Legal Notice

Please Read Eldernet's Disclaimer and Terms & Conditions Carefully Before Using This Site

Many service providers and a small number of other agreed parties enter and update their own information about their service. Eldernet is therefore a vehicle for their information and is not responsible for their content. These persons have been advised that by entering data onto the Eldernet site Eldernet Ltd understand that they agree to comply with relevant New Zealand standards, ethics and legislation eg Fair Trading Act 1986 and Privacy Act 1993 etc.

Eldernet Ltd make a conscientious effort to ensure that the information on this site is accurate and up to date, however we, or our agents, cannot accept liability for any omissions, errors or action taken on the basis of information contained on the site. The material on this site is intended for general information purposes only. It is not intended to replace information given to you by a health or other professional. Eldernet Ltd encourage you at all times, when seeking specific advice, to consult a professional in that field.

Eldernet also contains a large number of links to third party sites that in the opinion of Eldernet may provide information of interest to our users. However such information cannot be guaranteed to be accurate or up to date. We have very limited knowledge about the content of these sites, cannot give you any assurances about their information and take no responsibility for it. We ask you to exercise your judgment.

PLEASE NOTE – The information on this part of the site is specifically designed for those over 65 years of age or those who have an age related condition.

• More extensive information Each facility that has listed with ElderNet has provided us with standardised information. From this information a database has been designed that enables people to select features, facilities and services that are important to them. This has the potential to link the person to the facility that is most appropriate to their needs. To obtain the equivalent information in traditional printed material would be almost impossible.

• Ability to ‘view’ a large range of facilities Many people have told us that they would like to personally visit every facility in their locality, but realise that practically speaking, this is not possible. This Internet site is the next best thing to visiting each facility personally. By using this site people can browse and obtain information about any residential facilities listed on the site without moving from the computer or leaving the room. We have endeavoured to show the name address and telephone number of every residential facility in New Zealand. A number of the facilities that have listed with ElderNet (ie given us comprehensive information) have provided photographs so the visitors to the site can see the premises and personnel etc for themselves.

• Ability for others to be involved in decision making Often family members/significant others, are invited to and wish to be involved in the decision making process. It has previously been very difficult and expensive for these people who live away from the area, especially those overseas, to be involved to any great extent. This facility now means that they can be more included. If selecting a residential care facility they can also help in viewing and selecting an appropriately matched facility.

• Mr T has had some time to anticipate the move into residential care but has some reluctance to do anything about it. (A recent assessment shows he is eligible for residential care.) He has been finding it hard to manage at home even with formal home support services. His friends have either died or moved away. Other social supports have fallen away too and he has become quite isolated. He has numerous falls. His children who live in other parts of the country worry about him. He won’t go and live with any of them. Things are coming to a ‘head’.
• Miss D is typical of those who experience a sudden change in their circumstances or health. She had previously been very active and fit prior to her sudden severe and disabling stroke. She had never entertained the idea of residential care. She has no family.
• Mrs G who has a major disability, relied upon the significant support and care provided by her husband and formal support services. He died suddenly leaving her few options other than going into residential care.
• For a long time Mrs K has thought about and planned for life in a residential care facility. She has gathered quite a lot of information about residential care over the years and having used ‘short stay’ options in the past knows what to expect. She is eligible for residential care and now thinks the time has come to make the move. She’s looking forward to the companionship and support offered in a rest home and the freedom from the worry of maintaining her house in the suburbs.
• Mr B has dementia. His family can no longer care for him at home. His behaviour has become more difficult to manage. He wanders away from home and quickly gets ‘lost’ and becomes aggressive whenever any one tries to guide or help him. Family members are ‘stressed’. His assessment has established that he requires more specialised care than is possible in his community. (See also: I have been told that my relative requires Dementia Care. What does this mean?) Note: If someone has dementia it doesn’t automatically mean that they require residential care. If they are eligible for residential care this will be established following a specialised assessment. The assessment will also indicate whether secure dementia care is needed (as opposed to general rest home care).

Very occasionally some people require care for security and loss reasons. These people may, for example have suffered a trauma e.g. home invasion and feel unable to continue living alone.

Updated 14-01-09

It is important not to loose sight of the fact that the older person is central to this decision. Their best interests and what they want to happen should be a high priority. This consideration can get ‘buried’ by other things, particularly if there are many competing concerns such as family members feeling ‘stressed’. Competing demands and stress, especially if they are not spoken about or acknowledged, are an invitation to misunderstanding and conflict. Careful and sensitive consideration of all the issues will help all concerned work their way through the situation.

The following questions are useful in helping people think through the issues:

1. How can we sensitively discuss this?

2. What are the older person’s rights?

3. What expectations does the older person have?

4. What obstacles are there to these expectations?

5. What happens if we can’t agree?

6. If the older person is going to go into residential care who decides where?

1. How can we sensitively discuss this?

These tips may be helpful:

• Constructive discussion needs your goodwill.
• Make plenty of time for the discussion.
• Listen for longer than you talk.
• Listen without judging.
• Let everyone have his or her say.
• Do not interrupt. Unfinished sentences can easily lead to misunderstandings.
• Have a positive attitude.
• Be prepared to compromise. Sometimes the best solutions are those no-one had thought of beforehand.

2. What are the older person’s rights?

This is a good question to ask because the answer is often quite enlightening for families. Knowledge of the older person’s rights creates an environment where decisions can be made with greater sensitivity and awareness.

The Health and Disabilities Commissioner (Code of Health and Disability Services Consumers’ Rights) Regulations 1996 (SR 1996/78) (as at 03 September 2007) clearly lays out these rights in Right 7. The following sub clauses state:

“1. Services may be provided to a consumer only if that consumer makes an informed choice and gives informed consent, except where any enactment, or the common law, or any other provision of this Code provides otherwise.

2. Every consumer must be presumed competent to make an informed choice and give informed consent, unless there are reasonable grounds for believing that the consumer is not competent.

