not visiting and finding yourself scrubbing the shower
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Or the recommendation may be for a high level of care and this means you are eligible for an  Extended Aged Care at Home. ( EACH ) this is up to 20 hours a week of help.

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Or it may be that respite is agreed upon. This can be hard to get and needs to be planned if the main carer goes away each year and the other partner goes into respite. There is also emergency respite which is any where and  available when one  member  may suddenly go into hospital or become unwell and this is often seen, where couples have co dependency. This can happen within 24 hours.
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So you can see why it is quite a  process and we need to avoid the crisis  management of  home to care with no steps in between. The CACP allows your parent to stay home longer and may even avoid the NOT inevitable transition to residential care.
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The best reference for all of this confusing and what seems cumbersome process is page 5 in the Business of the White Pages phone directory and there are lots of phone  numbers and  web sites to work through.  And www.agedcareguide.com.au this is also available as a booklet.
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So how do you judge a RACF???? I don't know and do not believe it is possible, so I think you   need to look at your proximity to visit and also that of special friends. New and flash is not directly proportional to quality of care. I asked some of  my colleagues  this ( those  work with in Aged care)  and they all found it difficult. One  person related the story of her grandmother, who when her Dad looked at a place for care, it was shared  rooms and  he said no, however that is were her  grandmother went and in fact this was blessing for her and prevented that social isolation that can happen in institutions. Ask about bond or no bond or concession , this is well outside the scope of this talk but must be looked at.  You may hear the term Aging in place. Like so  many things  today it sounds nice, it is where a resident comes into care and they stay in that room until they leave the facility. That is seldom the case as  if  they start in low care and their needs become greater , then they  may need to go to a  nursing home and that is not the same room, or when the need for higher care occurs there is no bed in the higher care area, they may need to find alternative care facility.


I would now like to  mention a few things that are available in the community to help us keep healthy and possibly stay out of a RACF. I assume you all know 30 minutes of exercise, keep fit, eat less fat and drink less alcohol ,but I want to look at something different, WHY do   people go to a RACF?  Often after a fall. I have read a statistic that of  people over 70 who fall, a significant % will not return to their place of residence.  Falling is not a part of aging.  This a preventable situation, which is  why there is a  government funded council called Injury Control Council of WA of which falls prevention or the Stay on your feet program is huge component. It   is predicted  that falls will cost the WA health System $174 million in 2021.
So what can we do to prevent falls ? The SOYF WA  campaign has come up with the following 9 steps to stay on your feet.
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SOYF has also set up what is called Mall Walking          
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Tai Chi   has been found to be good at preventing falls and is good as it is done in a group setting. I do Tai Chi and some of the ladies I do it with are in their 90's             SLIDE 18
Council Of The Aging COTA also run exercises in local gymnasiums this involves quite significant weights and there is some interesting research coming out of ECU suggesting heavy weights are the way to go with older adults and in fact there is a suggestion that this may help slow down Alzhieimers.
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Another area we may be able to prevent/slow down is demebtia.Dementia is the biggest cause of disability in people over 65 and  1000 new cases of dementia are diagnosed each week in Australia .The scarey figures are 1 in 15 people over 65 and 1 in 4 over 84 are affected by Alzheimers, the most common form of dementia. In preparing this talk I found that it was first identified in 1906 by yes Dr Alzhiemer. So we will be seeing a lot more about this very nasty condition as more baby boomers reach the over 70's. I would say it seems like every week there is almost a new  piece of research in the media,  about this condition. And sadly the age at which it is first diagnosed  is getting younger.It has been seen in the 40's
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The other reason that may cause a person to go to care is incontinence. There is not the scope to talk about this today, as  it is an area which I could talk about for hours but it is something we pretend doesn't happen.It  should not be assumed that incontinence  goes hand in hand with aging. There are things to do about this and those things are called pelvic floor exercise. But why this causes people to go to care , is because they get up during the night, or even during the day they cannot  hold on, so they race to the toilet and may fall. With often serious consequences.
There are heaps of activities to do to keep active in our senior years and here are 2 papers that are dedicated only to older Australians. This one upsets me as it is for people over 45 and I qualified for this years ago and this is put out by the seniors recreation council
of WA
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So my take home message Keep active, do your pelvic floor exercises and avoid crisis management for care of your loved ones, start the processs early and  be proactive.
Thank you