May 28, 2024 • 29 mins
When we get to that point in our lives when we have to move out of our family home and find accommodation that's easier to manage, how do we create a "home away from home"?
And how can the family and children of older people have a calm and supportive discussion about what to do when the time comes?
Australian Unity's National General Manager of Residential Care, Brett Lafranchie, joins performer, author and ‘Parenting Up with Australian Unity’ host, Jean Kittson AM, to discuss helping a parent chose the most appropriate supported accommodation option and strategies to make the transition as smooth as possible.
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Episode Transcript
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Jean Kittson (00:00):
This is Parenting Up with Australian Unity, a podcast where
we're talking about ageing, and we're looking at some of
those essential conversations that we need to have with our
loved ones as they get older. I'm Jean Kittson, and
(00:21):
this is a subject that is particularly close to my heart.
Having been through this process with my own parents. My
mum is 99 almost and dad is 96. I've even
written a book about it to help us all, but
mainly to help me. We need to talk about mum
and dad. A guide to parenting our ageing parents. Each episode,
(00:43):
I'm going to be joined by expert guests who can
help us navigate these challenging conversations with care and compassion
and empathy and respect. This episode, we're really talking about
how to create a home away from home. When we
get to that difficult place in our lives where we
have to move out of our family home and find
(01:06):
somewhere else that is easier to manage as we get older.
And with me, I have an expert today, which is
fantastic and his name is Brett Lafranchi and Brett is
Australian Unity's national general manager of residential care. Hi, Brett.
Brett Lafranchi (01:22):
Good afternoon Jane, how are you?
Jean Kittson (01:23):
I'm really well. And this is a really tricky topic,
isn't it? I find there's a lot of fear around
moving home and when. When it may be necessary. And, um,
whether or not it's necessary. I think with my own experience,
we moved mum and dad out of their family home
a little bit too early because we thought they weren't coping,
(01:46):
so our decision about them moving home was in a
sort of crisis, and everyone had an opinion and it
was really hard to make these decisions, but really it
should just be calm and planned and then everything can,
you know, you can see what the future may look
like and when is a good time to move. Well,
(02:09):
how do you have these sort of conversations with people?
Brett Lafranchi (02:12):
It's certainly the most challenging gene, and certainly the majority
of our engagements with families, with, with prospective residents is
that it's triggered by an episode, and it could be
one of two things that there's been a medical episode
at home, and they need a high level of care
that they can't get within the home. So that's triggered it.
Or alternatively, the home that they're currently living in is
(02:36):
not fit for them for any further. So unfortunately, more
times than not, it's triggered by an episode or an event.
So what we encourage families and certainly the children, is
to have these conversations much sooner than what we're currently
having now. So it could be one, two, five years
plus earlier. And because then what happens is the prospective
(02:56):
resident feels a lot more engaged in the decision as
to what the future holds for them and what type
of accommodation or or accommodation that can provide the needs
that they want. So it's all about that respect and
and that choice that they get to make. Unfortunately, when
there is an emergency or a medical episode, it's pushed
on very quickly. And so the kids will say, we've
(03:18):
got you this residential aged care home. Or it might
be a retirement community or community or these other services
in place. The choice for them is typically in more
times than not, taken away. So which is really devastating.
It is. And I always say to families, it's like
an insurance policy. You don't insure your home after a fire.
You insure it for for many years, and that safety
(03:39):
net is in your back pocket. So when you need it,
the decisions have been made. You've chosen what type of
accommodation you'd like and a resident will feel far more engaged.
Jean Kittson (03:48):
Well, they will be. They won't only feel it, they
will be more engaged and it will be in their
hands and they will be making the decision. A lot
of people will say it's not safe for you to
be in your own home anymore. But there's something called
the dignity of risk, and that is a human right,
that you are able to take the same risks with
your amount of risk with your body as you want.
(04:11):
So if you fell down a couple of stairs and
then your family panics and says, we've got to get
you on even ground, you might say, well, actually, I'm
willing to take the risk to stay in my own home,
that I might hurt myself on stairs. That's my choice.
And what we've talked about in other episodes is as
long as you understand what the risk is, you can
(04:33):
take that risk. The first thing you really need to
talk about is how long do you envisage staying in
the family home? Can you see yourself in the family home?
Even if you become immobile, will that work? You know,
if you're on a pusher. Both my parents are on
frames now and they could never have. There were stairs
and a really steep driveway, so ultimately that was never
(04:56):
going to work in the long term. And when they
made the decision, well, they actually put their house on
the market and sold it before they'd even decided where
they were going. So it was like just this crazy mess. Luckily,
we found a very nice retirement village, but they weren't
expecting it. They had to get rid of 9/10 of
their stuff. I think first thing is talking with your
(05:19):
loved ones about what they want. Listen to what they want,
listen to what they're afraid of, listen to their fears,
their hopes. Really dig down. Because often our elders will
resist talking about this because they think they're going to
lose their autonomy, their independence. They think they're going to
(05:40):
be forced from the family home. And then people talk
about their stuff like, oh, well, this stuff you got,
you know, everything in their home. They know what it
is and there's a story attached. It's never stuff. Having
to downsize is a very big decision, and I think
we need to give it the respect and the seriousness
(06:02):
and what they will feel. They'll feel a sense of loss,
but it always should be their decision. Don't you agree?
Brett Lafranchi (06:09):
100%. And it's all about it comes back to respect
and choice. So it's important so that you know what
you want in the next stage of your accommodation, of
where you're going to reside. The importance of do I
want facilities? Do I want access to care? Do I
want residential aged care nearby or connected? Do I want
social groups, outings, all of those types of activities that
(06:30):
I can maintain my level of independence. But if you
can make those choices and plan ahead, your fingerprints are
all over it. You've made those calls. Don't wait until
it's too late because a lot of that will be
forced onto you because the options are more limited.