7. Every consumer has the right to refuse services and to withdraw consent to services.”

(Note: The test of competency is high. “A person can be competent even if they are under the Mental Health (Compulsory Assessment and Treatment) Act 1992 (MH Act). Compulsory treatment does not make people legally incompetent." See Mental Health Commission website . The law is very clear about the issue of competency and if there is serious reason to doubt a person’s competency this should be discussed with a doctor.)

Sub clause 1 (above) requires that the older person gives “informed consent”. Informed consent under the Health and Disability Code is a process that requires effective communication between all parties (Right 5) and the provision of all necessary information to the consumer, including information about options, risks and benefits (Right 6).

The important areas for consideration are therefore the older person’s freedom of choice and informed consent, the presumption that they are competent to make their own decisions and the weighing up of family concerns.

Families sometimes find it difficult observing their older relative living in what they believe is an unsatisfactory or unsafe situation. The choice that some older people make to remain at home despite the acknowledged risks may well put them ‘at odds’ with their family. The reality is however, the majority of older people want to preserve family harmony and they often ‘go along’ with what the family (or a family member) want and will subvert their own desires in order to achieve this. Families need to be aware of these dynamics and mindful of the ‘shift of power’ that occurs in such events. Where there are difficult issues to work through, strongly diverging opinions or concerns about safety a health professional such as a social worker should be involved.

3. What expectation does the older person have?

Expectations are as varied as the people involved or the social groups in which they live. For example, some older people have an expectation that they will be supported/cared for by family members. Harmony is maintained if this expectation is matched by a similar understanding of the family.

Then again the older person may have few expectations of their family. They may clearly see their future as being theirs alone to control. For example, recent evidence shows that older people are increasingly more likely to see their retirement savings or assets as being ‘their own’ to be used to meet their own needs and not for the ‘inheritance’ of their families. Many families are understanding and supportive of this rationale and don’t expect to receive an ‘inheritance’.

Sometimes however there is a mismatch between expectations of the older person and their family. A common mismatch is where the older person would like their family to care for them but the family is unable to do so. If support is not forthcoming it is sometimes seen as ‘rejection’ or a ‘lack of family commitment’. It’s easy to explain this as just a further ‘break down’ in modern society but there are a number of factors that need to be more carefully considered and understood.

4. What obstacles are there to these expectations?

Pressures on families today are quite different to those experienced by the previous generation. These significant differences often impact on families’ ability to provide care and support. They include:

• the long distances separating many families
• the increase in sole parenting
• remarriage and associated reconstituted family pressures and commitments
• casualisation of work and irregular working hours
• the need for both partners to find paid work in order to provide an adequate income
• the need for those in the paid work force to work towards their own retirement savings
• an often longer working life in ‘paid employment’
• middle aged children helping care for and support their own younger family members, eg raising grandchildren

No two circumstances are the same. There will be issues unique to your own situation. Older people and their families therefore need to be very clear about:

• what they do and do not expect
• what the obstacles are to having their expectations met
• what they can and can not realistically do to meet the expectations

Expectations that are ‘out in the open’ are much easier to deal with than those that are hidden.

5. What happens if we can’t agree?

By following the above process the family should have a better understanding of each person’s perspective and the obstacles they collectively face as a family. Compromise by family members will be necessary where agreement can’t be reached. Assuming that goodwill is present, the amount of compromise may need to be proportional to the amount of help that the individual can give i.e. if you can’t give much support should your expectations have the highest priority?

Consider the following situation: A 91 year old man who requires significant support may need to consider residential care. He would prefer to stay at home if possible. His daughter who lives nearby provides the most ‘hands on’ care but she is exhausted. The daughter who lives in another city thinks her father should be able to stay at home. His son who is very busy with ‘on call’ work and less available to help, reluctantly thinks his father should 'go into care'. All formal support services have been utilised in the past. The solution is not easy.

• Are any of the children willing/able to change their own situation e.g. live closer to their father, have their father come to live with them, change their job?
• Is there a possibility of engaging further help at home e.g. private care?
• What realistically can each member do?
• How can family avoid pressurising individual members?
• Can individuals agree to differ and yet support the final decision?

Hopefully a better understanding of the issues and other people's perspectives will make the acceptance of the final decision easier.

If you can’t work this issue through ask for a referral to a social worker. They are located in all areas of the country. An independent person can help you work though the issues more easily and arrive at a decision that everyone is more understanding of and satisfied with.

6. If the older person is going to go into residential care who decides where?

Ideally the older person should make the decision themselves, however if a persons ability to make a selection of residential facility is affected in any way e.g. by poor health, they will understandably be more dependent on others to help them make a choice. This is a big responsibility for those who assist. To make things more difficult there is often only a short time in which to make a choice. How you make the decision is just as important as who makes it.

A sense of powerlessness results when people feel that they have no input into decision making. Involve the older person in the decision making process as much as possible.

When it comes to choosing a residence it is important to avoid choosing a place that the helper would like ‘for themselves’ or one that they think would be ‘good for’ the other person. The most helpful way someone can assist is to try to choose a place that the person themselves might choose. One way that this can be done is to identify the things that are important to the older person, prioritise these; then find a facility that is most suited. (The Eldernet search function may be useful for this. Similarly you could email the facilities you are considering with your prioritised list and see what response you get.) A social worker or service coordinator has skill in this area. They can help you identify the things that you need to consider and that are specific to your situation.

A good idea is for family members to check out as many facilities as is possible/necessary, narrow this down to 2-3 ‘finalists’ and if possible encourage the older person to make their choice from this list. This way the final choice is still theirs.

Remember too that if residential care is decided upon and if the first choice of facility is not what you had expected (bearing in mind that it takes a reasonable time to settle in and assess this) then a change can be made. Your service co-ordinator must be notified so that they can make the necessary procedural arrangements.

Finally, once a decision has been made keep the channels of communication open by reviewing things on a regular basis.

