The aim of having support at home is to enable you to live as safely and independently as possible. Usually this involves support for you with your personal and practical needs. For the purpose of this article we are referring to ongoing services. (Short term intensive support programmes that you may be offered and ACC services are managed and funded differently.)
Personal care relates to services of a personal nature (e.g., showering, toileting,) registered nurse input, and support for your carer if you have one. Practical services are of a domestic nature and may include help with housework, meal preparation, grocery shopping etc.
There are two ways these services can be paid for; by private payment or by public funding (i.e., a subsidised service).
Publicly subsidised (funded) services
If you want to access publicly subsided services, then you must have been assessed as being needing these. If you haven’t been assessed, you can ask your GP to refer you or you can contact your local older person’s service yourself to request this.
As you can imagine rules apply to funded services. Amongst these is the understanding that those with complex and higher needs are given priority and commonly, extra support, and that your services will be reviewed on a regular basis and when/if your needs change.
If your assessment shows you need help with your personal care this is generally funded regardless of your financial circumstances. The funding of practical needs is treated differently with the availability of informal family support and your ability to pay being considered. You may be eligible for funded support if the following applies:
- you have a Community Services card. (You are responsible for advising MSD if your eligibility for a Community Services Card changes.)
- you also receive other services such as personal care,
- your assessment shows you have no other alternatives.
You can top up or add services you want by privately paying for them.
Choosing a private service gives you more options. It allows you:
- to buy a wider range of services, from dog walking and outings to sleepovers by support workers.
- more control over what happens and when, such as the timing of visits or selecting the support worker of your choice.
What happens next?
If you are privately paying contact the agency directly. If your service is funded, you will usually have a choice of home support agency drawn from the small list of health contracted providers.
- A person from the agency will generally meet with you (and your family/ whānau if you choose) to talk about what you need and how this can be arranged.
- You will be asked to sign a contract which includes conditions for service, any payment details that apply etc.
- A support or care plan will be written up. It may include goals you want to achieve such as getting strong enough to walk down to the corner or attend a wedding. Everyone’s goals are different. Setting targets like this help you maximise your abilities and to stay as independent as possible.
- When you have agreed on the plan you will be asked to sign it.
- Your service will begin. Be aware that you may see different people for different services, such as a registered nurse for clinical issues or a support worker for showering assistance.
Commonly, home support/help services (especially those that provide funded services) operate a restorative type of model/service. The aim of this type of service is to help you sustain, maximise, and even restore your skills where this is possible. This means your support worker is more likely to work with you rather than for you.
You will need to keep copies of your contract with the agency, your support/care plan, and other relevant documents such as your birth certificate, NZ Super number, Will and Enduring Powers of Attorney nearby, in an accessible, safe, and private place, as you may need to refer to them from time to time.
Occasionally thing do not go as planned and you need to make a complaint. If this is not sorted out satisfactory or if you feel uncomfortable making a complaint to your home support agency, you can get support from your local Health and Disability Advocacy Service or contact your local older persons service NASC/CCC.
Notes about private services
If you engage a private service, you need to manage part or all of this relationship, including the financial aspects, or have someone else such as your Enduring Power of Attorney do this with you or on your behalf. Most important is to have a written and signed agreement between you and the provider or support worker.
While an informal arrangement with a friend or neighbour might seem perfect, take care. There generally aren’t the same assurances as when using a formal agency, which should do police and reference checks. An agency will also be able to tell you its complaints process and who you can lodge your complaint with at the agency and outside it. In an informal arrangement, you may have to resolve issues directly with the support worker.
You should also know:
- What the hourly rate is – rates differ widely. Ask if this is GST inclusive.
- Whether they have a professional management team with staff holding relevant qualifications?
- Whether they provide training for staff?
- What your rights and responsibilities are, and those of support workers
- Whether you stop the service at any time without it costing more.
It’s important for both you and your support worker that there be clear boundaries about what’s OK and what’s not. Regardless of the funding arrangement, your support worker should:
- provide services in a culturally sensitive and appropriate way
- arrive on time and leave when the planned tasks have been completed.
- never access your bank account or your money, know your PIN numbers, or take or use any of your things for their own purpose.
- never threaten you or make you feel uncomfortable. This behaviour is not OK and must be addressed. Get support.
Staying at home when you could go into a care home.
In some areas of the country, it may be possible to stay at home. This is more likely if the person wants to stay at home, resources are available, and you and, commonly your family/whānau, are considered to be able to manage with this support. Make sure health professionals understand your and your whānau/family’s, perspective and wishes. To be successful all parties need to agree.