Jean Kittson (06:44):
Can you tell me the difference between, say, a retirement
community option and a residential care option?
Brett Lafranchi (06:53):
Yeah, absolutely. Gene retirement communities, uh, it is independent living.
So it might be living in a in a unit,
an apartment, uh, service department, assisted living apartment, but ultimately
it's independent. So you're doing the majority of things yourself.
You may still be cooking, cleaning, domestic assistance, you know,
you're showering and so forth, and you're far more engaged
(07:14):
in the wider community. That's sort of your your own
community as well. Now, of course, you can still have
services coming into that, but the area is or the
focus area is independence residential aged care. It's 24 seven
care services provided for you. So there's a level of
dependence there where you can no longer cook for yourself,
perhaps activities of daily living. It might be you need
(07:36):
support to to wash or shower, uh, with mobility, all
of those things. So level of independence within retirement versus
dependency within residential aged care.
Jean Kittson (07:47):
So a retirement community is when you have your own
space in there and it might be two bedrooms, lounge, kitchen, bathroom. Yeah.
Brett Lafranchi (07:58):
So it's a it's independent. That's the critical word. So
independent living. And it could be in a unit or
apartment or villa. You also have service departments or, or
assisted living as well which might be then you'll typically
have associated with that accommodation a package. And it could
be a food package, a cleaning package, domestic assistance or other.
(08:18):
And that's all considered independent living. It could be out
and about playing golf every other day. What do you.
Jean Kittson (08:23):
Mean by a food package? You mean a home care package?
Only for food?
Brett Lafranchi (08:28):
Absolutely. But within our service departments, we will actually have
a kitchen and dining room on the site and provide
the meals for those residents in the service departments or
the the assisted living.
Jean Kittson (08:39):
So they're in their own apartment?
Brett Lafranchi (08:41):
Yeah. Within the retirement village. Yeah. But a higher level.
They've got more services and, and package, you know, packages
could be home care funded or through the, the village
and who provide those services. But it's a higher level
because they're less independent at this point in, in their
life than others that are living in the village as well.
But they're able to stay in the village with those
(09:01):
services being connected and provided to them.
Jean Kittson (09:04):
So when you say a package, you mean you buy
that package, or is this a given to you by the.
You get assessed for it.
Brett Lafranchi (09:12):
Correct. You get assessed an assessment for to determine the
level of funding that the government will provide. On what level?
One two, three, four. Or alternatively, it could be private
so you can pay fee for service. For those it
could be $10 a meal. It could be, you know,
$50 a week to get cleaning and laundry or unit cleaned.
That's marvelous. So yeah. So we have a vertical like
(09:34):
an apartment block. Um, most recent one, we opened one, uh,
in June this year. It was, it used to be
our old corporate office in, in Albert Road in, in
South Melbourne. Uh, and we have converted that to an
easy living, so it's independent living and residential aged care
across 15 levels. Got a restaurant up on the top floor,
cafe down on the the ground floor and can provide
(09:57):
all different levels of accommodation for those residents in that
in that vertical building. Others we've got on acreage and
all single storey.
S3 (10:06):
Um, you can.
Jean Kittson (10:07):
Have your own garden and.
Brett Lafranchi (10:08):
Absolutely. And so it's whether it's like a tree change
or a sea change or you want to still live.
You may have lived in a city all your life,
or your family now live in a city. So that's
the motivation, uh, each to their own. We have some
beautiful sites out on acreage, uh, trees, birds. And we
have some wonderful vertical sites in the inner city as well.
Jean Kittson (10:29):
That's great. So, um, how does the financing, I mean,
the one thing we didn't know when Mum and dad
moved into the retirement unit was they don't actually own
their unit. I think people have to be really aware
that you are buying. It's a different sort of contractual thing.
It's not. You need to look at the contract. You
need to get a solicitor, your own solicitor. You need
(10:51):
to be really understanding the fees which there has to
be because the people are paying your rates and everything
like that. Yes. And it's incredibly important to understand that,
because I guess someone explained it to me when I
was writing my book and researching, they didn't realize that
you didn't own your own unit. So when they went
(11:12):
to sort of get a loan for a holiday against
the unit, they couldn't do it because it wasn't their unit?
Brett Lafranchi (11:19):
No. So in our case at Australian Uni, their all
their leases and typically the price that you'd pay. So
there's three sets of costs when you're in retirement living.
There's the in going costs, there's the ongoing costs and
there's the outgoing costs. If we look at the ingoing costs,
typically anywhere between 80 and 90% of the median house
price is what you'll pay for an equivalent unit in
(11:41):
a retirement community versus one that's that's out in the suburbs.
You then pay an ongoing cost. So, as you said,
the cost of maintenance and upkeep of the facilities at
the retirement village and the staff and so forth. So
you pay that and then you pay an out going
cost at the end. So new resident comes in, acquires
(12:01):
your unit, and there'll be an out going, which is
typically a deferred management fee or a capital gain share
or split. That's the outgoing element of it. That as well,
it's a lot of this is new for people because
they do think, hang on, my name's on the the title.
So you're not an owner of the property. So that
saves you at least in stamp duty, not paying stamp
duty when you move into a retirement community. But it's important,
(12:22):
critically important to get that financial advice to know. So
beforehand what assets have I got? Shares, cash, etc.. What
do I need to live for the rest of my time?
And then what can I afford going into a retirement
community or residential aged care? Residential aged care. You've got
to pay a refundable accommodation deposit for the bed so
that financial legal advice is critical. We don't provide that
(12:45):
to our prospective residents or families. We ensure they get
that independent.