Updated 15-01-09

The majority of the obstacles sadly stem from other people's misconceptions, prejudices, disapproval and lack of knowledge. This combined with the possible logistics and the fact that the home is a place shared with others makes the ability to engage in an intimate relationship even more difficult.

Other people

In the residential care setting you are obliged to live at close proximity with others. The human dynamics around you will impact on you much more than they would have in the wider community. Possible things you may have to contend with range from the lack of knowledge around this subject by staff (and others), the 'sensibilities' of your own family/families, through to the issue of dementia.

Many people find it difficult to talk about the sexuality of older people. They are often shocked at the thought of older people having a sexual relationship; others may feel awkward or express a judgmental attitude. You may even remember feeling that way yourself. It is not uncommon either for a staff member to discourage a blossoming relationship because they lack the skill to know how to handle it properly. Poor management of such situations can be demoralizing for residents. Older people like to be 'fancied' too. "When allowed to engage in relationships with others, these positive experiences enable (d) them to feel joyful, special, loved and attractive again ." (Promoting awareness of sexuality of older people in residential care. Lisa Low et al)

Managers of residential care facilities are now more aware of these issues. In fact resident's rights to intimacy are a component of staff training. While staff are trained to be mindful of their own values, culture and customs and not to impose those on residents, the reality is that some people struggle with this.

Family sensibilities can be another issue. It's one thing if mum and dad want to have sex at the rest home but it seems to be another thing if the person 'in care' forms a new relationship and wants to have sex with someone else. The reaction is not always positive. Families can feel rejected, threatened, distressed and in some instances concerned about remarriage and inheritance issues. Over time, particularly if their parent is single, most families are generally very supportive and pleased. They find it comforting that there is someone else nearby who is important in their parent's life.

Dementia brings its own set of issues when it comes to sexuality. "People with dementia continue to need caring, safe relationships and touch. However, they will vary in their individual ways of giving and receiving affection, and the way in which their dementia affects that capacity. As a result of the disease, some people with dementia may become demanding and insensitive to the needs of others, and less able to provide caring support for their family and partners. They may also experience changes in their expression of sexuality. Some people continue to desire sexual contact while others may lose interest in sexual activity. Others may display inappropriate sexual behaviours."  (Disability online - www.disability.vic.gov.au

Staff in dementia care facilities are generally used to residents forming relationships; often platonic but sometimes more intimate. Occasionally the person with dementia will form a relationship with another resident, to the initial consternation of their partner (if they have one). There are a number of reasons why this occurs but most commonly it is due to mistaken identity, seeking physical closeness or needing relief from sexual tension. Staff will be understanding about this situation and in many instances will have the skill to be able to work this through with the individuals or family concerned. If they don't we suggest you contact Alzheimers New Zealand, an excellent source for support and somewhere you can safely debrief.

It goes without saying that staff/resident relationships are not permitted. A professional distance should be maintained at all times between staff and residents.

Privacy

It is not always easy to ensure the degree of privacy that one would wish for in a residential care facility. You probably require assistance by staff for your activities of daily living and this means that, by necessity they will come and go from your room frequently. They also need to have easy access to your room in the event of an accident, emergency etc.

There are a number of things that can be done to increase the sense of privacy. Staff know that they should knock and wait to be invited into your room before entering. Ask them to do this and insist (in as nice a way as possible) that all staff adhere to this at all times. Senior staff can help by reinforcing this and talking quietly with their colleagues. A 'Please do not disturb' sign on the door is another possibility. Put this up whenever you want a quiet time. Everyone therefore gets used to the idea that you want uninterrupted time for a variety of reasons. Discuss other options with senior staff.

Occasionally other residents may inadvertently come into your room. If there are residents who bother you in this way talk quietly to management about possible solutions.

Double beds

Of course while a double bed isn't essential for the enjoyment of intimacy for some couples it is quite important. Occasionally facilities are able to accommodate the request to bring in a double bed. The room needs to be big enough to provide sufficient free space around the bed for staff to carry out their tasks in safety. It is also needs to be said that it is more difficulty for the staff to provide nursing care to someone in a double bed.

Consent

A loving relationship is enjoyable to both parties and it is usually evident to others in body language and a multitude of other ways. The distress of one party is also usually quite evident. Staff will intervene in any situation if they suspect it is not consensual or is causing distress to one of the parties.

If you as a resident are beginning a new intimate relationship it is vital to ensure that the other person involved is agreeable to this. If your partner is in a dementia care facility, recognizes you as the partner, is able to say no to you if they want to, and is enjoying physical intimacy with you then it is not likely to cause concern to health professionals or staff. Consent can be a tricky issue particularly where dementia is concerned. If you have doubts yourself check it out with your doctor. See also the article "Sexual exploitation is not condoned by Alzheimers New Zealand."  (Alzheimers New Zealand)

As there are vulnerable people in residential care anyone considered to have knowingly taken advantage of another person will face the consequences of their actions just as they would in the wider community.

Sexual Health

Older people are not immune to sexually transmitted infections. Usual precautions should be taken.

Viagra has played a part by raising the profile of the sexuality of older people. If you have concerns about sexual performance or other issues pertaining to sexual health please see your doctor.

Finally

The point to remember is if you live in a residential care facility it is your home and despite the restrictions imposed by your own health and the shared living environment, you need to be able to continue your lifestyle as freely as possible (as long as it does not infringe on the rights of others). Choose a home that will respect this and help you achieve your goals.

See also:

Coming out coming in. How do dominant discourses around aged care facilities take into account the identity and needs of ageing lesbians?

A Resource Guide from the American Psychology Association

Updated 14-01-09

This is a complex question as every situation varies. There are many aspects to consider such as:

• Do you pay privately for all your services? (If you do and you have a ‘care contract’ and the proprietor is confident that the required level of care can be safely delivered to you in your unit then you are likely to be able to stay there.)
• If you are paying privately how long will your funds last? (Do you know what your options are when your funds run out?)
• Does the village offer care packages? (If they don’t, you may have to move.)
• Does your DHB provide a high care level ‘home help programme’ to people at home (i.e. you in your unit)? (If they do, and you qualify, does your village contract permit other providers to come in to your unit and deliver this service? Are there other considerations or obstacles?)
• Do you require a residential care subsidy? (If so, in what [if any] situations does the District Health Board and the village proprietor allow a subsidised resident to remain in their unit?) See The Ministry of Health website ‘What is a Licence to Occupy’ and the response to the question below.
• Do you have a partner living with you? (If you do then other criteria need to be considered.)