Jean Kittson (12:49):
Third party independently. Of course, of course. So residential aged
care is like the old what we used to call
nursing homes. So that's where people move in. They're usually
in a room and you have all the care 24
over seven care. Nowadays it's mandated 24 over seven registered
nurse on duty. So when you move into these places,
(13:12):
people are terrified of them because of all the, you know,
abuse that was often and isolation and neglect that we've
all read about and we're all, um, we're still carrying
those stories with us. But happily, things have changed a lot.
The Royal Commission has laid it all out on the table.
(13:33):
Things are much more transparent. There's residential aged care has
to have a higher level of care hours. And there
are as always, there are the good ones and the
not good ones. So to choose a good one, you
just have to do your homework and you have to
ask the right questions. And you have to make sure
(13:55):
that whichever residential aged care slash nursing home you choose,
you have looked into it, you have visited them, you
have talked to the, um, CEO, you've talked to the.
Brett Lafranchi (14:06):
General manager of a home. Or it could be the
well-being and transitions manager at, in our case, who will
write tour a prospective family. But Gene, you've hit the
nail on the head. But I will say the the
the analogy with the nursing homes. Uh, it is an
old one, but it is still people think of a
nursing home, and we have heard all the horrible, horrible
stories on the news over the past decades. But a
(14:28):
residential aged care facility now is not that we have
turned the corner in terms of the big providers with
the the developments and refurbishments of their homes and Australian uni.
We we are a promoter and certainly deliver the small
household model, and the small household model will say that
a household doesn't have any more than 17 residents in
it and effectively what you had at home. Close proximity
(14:50):
to your bedroom, en suite, lounge, living, dining, kitchen is
all within a very small household within a residential aged
care facility. Not like the old days. With the nursing home,
you might have to travel 50m 80m down the corridor
to the communal dining room, which was like a school
canteen rather than a small household. So you come to
(15:10):
residential aged care facilities. Now most of them are certainly
the Australian uni ones are stunning in terms of that
small household design. Uh, and it's, it's like it's like
walking into a hotel. So that's.
Jean Kittson (15:22):
Great.
Brett Lafranchi (15:22):
But it's critical that families tour multiple times. Yeah. Before
you settle on on a on a home, there are
some critical decisions you need to make and post royal commission.
The government has been very proactive in terms of lifting
the the standard and even just more recently in the
last 12 months was the the star ratings. So every
(15:43):
aged care home in this country is provided with a
star rating for different categories that give you the rating,
whether it's five stars or one star. Compliance. So how
compliant are you to the accreditation requirements and standards resident experience?
So they'll interview residents and see their overall experience of
living in that home. Um, staffing. So as you said,
(16:04):
you're mandated care minutes at least are, you know, Indicatively
200 care minutes per resident per day, including 40 registered
nurse minutes per minute per day, and And it also
quality measures. So key indicators from a quality perspective falls
medication management, um, uh, pressure wounds and so forth. All
(16:27):
of those key metrics that I'll measure those, you've got
to report those to the government on a quarterly basis,
and that determines what your overall star rating is. So
that can give families reassurance. You compare all your local
aged care facilities in your area that you're looking at,
and those are a controls the government has recently put
in place post royal commission to reassure families that, you know,
(16:47):
it's meeting the expected requirements that you would put, expect
before you put mum or dad into the facility.
Jean Kittson (16:54):
But I'm thrilled to hear about the model of residential
aged care being the smaller community house, the community, the
family home. So you would have. How many did you
say 7 or 17?
Brett Lafranchi (17:08):
No, 17 would be a typical household size for for
us in our small household model and our Better together
design at Australian Uni across our homes. So now we've
got some homes that are 160 beds, so you've got
multiple households within that. And one of those would be
a memory support unit. So yes. So if you walked
into a household you'd know you'd be in there. There's
(17:29):
the kitchen, there's the lounge dining, but it's a small
dining where no more than 17 people would be sitting there.
Not a big cafeteria style. There's my room. I've got
an en suite there. It's all within short proximity, so
it's not like the old racecourse style nursing home. You'd
walk laps of the facility. And here's my lounge room
next to 20m down. Here's my dining room. This is
(17:51):
where I have my meals. Um, it's all very much changed.
It is everything within close proximity. You don't have to
walk far to have all of the services and facilities
that you would have had in the family home.
Jean Kittson (18:02):
How have you come up with a figure 17?
Brett Lafranchi (18:05):
How did that? There was many algorithms to, to, to
establish and look at that and also from the staffing.
So with our Better Together philosophy with staffing is that
the same staff will be in that small household day in,
day out, so that they get to know 17 residents
or if the ratio is in the morning are one
staff to six residents or something similar along those lines.
(18:26):
They know very to a to a significant level of detail,
the ins and outs of that resident, what their needs
are and if they're potentially having an off day and can,
you know, escalate that need to perhaps the GP or
the registered nurse to have a look and they'll often
know that to a higher extent or a better extent
than family who aren't seen them every day. No. That's right.
So so that they're the same level of staffing, they're
(18:49):
very engaged to to provide the services and, and level
of care that that the resident.
Jean Kittson (18:54):
Care is everything. You know, people talk about, oh, look
at the water feature. And you know, we've got free
WiFi for the grandkids. But that's not as important as
care everything comes down to how people are treated.
Brett Lafranchi (19:08):
Yeah, and I'll say also, I put clinical care and care,
which is your activities of daily living is, is is
all in in one bucket. But just equally as critical
to that is is food is you know, you want
three hearty meals plus two teas, plus maybe a supper.
So six you know, chances to to eat. We our
small household models have stocked pantries, so if you want
(19:31):
to grab something during the day, a piece of fruit
or something, you just go and you go and do that.
You make that choice and that decision.
Jean Kittson (19:37):
Can you make your own cup of tea?
Brett Lafranchi (19:39):
Absolutely. So, but.
Jean Kittson (19:40):
Also in a real.
Brett Lafranchi (19:41):
Cup, 100%, yes you can. And just like we have
also at our aged care facilities, it could be a washing.
So laundry with, you know washing machine drying ironing board
if you want to. We'll do that for every resident.
But if a resident says no, no, I want to
remain independent and do my own laundry, of course they can.
So it's all about choice, respect and ensuring that can happen.
Jean Kittson (20:02):
When I was researching, I would go on websites and
all these residential aged care there would say there are
five important questions you need to ask before you move
into residential aged care. But when I dug deeper and
talked to CEOs of residential aged care, good ones, they said, no, no, no.
(20:24):
There's about 160 questions you need to ask. You need
to ask questions about the funding side, the food, the security,
the clinical care. Like if you are going to age
in place in residential aged care, then have they got
palliative care specialists and what you know, can the family
(20:44):
stay there. There's 160 questions.
Brett Lafranchi (20:47):
And could ask questions forever and a day. That's why
we always encourage families and prospects. Come once, come twice,
come three times. You cannot make a decision after a
two hour visit. Um, I also encourage respite. The government
will give you nine weeks, 63 days per a year
of paid funded respite. And so where you've got a
family member who may be a little bit resistant to,
(21:08):
to going to a two week stay, it's like a holiday.
It's like being on a cruise ship and then come
home to your family home, maybe a few months later,
go back for more respite. And that transition or the
slow low, slowly but surely trying before you buy. Yeah.
Is the is an effective way so that then the
residents thinking ah I'm actually I'm making this decision. I'm
not being forced by the kids. You might have provided the,
(21:30):
the the accommodation option to the loved one, but they've
ultimately made the decision. So respite works wonderfully well. And
you'll go through everything as you said. Jean, what are
we eating today? What's how often do you change the menu? Oh,
we'll do it seasonally. Uh, is it all prepared fresh? Uh,
you could ask 100 things, dietary needs and so forth.
Once you know your your care needs or your dietitian
(21:55):
type needs change activities, funding, uh, security.
Jean Kittson (22:00):
Funding, staffing ratios and the depths are, you know, those
types of things.
Brett Lafranchi (22:05):
So you've got, um, you've got your red refundable accommodation deposit,
which is the, the value of the, the bed, the
room price that the government has approved. Uh, you may
choose to not pay it up front half $1 million
or something. So you can take a DAP, which is
a daily accommodation payment. So effectively it's an interest rate
on that capital amount of half $1 million.
Jean Kittson (22:25):
Can I just explain, um, what I understand is refundable
accommodation deposit because some people go, we gave you $500,000
and and, you know, and we have to share a
room or whatever, but you don't get that money. You
can only use the interest off that money. That money
goes into a trust or something to be repaid to family,
(22:47):
doesn't it?
Brett Lafranchi (22:48):
So government is very clear on permitted use of the
prudential obligations with with refundable accommodation deposits. Absolutely. And it
is exactly that refundable accommodation deposit if you have given
the provider of the aged care facility half $1 million
upon exit of the resident, you get that $500,000 back
then there's a daily charge, which is, you know, your
(23:08):
daily care fee, which is 85% of the pension. If
you've got money, financials, assets, the government might, might ask
you to contribute to your care daily care costs through
a means tested fee. Um, there could be some additional
type services. So you get the choice of, you know,
a hot breakfast or something, you know, for, for brekkie
(23:29):
or multiple hot meals for lunch to get that choice.
There'll be an additional potential charge there. So and then
at the, um, upon exit, that money is fully refunded.
So that refundable accommodation deposit amount, you want to make
sure it's all appropriately documented. Hence why you get your
financial and legal advice to. Yeah, to dot all those i's,
(23:50):
cross those t's before signing any residential agreement and moving
into residential aged care.
Jean Kittson (23:55):
Um, we've talked about how to look at all the
different aspects and how to get the right advice and
get independent advice, but always, I guess always, it's really
important to come back to sitting down. And as you say,
having these conversations earlier rather than later checking out a
(24:17):
few places. So that's no fear. No one's going to
put you in a home. No one's going to make
you sell your family home. But if the time comes
when you can no longer manage and that's your decision,
when you no longer want to manage all the things
that go into a family home, the constant upkeep and things,
(24:39):
then these are your options. And you've already had a
look at them and you've had to think about them.
You've chatted to them and there's no fear involved.
Brett Lafranchi (24:49):
And I will always encourage because when you age, you
become fiercely independent of the remaining independence that you have.
And I see it with people giving up driving licences,
their licences they've had since they were a teenager. Um,
it's incredibly challenging. I'll always encourage families to plant the
seed and it can sometimes take years. It's a slow burn.
It's not a it's not a knee jerk.
Jean Kittson (25:10):
It's not one conversation.
Brett Lafranchi (25:11):
No plant the seed. I leave information. I've had the
same challenging conversations with my family, my parents who were interstate, um,
and I provide with them with the information that I
think they can read through in their own time. If
I push, they will push back, so they'll draw back.
So I leave it. They have to read through it
in their own time. And, you know, it's effectively they'll
we'll get to their end where we want to. But
(25:34):
they feel that the choice, the respect, the decision has
sat with them with the support of the family, not
the other way around where the family has made the
decision on their behalf.
Jean Kittson (25:42):
Thank you so much. Thank you Jane. So Brett is
Australian Unity's national general manager of residential aged care. So
it's going to be a breeze with your parents, right?
Brett Lafranchi (25:51):
I hope so, um, fiercely independent, but, um, yeah. Small steps.
I've started those conversations a couple of years ago. So
all going, all progressing well at the moment.