Even if you think your situation is clear cut it is advisable to obtain:

• written information relevant to your situation from the proprietor
• professional advice from your lawyer
• advice from Work and Income

Updated 17-09-09

Assessment process

The assessment is usually undertaken by one person although it should be done in consultation with other health professionals. During the assessment the assessor will consult with you (and with your consent, your family/whanau). Lots of questions will be asked and at some stage you may be seen by a doctor or other health professionals such as physiotherapist or occupational therapist. On completion of the assessment, the outcome will be discussed with you (and your family/whanau if you agree) and a support plan (often including the goals you have identified) put into place. (If the assessment indicates that you need support services then someone who has skills in service coordination may also be contacted to help to arrange these.) You will be given a copy of the assessment which will also show the type and level of any support that you may require.

During the process if you don’t feel that your real concerns and issues are being addressed, say so. There is provision for a review if you request this.

An assessment may occur on referral (when the need for medical or other input may be identified), following specialist advice and treatment of medical conditions or following rehabilitation. It can be conducted at your home or another domestic/community setting and sometimes in a health facility e.g. the hospital following an inpatient stay.

Assessment services are free to New Zealand residents.

How to obtain an assessment

You can contact your local service yourself, or you can ask your doctor to refer you. Your initial contact is considered, prioritised and then passed on to the relevant part of the service. You should be notified if you are placed on a waiting list. If you have referred yourself your doctor may be contacted for further information. If you phone these services yourself and get an answer phone, leave a message giving your name and phone number and someone will get back to you.

Benefits of having an assessment

• You will be put in touch with people who have considerable expertise in this field. Their knowledge is valuable.
• There will be a coordinated team approach (i.e. comprising of doctors, physiotherapists, occupational therapists, social workers etc) to identify the issues that might impact on your ability to be as independent as possible.
• You will have access to specialist advice as required (as above)
• You may have access to a rehabilitation programme
• If you want to access any subsidised services you must be assessed as requiring these. You will be advised as to whether you meet eligibility criteria

Note: If you are not eligible for subsidised support services you may purchase them yourself.

Assessment and residential care

In the past people were often encouraged to enter residential facilities long before care or support was really needed; the death of a spouse being a common trigger. Understandably many of these folk lived to a good old age so that when they eventually ran out of their own money they required a government subsidy (sometimes without requiring the corresponding care). Not only did this arrangement deprive many of these people of their independence, it was also not cost effective for them or the government.

Nowadays things have changed. With advances in health care and technology people are living longer. Treatment and rehabilitation successes are also better. People are now able to stay in their own homes and receive care and support there. Even the services that residential facilities now provide have changed in that they give much more intensive care than they did in the past.

Access to residential care is now more closely monitored and the threshold to entry is high. Health policy states that unless someone has been assessed as requiring residential care then the Government will not guarantee the granting of a subsidy if they exhaust their own funds. In practical terms, this means that people no longer have the freedom to enter a residential facility whenever they choose. Appropriateness and eligibility are now determined by the assessment.

Generally managers of residential facilities will not agree to admit someone prior to assessment. If they do admit private paying people they are required to inform them of the health authority’s policy regarding this situation.

If your relative/older person has been assessed as requiring this care it is important to choose a facility where you can see that:

• the residents dignity is upheld
• the staff have a genuine concern for the residents and an interest in this specialised work
• there is a high staff to patient ratio
• there is a comprehensive programme of motivational/diversional therapy
• you are also supported

It is important to ask about policy for managing difficult behaviour eg ‘Calming and Restraint Policy’. There are a number of different options and strategies that avoid medication and/or physical restraint.

Visiting can be a stressful time especially if you do not understand the condition. Seek support for yourself. A supportive dementia care facility will give you some helpful ideas about how you can make visits easier for you and your loved one. For example:

• keep the visits short
• use photographs or other mementos to remember special times
• play favourite music
• choose a time of day to visit when the person is more settled (staff can often advise you)
• avoid questions (silence is ok)

We suggest that you contact the Alzheimers New Zealand where you can access a large range of information, support and resources.

1) ) Use Eldernet to find information about a large number of services
Each residential care facility provides their own information which they usually describe in their own words. By carefully reading this you can begin to identify points of difference between services.

2) Use appropriate professionals and significant others to help you
Discuss your options with those who know your needs and wishes e.g. a social worker, service co-ordinator, family, friends etc. Remember the final decision is yours.

3) Identify the things that are important to you

• proximity to family (If you move away from your home area to be closer to family will they be able to visit more frequently? Be realistic.)
• proximity to your church or other important place of faith (Can you continue to practice your faith?)
• proximity to well known friends and places
• ability to maintain your lifestyle (including previous associations with clubs and groups)
• the visual appeal of the site
• other onsite services
• staffing levels
• dynamics within the facility
• accountability systems of the facility e.g. are they a member of a professional association?

4) Evaluate and prioritise the different factors
It may even be helpful to number the factors according to important they are. How important is the ease for visitors, the physical surroundings, the dynamics between staff and residents, proximity to other services etc (See the CHECKLIST)

5) Narrow down the field in which to begin the search
You may decide that you can afford to search over a wide area and may therefore look at every facility in a region. However you may choose to narrow the field according to the priorities that you have identified. The search function on the Eldernet website is useful.