Jean Kittson (26:00):
Well, you can still stay independent. That's what I'm hearing.
Brett Lafranchi (26:03):
Absolutely.
Jean Kittson (26:04):
So yeah. Yeah. Well that's a huge step. And well
thanks for sharing. Wonderful. Thank you Jane.
Brett Lafranchi (26:09):
It's been a.
Jean Kittson (26:09):
Delight. Thank you. Thanks. Yeah. Ditto. Okay. What have we
learned from this episode? One of the most important key
takeaways is have the conversation about the family home and
the possibility of having to move out before you need to.
Don't wait for a crisis. You may even start this
conversation one, two, five years before your parents need to
(26:31):
move out of the family home. And maybe they never
need to move out of the family home. But the
earlier you talk about it, the more you understand what
the choices are, and the more you talk about it
with your parents, the more control your parents will have
in the decision that whatever decision they need to make,
retirement communities offer independent and assisted living options. With lots
(26:56):
of different levels of support and different packages available, it's
important to consider what sort of support and independence you
want now and in the future. I mean, we all
want independence in the future. Another key takeaway is that
a move to a retirement community or residential aged care
involves in going ongoing and outgoing costs. So make sure
(27:19):
you understand what those costs are and you seek independent
advice to help you work out how to finance a
move and what it's going to cost, and what your ingoing,
ongoing and outgoing costs will be. Another thing we've learned
is that residential aged care standards are so much better
now since the Royal Commission, much higher standards, and these
(27:43):
facilities have to be much more transparent and much more accountable.
But you will still need to do your homework on
these facilities. You'll still need to look into them, tour
them multiple times, just drop in unexpectedly to try before
you buy. Your loved one could go into a government
funded respite option and stay for a couple of weeks
(28:07):
and see how it feels. You can also check the ratings.
There's star ratings now. You can make comparisons with other
residential aged care facilities. And of course, as I said,
just ask those questions. Ask as many questions as you can.
Thank you so much for joining me for this podcast series,
Parenting Up with Australian Unity. I've really enjoyed chatting to
(28:31):
all these wonderful experts, and I hope their knowledge and
experience has helped you to support your loved ones and
make sure they are healthy, safe, independent and most importantly,
happy for as long as possible. Thank you. The information
(29:00):
provided in this episode of Parenting Up is general in
nature and does not consider your personal circumstances. Australian unity
accepts no responsibility for the accuracy of any opinions, advice,
representations or information contained in this podcast. Listeners should rely
(29:20):
on their own independent advice and inquiries when making decisions
affecting their own or their loved ones finances, health, wellbeing
or other interests.
This is Parenting Up with Australian Unity, a podcast where
we're talking about ageing, and we're looking at some of
those essential conversations that we need to have with our
loved ones as they get older. I'm Jean Kittson, and
(00:21):
this is a subject that is particularly close to my heart.
Having been through this process with my own parents. My
mum is 99 almost and dad is 96. I've even
written a book about it to help us all, but
mainly to help me. We need to talk about mum
and dad. A guide to parenting our ageing parents. Each episode,
(00:43):
I'm going to be joined by expert guests who can
help us navigate these challenging conversations with care and compassion
and empathy and respect. This episode, we're really talking about
how to create a home away from home. When we
get to that difficult place in our lives where we
have to move out of our family home and find
(01:06):
somewhere else that is easier to manage as we get older.
And with me, I have an expert today, which is
fantastic and his name is Brett Lafranchi and Brett is
Australian Unity's national general manager of residential care. Hi, Brett.
Brett Lafranchi (01:22):
Good afternoon Jane, how are you?
Jean Kittson (01:23):
I'm really well. And this is a really tricky topic,
isn't it? I find there's a lot of fear around
moving home and when. When it may be necessary. And, um,
whether or not it's necessary. I think with my own experience,
we moved mum and dad out of their family home
a little bit too early because we thought they weren't coping,
(01:46):
so our decision about them moving home was in a
sort of crisis, and everyone had an opinion and it
was really hard to make these decisions, but really it
should just be calm and planned and then everything can,
you know, you can see what the future may look
like and when is a good time to move. Well,
(02:09):
how do you have these sort of conversations with people?
Brett Lafranchi (02:12):
It's certainly the most challenging gene, and certainly the majority
of our engagements with families, with, with prospective residents is
that it's triggered by an episode, and it could be
one of two things that there's been a medical episode
at home, and they need a high level of care
that they can't get within the home. So that's triggered it.
Or alternatively, the home that they're currently living in is
(02:36):
not fit for them for any further. So unfortunately, more
times than not, it's triggered by an episode or an event.
So what we encourage families and certainly the children, is
to have these conversations much sooner than what we're currently
having now. So it could be one, two, five years
plus earlier. And because then what happens is the prospective
(02:56):
resident feels a lot more engaged in the decision as
to what the future holds for them and what type
of accommodation or or accommodation that can provide the needs
that they want. So it's all about that respect and
and that choice that they get to make. Unfortunately, when
there is an emergency or a medical episode, it's pushed
on very quickly. And so the kids will say, we've
(03:18):
got you this residential aged care home. Or it might
be a retirement community or community or these other services
in place. The choice for them is typically in more
times than not, taken away. So which is really devastating.
It is. And I always say to families, it's like
an insurance policy. You don't insure your home after a fire.
You insure it for for many years, and that safety
(03:39):
net is in your back pocket. So when you need it,
the decisions have been made. You've chosen what type of
accommodation you'd like and a resident will feel far more engaged.
Jean Kittson (03:48):
Well, they will be. They won't only feel it, they
will be more engaged and it will be in their
hands and they will be making the decision. A lot
of people will say it's not safe for you to
be in your own home anymore. But there's something called
the dignity of risk, and that is a human right,
that you are able to take the same risks with
your amount of risk with your body as you want.
(04:11):
So if you fell down a couple of stairs and
then your family panics and says, we've got to get
you on even ground, you might say, well, actually, I'm
willing to take the risk to stay in my own home,
that I might hurt myself on stairs. That's my choice.
And what we've talked about in other episodes is as
long as you understand what the risk is, you can
(04:33):
take that risk. The first thing you really need to
talk about is how long do you envisage staying in
the family home? Can you see yourself in the family home?
Even if you become immobile, will that work? You know,
if you're on a pusher. Both my parents are on
frames now and they could never have. There were stairs
and a really steep driveway, so ultimately that was never
(04:56):
going to work in the long term. And when they
made the decision, well, they actually put their house on
the market and sold it before they'd even decided where
they were going. So it was like just this crazy mess. Luckily,
we found a very nice retirement village, but they weren't
expecting it. They had to get rid of 9/10 of
their stuff. I think first thing is talking with your
(05:19):
loved ones about what they want. Listen to what they want,
listen to what they're afraid of, listen to their fears,
their hopes. Really dig down. Because often our elders will
resist talking about this because they think they're going to
lose their autonomy, their independence. They think they're going to
(05:40):
be forced from the family home. And then people talk
about their stuff like, oh, well, this stuff you got,
you know, everything in their home. They know what it
is and there's a story attached. It's never stuff. Having
to downsize is a very big decision, and I think
we need to give it the respect and the seriousness
(06:02):
and what they will feel. They'll feel a sense of loss,
but it always should be their decision. Don't you agree?
Brett Lafranchi (06:09):
100%. And it's all about it comes back to respect
and choice. So it's important so that you know what
you want in the next stage of your accommodation, of
where you're going to reside. The importance of do I
want facilities? Do I want access to care? Do I
want residential aged care nearby or connected? Do I want
social groups, outings, all of those types of activities that
(06:30):
I can maintain my level of independence. But if you
can make those choices and plan ahead, your fingerprints are
all over it. You've made those calls. Don't wait until
it's too late because a lot of that will be
forced onto you because the options are more limited.
Jean Kittson (06:44):
Can you tell me the difference between, say, a retirement
community option and a residential care option?
Brett Lafranchi (06:53):
Yeah, absolutely. Gene retirement communities, uh, it is independent living.
So it might be living in a in a unit,
an apartment, uh, service department, assisted living apartment, but ultimately
it's independent. So you're doing the majority of things yourself.
You may still be cooking, cleaning, domestic assistance, you know,
you're showering and so forth, and you're far more engaged
(07:14):
in the wider community. That's sort of your your own
community as well. Now, of course, you can still have
services coming into that, but the area is or the
focus area is independence residential aged care. It's 24 seven
care services provided for you. So there's a level of
dependence there where you can no longer cook for yourself,
perhaps activities of daily living. It might be you need
(07:36):
support to to wash or shower, uh, with mobility, all
of those things. So level of independence within retirement versus
dependency within residential aged care.
Jean Kittson (07:47):
So a retirement community is when you have your own
space in there and it might be two bedrooms, lounge, kitchen, bathroom. Yeah.
Brett Lafranchi (07:58):
So it's a it's independent. That's the critical word. So
independent living. And it could be in a unit or
apartment or villa. You also have service departments or, or
assisted living as well which might be then you'll typically
have associated with that accommodation a package. And it could
be a food package, a cleaning package, domestic assistance or other.
(08:18):
And that's all considered independent living. It could be out
and about playing golf every other day. What do you.
Jean Kittson (08:23):
Mean by a food package? You mean a home care package?
Only for food?
Brett Lafranchi (08:28):
Absolutely. But within our service departments, we will actually have
a kitchen and dining room on the site and provide
the meals for those residents in the service departments or
the the assisted living.
Jean Kittson (08:39):
So they're in their own apartment?
Brett Lafranchi (08:41):
Yeah. Within the retirement village. Yeah. But a higher level.
They've got more services and, and package, you know, packages
could be home care funded or through the, the village
and who provide those services. But it's a higher level
because they're less independent at this point in, in their
life than others that are living in the village as well.
But they're able to stay in the village with those
(09:01):
services being connected and provided to them.
Jean Kittson (09:04):
So when you say a package, you mean you buy
that package, or is this a given to you by the.
You get assessed for it.
Brett Lafranchi (09:12):
Correct. You get assessed an assessment for to determine the
level of funding that the government will provide. On what level?
One two, three, four. Or alternatively, it could be private
so you can pay fee for service. For those it
could be $10 a meal. It could be, you know,
$50 a week to get cleaning and laundry or unit cleaned.
That's marvelous. So yeah. So we have a vertical like
(09:34):
an apartment block. Um, most recent one, we opened one, uh,
in June this year. It was, it used to be
our old corporate office in, in Albert Road in, in
South Melbourne. Uh, and we have converted that to an
easy living, so it's independent living and residential aged care
across 15 levels. Got a restaurant up on the top floor,
cafe down on the the ground floor and can provide
(09:57):
all different levels of accommodation for those residents in that
in that vertical building. Others we've got on acreage and
all single storey.
S3 (10:06):
Um, you can.
Jean Kittson (10:07):
Have your own garden and.
Brett Lafranchi (10:08):
Absolutely. And so it's whether it's like a tree change
or a sea change or you want to still live.
You may have lived in a city all your life,
or your family now live in a city. So that's
the motivation, uh, each to their own. We have some
beautiful sites out on acreage, uh, trees, birds. And we
have some wonderful vertical sites in the inner city as well.
Jean Kittson (10:29):
That's great. So, um, how does the financing, I mean,
the one thing we didn't know when Mum and dad
moved into the retirement unit was they don't actually own
their unit. I think people have to be really aware
that you are buying. It's a different sort of contractual thing.