6) Identify potential residences
The information from Eldernet will give you basic, standardised information on all listed facilities and more extensive information from those who have provided it. Select the facilities that most match your requirements. As with most decisions it is advisable to have at least two or more options. It is important to ensure that the facilities that you are interested in have a contract with the health funders (usually the District Health Board). If you should qualify for a subsidy at any time it is this funder that is responsible and you will only be able to reside in a contracted facility. (Most residential care facilities are contracted.)

7) Visit the facilities
Make an appointment to view each facility in the first instance. That way you can be assured of being given focused attention. It is advisable to set aside at least one hour for the first visit. There is only a limited amount of new information one can absorb at any one time. If time permits it may be preferable to visit different facilities on different days. Do not be afraid of visiting more than once; in fact it is often a good idea to visit at evenings or weekends too. People often visit a house more than once before purchasing! This is no different. Be observant; take notice of your intuition. Do you like the feeling of the place? Watch and listen to people interacting; would you feel at home there?

Take advantage of any offers of hospitality e.g. cup of tea or meal offer. It is at times like this that people talk more freely. As you will often be seated in a semi public area it gives you the opportunity to closely observe and to get a more accurate impression of the facility.

8) Ask questions
You have a right to good and appropriate care so you need to ask questions to determine the suitability of each service for you. Ask questions of the staff, residents and some visitors. This will give you a good overall impression of how the service operates.

9) Make an unannounced visit
Are you treated differently?

10) If you feel you have made your choice, request a trial period
Managers will often offer you a trial period and you are entitled to ask for this. A useful period is usually about one month and during this time you can get some idea about how well you may ‘fit in' with the place. Usual fees generally apply although you may be offered a trial period at a ‘special rate’. You are of course under no obligation at any time to remain in the facility. If you are clear from the beginning that this is ‘a trial’ then by being more explicit you will feel less obligated to stay.

11) Begin to make your new place your home
Give yourself time to adjust. It takes time to orientate yourself to your new surroundings, to feel comfortable and to begin making new friends.

12) You do not have to stay if you feel you have made the wrong choice
It may be that for a variety of reasons the residential facility is just ‘not you’, and you wish to move on. Contact your service coordinator who will ensure that the correct procedures and paperwork are attended to. They will also discuss any other issues you wish to raise. (If you have any serious issues such as concerns about the care being delivered, please let the service coordinator know).

All residential facilities should have a complaints procedure and many of them give a copy of this to prospective residents. The complaints form should also be freely available for you to pick up from a designated area in the facility eg by the office, front door or lounge entrance.

It is not easy to make a complaint, especially if you feel in a less powerful position than those whom you wish to complain about. Sometimes it feels easier just to ‘let things be’ and do nothing about it. Unsatisfactory situations are more likely to be addressed, however, if appropriate people know about them. Discuss this with your service coordinator/NASC, social worker or advocate if possible so that you can decide what the best course of action is. It is a role of social workers and advocates to support you or to act on your behalf if you request this. Complaints, which are channelled through to the Health and Disability Commissioner , are reviewed to determine the most appropriate course of action.  This may include a referral to another body (eg. MOH), use of advocacy, investigation or no action.  Reports of investigation findings may be published on the Health and Disability Commissioner’s website.

The Health and Disability Advocacy Service is a consumer advocacy service for all users of health and disability services.  Independent health and disability advocates are located all over New Zealand.  Their role is to :

• inform consumers about their rights when using health and disability services

• assist consumers who have concerns and want to make a complaint

• offer education and training about consumer rights and provider duties to the providers of health and disability services.

The service is free, independent and confidential.  Free phone 0800 555 050 or email .  Alternatively contact your local office.

There are a number of aspects to this question:

• The Maximum Contribution
• Additional services
• Those receiving a subsidy
• ‘Top up’

The ‘Maximum Contribution’

Those who have had their needs assessed and been found to be eligible for residential care and who reside or will reside in a DHB contracted facility need pay no more than the ‘Maximum Contribution’. The ‘Maximum Contribution’ is the maximum amount that any resident should have to pay for their ‘basic’ care.

The amount varies between ‘local body’ regions and is adjusted annually. Further information and the weekly rate per region can be found via the Ministry of Health website section ‘Maximum Contribution’.

Fully subsidised residents costs are covered by the residential care subsidy.

Where confusion seems to creep in is around ‘Additional services’.

Additional Services

Additional Services are those services over and above the ‘basic’ District Health Board contracted services. You will have to pay for any additional services yourself. Additional services may be purchased by any resident whether privately paying or subsidised and can range from a personal copy of the daily newspaper through to items such as a personal phone line, Sky TV or luxury accommodation.

The definition as to what constitutes a ‘basic service’ varies from facility to facility. For example a number of providers define an ensuite as an ‘additional service’ (i.e. separate from the DHB contract). In those facilities you could therefore be asked to pay more for an ensuited room. As you can imagine there is a ‘grey area’ around what constitutes ‘additional services’.

All residents should be given an admission agreement to consider and sign before taking up residency. Amongst other things the admission agreement should tell you what you will and will not have to pay for. It is wise to take it away before signing so that you can look at it more carefully at your own pace and in your own time. You may also like to get a legal opinion. Always ensure that any additional services you agree to are itemised on this agreement.

Note: If you are at the stage of deciding on your choice of facility and you are facing costs over and above the ‘basic’ service that you are not willing or able to pay for then you need to be aware that if the service does not have another option for you, you will probably have to go elsewhere.

Those receiving a subsidy

If you receive a Residential Care Subsidy and are residing in a District Health Board contracted facility all your essential ‘basic’ costs must be provided for.

In general the subsidy covers: food services, laundry, nursing and care services, continence products, GP visits, health care that is ordered by the GP, prescriptions and transport to health services.

Examples of what the subsidy does not cover include: specialist visits, hairdresser and personal toiletries, transport and recreational activities beyond the usual day to day activities incorporated into the programme, private phone, satellite TV, personal reading material, spectacles, hearing aids and dental care. Further information and examples can be seen on the Ministry of Health website in the section ‘Questions and Answers on Residential Care’

As a subsidised resident you may also be offered additional services which you can either agree to or decline. If you do agree to additional services make sure these are itemised on your agreement and that you include these in your budget.

‘Top up’

If you do not meet the asset threshold (i.e. privately paying) and you require care that in reality costs more than the Maximum Contribution e.g. dementia or hospital care, then the DHB pay a ‘top up’ price (up to the DHB contract price). You will not be asked to pay this amount.

For other information relevant to this subject see the Residential Care Line website section ‘Moving into care’.

Updated: 10-02-09

• The Auckland District Health Board website Residential Care Line http://www.adhb.govt.nz/rcline/ gives very comprehensive, specific information for those in the Auckland and Northland area and well as information relevant to other regions.
• People in a number of regions including Waitemata, Auckland, Counties Manukau (South Auckland), Taranaki, Waikato, Lakes and Canterbury area have access to webhealth. This service offers Online Assistance, and gives you the opportunity to chat confidentially, one-to-one online with a Webhealth staff member. The service is FREE. A range of issues can be discussed including: Housing, Finances, Relationships, Employment, Education, Addiction, Spiritual, Health, etc. The main function of Webhealth is to link people to health and social services in their region. One of the major benefits therefore of webhealth is for people to be able to search online for local health and social services themselves - for example people might be looking for GPs, counsellors, housing providers, or budgeting etc. If people do not have internet access then they are welcome to use the computers at the service centre/s for free. They can also check out their local library for internet access.

This page updated 18-11-08

If you are a subsidised resident the two circumstances are treated differently.

• If you are in hospital you can be absent for 21 days per financial year (1 July - 30 June). During this time the subsidy will continue to be paid. This period may be extended following a recommendation by NASC.
• If you are on holiday you can take up to two weeks at a time up to a maximum of 28 days per financial year (1 July - 30 June). During this time the subsidy will continue to be paid.

Updated 12-02-09

Updated 02-04-2009

The first of these is Joint Tenancy . A majority of married people or people in long term de facto relationships own their properties as joint tenants. The significant feature of this form of ownership is that on the death of the first partner, the property automatically passes to the survivor by way of a rule of law known as Survivorship . It does not matter what is in your Will or, for that matter, whether you even have a Will. Your surviving partner will take the entire property in his or her own name. The property is not administered under the Will of the person who has died.

The second common form of legal ownership where two (or more) people own property together is Tenancy in common. Quite simply, this form of ownership allows for property to be owned in distinct shares. The most common form is tenancy in common in equal shares, but, by creating a tenancy in common, ownership can be in unequal shares. Significantly, the rule of survivorship does not apply and as a consequence what happens to your share of the property on your death depends entirely on what you state in your Will. You can choose to leave your share in any given property to someone other than your surviving spouse, should you so desire.

Rest home subsidies

As has been stated above, if property is owned as joint tenants, on the death of the first spouse, the whole property passes to the survivor. If the last surviving spouse should at some later stage require either long stay hospital care or rest home care, they will have to meet Work and Income criteria before qualifying for any assistance in the form of a subsidy. The matrimonial home is included as an asset and must be declared. If the home is included (and a surviving spouse or dependent relative is not living in it) then the home will need to be sold to pay for rest home care.

You may qualify for assistance before the sale of the home by arrangement with Work and Income but they would take a charge (similar to a mortgage) over the home. Any funds advanced for your care against the home are then repayable when the home is ultimately sold.

Because of this situation, many people are today choosing tenancy in common as their preferred form of ownership. See 'What is a Life Interest Will' below for more detail on the reasons why this is so.

This information is provided by Brent Selwyn, Harmans Lawyers, Solicitors. February 2009. http://www.harman.co.nz

By owning your property in this manner, you are then able to leave a type of Will, known as a Life Interest Will. As you would do normally, you appoint one or more trustees (say for example your two children) to administer your estate after your death. The significant difference is that you then leave your share of the property (in this case a half share) to your trustees and instruct them in the Will that they are to allow your surviving spouse to live in the property for the remainder of his or her lifetime. Upon the ultimate death of the survivor, the share of the property then goes to the final or residuary beneficiaries (usually the children).

The significance of this is that the survivor now owns in his or her own name only a one half share of the property. The other share is then recorded on the Certificate of Title as being in the name of the Trustees and to be dealt with as specified in the will. Therefore, should the survivor ever end up requiring a subsidy, in making any declaration to Work and Income about the extent of their assets, they do not need to declare ownership of the other half of the dwelling, quite simply because in law, they do not own it. They enjoy only a life interest in that half share of the property.

So, although the family home might still have to be sold (or at least charged by Work and Income) to pay for your care, only the sale proceeds from the half of the property owned by you (subject to the allowable asset limits) needs to be used for your care. Because Rest Home Subsidies are also income tested, if the house were sold and the proceeds from the sale of your late spouses share invested, the income from that would also need to be used for your weekly care. Significantly though, the capital is preserved and upon the death of the survivor, it goes to the final or residuary beneficiaries (usually the surviving children of the marriage).

There are anti avoidance provisions in the Social Security Act and it is important that you seek professional advice before taking any action. The Director-general of social welfare has wide powers to set aside any disposition of property which is considered to have been entered into to ensure that you qualify for a benefit that you may not otherwise have. For that reason, timing is important as is good legal advice. Gifts made within a five year period of application for a subsidy are also clawed back and there is a discretion for the Director-general to look back further if he sees fit.

What is the cost of transferring your home to a tenancy in common and completing Life Interest Wills? The simple answer is somewhere between $600 to 800 plus GST if there is no mortgage involved. This is of course much cheaper than the more complicated, expensive and often time consuming option of transferring your home into a discretionary family trust. Also, depending on your ages, it may not be practical to look at transferring the home into a Trust. However, if you act early enough, the family trust option can protect the whole property whereas the life interest situation we have considered should ensure that one half of the property will be protected and preserved for your children. If because of your ages, you do not have the time to transfer your home to a Trust, this is an affordable option and can be completed within a very short time frame.