It's not. You need to look at the contract. You
need to get a solicitor, your own solicitor. You need
(10:51):
to be really understanding the fees which there has to
be because the people are paying your rates and everything
like that. Yes. And it's incredibly important to understand that,
because I guess someone explained it to me when I
was writing my book and researching, they didn't realize that
you didn't own your own unit. So when they went
(11:12):
to sort of get a loan for a holiday against
the unit, they couldn't do it because it wasn't their unit?
Brett Lafranchi (11:19):
No. So in our case at Australian Uni, their all
their leases and typically the price that you'd pay. So
there's three sets of costs when you're in retirement living.
There's the in going costs, there's the ongoing costs and
there's the outgoing costs. If we look at the ingoing costs,
typically anywhere between 80 and 90% of the median house
price is what you'll pay for an equivalent unit in
(11:41):
a retirement community versus one that's that's out in the suburbs.
You then pay an ongoing cost. So, as you said,
the cost of maintenance and upkeep of the facilities at
the retirement village and the staff and so forth. So
you pay that and then you pay an out going
cost at the end. So new resident comes in, acquires
(12:01):
your unit, and there'll be an out going, which is
typically a deferred management fee or a capital gain share
or split. That's the outgoing element of it. That as well,
it's a lot of this is new for people because
they do think, hang on, my name's on the the title.
So you're not an owner of the property. So that
saves you at least in stamp duty, not paying stamp
duty when you move into a retirement community. But it's important,
(12:22):
critically important to get that financial advice to know. So
beforehand what assets have I got? Shares, cash, etc.. What
do I need to live for the rest of my time?
And then what can I afford going into a retirement
community or residential aged care? Residential aged care. You've got
to pay a refundable accommodation deposit for the bed so
that financial legal advice is critical. We don't provide that
(12:45):
to our prospective residents or families. We ensure they get
that independent.
Jean Kittson (12:49):
Third party independently. Of course, of course. So residential aged
care is like the old what we used to call
nursing homes. So that's where people move in. They're usually
in a room and you have all the care 24
over seven care. Nowadays it's mandated 24 over seven registered
nurse on duty. So when you move into these places,
(13:12):
people are terrified of them because of all the, you know,
abuse that was often and isolation and neglect that we've
all read about and we're all, um, we're still carrying
those stories with us. But happily, things have changed a lot.
The Royal Commission has laid it all out on the table.
(13:33):
Things are much more transparent. There's residential aged care has
to have a higher level of care hours. And there
are as always, there are the good ones and the
not good ones. So to choose a good one, you
just have to do your homework and you have to
ask the right questions. And you have to make sure
(13:55):
that whichever residential aged care slash nursing home you choose,
you have looked into it, you have visited them, you
have talked to the, um, CEO, you've talked to the.
Brett Lafranchi (14:06):
General manager of a home. Or it could be the
well-being and transitions manager at, in our case, who will
write tour a prospective family. But Gene, you've hit the
nail on the head. But I will say the the
the analogy with the nursing homes. Uh, it is an
old one, but it is still people think of a
nursing home, and we have heard all the horrible, horrible
stories on the news over the past decades. But a
(14:28):
residential aged care facility now is not that we have
turned the corner in terms of the big providers with
the the developments and refurbishments of their homes and Australian uni.
We we are a promoter and certainly deliver the small
household model, and the small household model will say that
a household doesn't have any more than 17 residents in
it and effectively what you had at home. Close proximity
(14:50):
to your bedroom, en suite, lounge, living, dining, kitchen is
all within a very small household within a residential aged
care facility. Not like the old days. With the nursing home,
you might have to travel 50m 80m down the corridor
to the communal dining room, which was like a school
canteen rather than a small household. So you come to
(15:10):
residential aged care facilities. Now most of them are certainly
the Australian uni ones are stunning in terms of that
small household design. Uh, and it's, it's like it's like
walking into a hotel. So that's.
Jean Kittson (15:22):
Great.
Brett Lafranchi (15:22):
But it's critical that families tour multiple times. Yeah. Before
you settle on on a on a home, there are
some critical decisions you need to make and post royal commission.
The government has been very proactive in terms of lifting
the the standard and even just more recently in the
last 12 months was the the star ratings. So every
(15:43):
aged care home in this country is provided with a
star rating for different categories that give you the rating,
whether it's five stars or one star. Compliance. So how
compliant are you to the accreditation requirements and standards resident experience?
So they'll interview residents and see their overall experience of
living in that home. Um, staffing. So as you said,
(16:04):
you're mandated care minutes at least are, you know, Indicatively
200 care minutes per resident per day, including 40 registered
nurse minutes per minute per day, and And it also
quality measures. So key indicators from a quality perspective falls
medication management, um, uh, pressure wounds and so forth. All
(16:27):
of those key metrics that I'll measure those, you've got
to report those to the government on a quarterly basis,
and that determines what your overall star rating is. So
that can give families reassurance. You compare all your local
aged care facilities in your area that you're looking at,
and those are a controls the government has recently put
in place post royal commission to reassure families that, you know,
(16:47):
it's meeting the expected requirements that you would put, expect
before you put mum or dad into the facility.
Jean Kittson (16:54):
But I'm thrilled to hear about the model of residential
aged care being the smaller community house, the community, the
family home. So you would have. How many did you
say 7 or 17?
Brett Lafranchi (17:08):
No, 17 would be a typical household size for for
us in our small household model and our Better together
design at Australian Uni across our homes. So now we've
got some homes that are 160 beds, so you've got
multiple households within that. And one of those would be
a memory support unit. So yes. So if you walked
into a household you'd know you'd be in there. There's
(17:29):
the kitchen, there's the lounge dining, but it's a small
dining where no more than 17 people would be sitting there.