This information is provided by Brent Selwyn, Harmans Lawyers, Solicitors. February 2009. http://www.harman.co.nz

Family arguments can be avoided by stating clearly which possessions you wish to go to which person. As well as leaving specific bequests of your personal belongings, many people will choose to leave monetary amounts to family or friends and in some circumstances to a charity close to their heart.

If you have a child with special needs and it would be inappropriate for him or her to receive cash from your estate, it is possible to set up a Testamentary Trust in your Will, to ensure that the child’s needs are met during their lifetime and then upon their death, the remainder of the capital and interest of the Trust can be divided among other beneficiaries.

Similarly, sometimes people will choose to leave their surviving spouse a life interest only in their share of a house property or other investments, so that they enjoy the use of the asset (or the income from it) during the remainder of their lifetime, but on their death, the capital is passed to the children of the relationship.

If at the time of your death you are owed money by family members or the Trustees of a Family Trust formed by you during your lifetime, it is possible to forgive that debt if you wish. Similarly, in your Will you can appoint new Trustees of your Family Trust and you can nominate someone to have the power of appointment of Trustees or Beneficiaries of your Trust. As you might have gathered by now, a Will is a flexible document, which if properly structured, can relieve financial strain on your family and avoid arguments between those close to you.

This information is provided by Brent Selwyn, Harmans Lawyers, Solicitors. February 2009. http://www.harman.co.nz

A Living Will is effectively an advance directive in relation to the course of action that you would like to see taken, in the event of certain health circumstances. Examples of such directives are the desire not to receive medical treatment in certain circumstances, not to receive blood transfusions, not to be resuscitated and so on.

Living Wills are frequently encouraged in the United States by health providers seeking to avoid possible liability arising from carrying out the wishes of a patient. In New Zealand on the other hand, litigation based on medical malpractice has been all but eliminated by the Accident Compensation legislation.

Such legislation as there is dealing with patient’s rights in NZ is effectively found in two places. Firstly, Right 7 of the Code of Health and Disability Consumers Rights deals with “The right to make informed choice and give informed consent” and, at paragraph 5 in particular provides “Every consumer may use an advance directive in accordance with the common law"”

In addition, s11 of the Bill of Rights Act 1990 provides “Everyone has the right to refuse to undergo medical treatment”

Some fundamental issues arise in relation to the validity of an advance directive. Firstly, the person making the directive must be competent to do so and must not do so under any undue influence. One must also consider whether the person was sufficiently armed with the information required to make an informed decision on the types of medical treatments being requested or refused. Finally, such a directive might be questioned where treatments for a certain condition changes over the years and one might ask if the person was sufficiently informed as to those changes. One possible way around this problem is to state clearly in the Living Will that knowledge of new medical treatments would not have affected the decision.

This information is provided by Brent Selwyn, Harmans Lawyers, Solicitors. May 2006. http://www.harman.co.nz

The occupation right agreement must be clear and unambiguous. It may consist of more than one document.

The occupation right agreement must comply and be consistent with the provisions of the Retirement Villages Act,(‘the Act’) the regulations and the Code of Practice (although the village may be exempted from any provision of the Code of Practice). The agreement must also provide information on the Code of Residents' Rights and the Code of Practice.

Operators must register their standard form of occupation right agreement with the Registrar of Retirement Villages. The terms of a resident's particular agreement must be either the same as those in the registered form or more favourable they can't be less favourable.

Schedule 3 of the Act and the Retirement Villages (General) Regulations set out what must be covered in the occupation right agreement, and Part 2 of the Act covers the process for entering into an agreement. The Code of Practice (in force on 2 October 2008) specifies minimum requirements for most of these areas, which must be included in occupation agreements if not, they'll apply anyway.

What issues does the agreement have to deal with?

The village and its operations

The occupation right agreement must cover:

• the management of the village
• the village's services and facilities
• the nature of the resident's right to occupy the unit, and the resident's and operator's respective rights to deal with the unit
• the charges relating to the village and to the use of its services and facilities
• the operator's obligation to run the village properly
• the resident's rights to be given key financial documents and other relevant information that they ask for
• staffing
• residents' safety and personal security
• fire protection and emergency management
• the transfer of residents within the village
• meetings of residents with the operator
• accounts
• maintenance and upgrading
• termination of the agreement by a resident or the operator
• communication to those for whom English is a second language or whose ability to communicate is limited
• a complaints facility and a disputes procedure.

Consultation with residents

The agreement must also require the operator to consult with residents:

• before a village is sold or disposed of
• before a new manager is appointed
• about any proposed changes to the services or benefits provided or to charges that could affect residents' ability to pay for them.

Treatment of residents

In addition, the agreement must require the operator and the people who work at the village and provide services to:

• treat the residents with courtesy
• respect their rights, and
• not exploit them.

Where the village or unit hasn't been built

If the village or unit is not yet completed when the agreement is signed, the agreement must state the unit's proposed completion date. The disclosure statement given to the intending resident before they signed the agreement must also give information about the state of the village, including its stage of completion.

Getting independent legal advice before the agreement is signed

Intending residents must get independent legal advice before they sign an occupation right agreement. This means advice from a lawyer who is completely independent of the retirement village operator.

The lawyer must explain to the intending resident the general effect of the agreement and its implications, before the person signs it. This lawyer must do this in a way that's appropriate to the person's age and understanding. The lawyer must then witness the person's signature and certify that they explained these things.

It's not enough that a person such as a staff member from the village explains the agreement to the intending resident it must be an independent lawyer (and not a legal executive).

If in some substantial way any of these requirements is not met, a resident can avoid (cancel) the agreement.

Cancelling an agreement while "cooling off" or for delay

A "cooling-off" period after the agreement is signed

After new residents have signed an occupation right agreement, they have 15 working days in which they can change their mind and cancel the agreement. This applies to everyone who signs an occupation right agreement with a retirement village. It’s not necessary for the operator to have done anything wrong.

The cancellation must be notified in writing to the operator or their agent. No particular words need be used, so long as the intention to cancel is clear. No reason has to be given.

Once the agreement is cancelled, the person will get back everything they paid, plus interest, within 10 working days . However, they must pay for any services they used if they lived in the unit during this period, and for any damage they may have caused.

Cancellation for delay

The buyer can cancel the agreement if the unit is not, for practical purposes, completed within six months of the proposed completion date. They can do this any time after the six-month period. They must then be refunded all payments they’ve made.

The buyer must notify the operator or their agent in writing that they are cancelling the agreement. They don’t have to use any particular words so long as their intention to cancel is clear.

Deposits and progress payments to be independently held

Every deposit, progress payment or other payment that a person makes for a right to live in a unit must be held by the village’s statutory supervisor. The supervisor holds the payment until the transaction’s settlement date (or until the agreement is cancelled during the cooling-off period).

If the retirement village is exempt from appointing a statutory supervisor, a lawyer nominated by both the resident and operator must hold the money. The nomination must be in writing, in a separate document from the occupation right agreement.

Avoiding (cancelling) for a breach of the agreement

The Retirement Villages Act gives residents the ability to "avoid" (cancel) their occupation right agreement if it was entered into in breach of important provisions of the Act in a substantial way. This means that the agreement is cancelled and the operator must refund the purchase price and other costs to the resident.

When can a resident avoid an agreement?

This can be done where any of the following things has happened, if the breach was in a "substantial respect":

• the village wasn’t registered when it’s required to be or its registration was suspended when the operator advertised, made an offer of occupation, or entered into the occupation right agreement with the resident.
• something was left out of the information that’s required to be in or to accompany the disclosure statement.
• the occupation right agreement did not include the required information.
• an independent lawyer did not explain the general effect of the agreement and its implications before the resident signed it, and witness and certify that they did this.

When a breach is in a "substantial respect"

An agreement can only be avoided where the breach was in any "substantial respect". This is where the breach:

• involves a "significant detriment" to the resident, or
• is material and not simply technical or minor, or
• involves deliberate misconduct by the operator.

How does a resident avoid an agreement?

The resident must notify both the operator and the village’s statutory supervisor in writing, within the set time limits (see below). This can be done only if the agreement hasn't already been terminated.

The procedures for ending an agreement because of a breach are quite different from where the agreement is ended on other grounds, and it's important that the correct procedures are followed.

What are the time limits?

If the village wasn't registered or if its registration was suspended, the operator and statutory supervisor must be notified:

• within three years after the agreement was entered into, or
• within six months after the resident knew (or ought to have known) of the breach,

whichever period is shorter.

For other breaches, the time limit is:

• within one year after the agreement was entered into, or
• within six months after the resident knew (or ought to have known) of the breach,

whichever period is shorter.

What happens when an agreement is avoided?

The agreement is at an end and the operator must pay the resident:

• a refund of all capital sums paid before or while the resident occupied their unit
• a refund of all other payments made for which services or facilities were not provided
• interest (at the rate set down in regulations)
• actual and reasonable costs associated with ending the agreement (such as legal expenses and removal costs).

What if there's a dispute about this?

If the operator believes there hasn't been a breach, they can take the matter to a disputes panel by giving a "dispute notice". While the dispute is unresolved they must take all reasonable steps to put right any breach. They do not have to pay any refund.

If the operator and resident don't agree when the refund is to be made, either of them can give a dispute notice to resolve this.

Part 4 of the Act has more information about giving a dispute notice in these situations (particularly sections 53 and 54).

This information is provided by Brent Selwyn, Harmans Lawyers, Solicitors. February 2009. http://www.harman.co.nz

Some of the many reasons include.

Preservation of family assets

• Invariably the primary reason behind every Trust is the genuine desire to preserve hard earned family assets for children and grandchildren

Family Protection

• To protect assets from claims by undeserving children in certain circumstances
• To provide for the needs of dependants without giving them the right to demand money or capital
• To provide flexibility to cater for the needs of beneficiaries at various times in their lives (i.e. children and grandchildren) – a trust can last for up to 80 years
• In your Will you have certain legal obligations to next of kin and omission from a Will can give rise to claims against estates under The Family Protection Act. However, if on your death, certain assets are owned by a Trust, then they do not form part of your estate and are less likely to be subject to such claims

Matrimonial Property matters

• Having property in a Trust presents a more “comfortable” option to some people than the alternative, a pre nuptial agreement
• To cater for children of a particular relationship separately. A Trust can enable you to cater for those children whilst still recognising obligations to children from other or subsequent relationships
• To ensure that the husband or wife of one of your children is not able to gain any interest in family assets upon the failure of a marriage

Taxes

• To protect family assets from new laws which may introduce such taxes as capital gains tax, wealth tax, reintroduction of estate duty, succession tax and inheritance tax
• To enable flexibility in income distribution thereby enabling effective income splitting among beneficiaries 16 or over at the lower marginal tax rates

Creditor protection

• To protect assets from being at risk to possible creditors and from unsecured business debts
• Protection from user pays charges
• To increase the likelihood of qualifying for certain income or asset tested benefits such as rest home subsidies, child support, student benefits etc, by removing ownership of assets and or income producing assets from yourself and putting them in the Trust

Confidentiality

• Trusts, unlike companies, are not a matter of public record and do not need to be registered thereby enabling the extent of the trust assets to be kept confidential.

Flexibility

• Trusts are flexible and can therefore cater for unforeseen and differing needs of beneficiaries at various times.

This information is provided by Brent Selwyn, Harmans Lawyers, Solicitors. February 2009. http://www.harman.co.nz

• Managing the Trust
• Making information available to beneficiaries
• Acting personally (and not delegating)
• Investing prudently and properly
• Acting in the best interests of the beneficiaries
• Being aware and prudent in relation to tax requirements

This information is provided by Brent Selwyn, Harmans Lawyers, Solicitors. February 2009. http://www.harman.co.nz