Not a big cafeteria style. There's my room. I've got
an en suite there. It's all within short proximity, so
it's not like the old racecourse style nursing home. You'd
walk laps of the facility. And here's my lounge room
next to 20m down. Here's my dining room. This is
(17:51):
where I have my meals. Um, it's all very much changed.
It is everything within close proximity. You don't have to
walk far to have all of the services and facilities
that you would have had in the family home.
Jean Kittson (18:02):
How have you come up with a figure 17?
Brett Lafranchi (18:05):
How did that? There was many algorithms to, to, to
establish and look at that and also from the staffing.
So with our Better Together philosophy with staffing is that
the same staff will be in that small household day in,
day out, so that they get to know 17 residents
or if the ratio is in the morning are one
staff to six residents or something similar along those lines.
(18:26):
They know very to a to a significant level of detail,
the ins and outs of that resident, what their needs
are and if they're potentially having an off day and can,
you know, escalate that need to perhaps the GP or
the registered nurse to have a look and they'll often
know that to a higher extent or a better extent
than family who aren't seen them every day. No. That's right.
So so that they're the same level of staffing, they're
(18:49):
very engaged to to provide the services and, and level
of care that that the resident.
Jean Kittson (18:54):
Care is everything. You know, people talk about, oh, look
at the water feature. And you know, we've got free
WiFi for the grandkids. But that's not as important as
care everything comes down to how people are treated.
Brett Lafranchi (19:08):
Yeah, and I'll say also, I put clinical care and care,
which is your activities of daily living is, is is
all in in one bucket. But just equally as critical
to that is is food is you know, you want
three hearty meals plus two teas, plus maybe a supper.
So six you know, chances to to eat. We our
small household models have stocked pantries, so if you want
(19:31):
to grab something during the day, a piece of fruit
or something, you just go and you go and do that.
You make that choice and that decision.
Jean Kittson (19:37):
Can you make your own cup of tea?
Brett Lafranchi (19:39):
Absolutely. So, but.
Jean Kittson (19:40):
Also in a real.
Brett Lafranchi (19:41):
Cup, 100%, yes you can. And just like we have
also at our aged care facilities, it could be a washing.
So laundry with, you know washing machine drying ironing board
if you want to. We'll do that for every resident.
But if a resident says no, no, I want to
remain independent and do my own laundry, of course they can.
So it's all about choice, respect and ensuring that can happen.
Jean Kittson (20:02):
When I was researching, I would go on websites and
all these residential aged care there would say there are
five important questions you need to ask before you move
into residential aged care. But when I dug deeper and
talked to CEOs of residential aged care, good ones, they said, no, no, no.
(20:24):
There's about 160 questions you need to ask. You need
to ask questions about the funding side, the food, the security,
the clinical care. Like if you are going to age
in place in residential aged care, then have they got
palliative care specialists and what you know, can the family
(20:44):
stay there. There's 160 questions.
Brett Lafranchi (20:47):
And could ask questions forever and a day. That's why
we always encourage families and prospects. Come once, come twice,
come three times. You cannot make a decision after a
two hour visit. Um, I also encourage respite. The government
will give you nine weeks, 63 days per a year
of paid funded respite. And so where you've got a
family member who may be a little bit resistant to,
(21:08):
to going to a two week stay, it's like a holiday.
It's like being on a cruise ship and then come
home to your family home, maybe a few months later,
go back for more respite. And that transition or the
slow low, slowly but surely trying before you buy. Yeah.
Is the is an effective way so that then the
residents thinking ah I'm actually I'm making this decision. I'm
not being forced by the kids. You might have provided the,
(21:30):
the the accommodation option to the loved one, but they've
ultimately made the decision. So respite works wonderfully well. And
you'll go through everything as you said. Jean, what are
we eating today? What's how often do you change the menu? Oh,
we'll do it seasonally. Uh, is it all prepared fresh? Uh,
you could ask 100 things, dietary needs and so forth.
Once you know your your care needs or your dietitian
(21:55):
type needs change activities, funding, uh, security.
Jean Kittson (22:00):
Funding, staffing ratios and the depths are, you know, those
types of things.
Brett Lafranchi (22:05):
So you've got, um, you've got your red refundable accommodation deposit,
which is the, the value of the, the bed, the
room price that the government has approved. Uh, you may
choose to not pay it up front half $1 million
or something. So you can take a DAP, which is
a daily accommodation payment. So effectively it's an interest rate
on that capital amount of half $1 million.
Jean Kittson (22:25):
Can I just explain, um, what I understand is refundable
accommodation deposit because some people go, we gave you $500,000
and and, you know, and we have to share a
room or whatever, but you don't get that money. You
can only use the interest off that money. That money
goes into a trust or something to be repaid to family,
(22:47):
doesn't it?
Brett Lafranchi (22:48):
So government is very clear on permitted use of the
prudential obligations with with refundable accommodation deposits. Absolutely. And it
is exactly that refundable accommodation deposit if you have given
the provider of the aged care facility half $1 million
upon exit of the resident, you get that $500,000 back
then there's a daily charge, which is, you know, your
(23:08):
daily care fee, which is 85% of the pension. If
you've got money, financials, assets, the government might, might ask
you to contribute to your care daily care costs through
a means tested fee. Um, there could be some additional
type services. So you get the choice of, you know,
a hot breakfast or something, you know, for, for brekkie
(23:29):
or multiple hot meals for lunch to get that choice.
There'll be an additional potential charge there. So and then
at the, um, upon exit, that money is fully refunded.
So that refundable accommodation deposit amount, you want to make
sure it's all appropriately documented. Hence why you get your
financial and legal advice to. Yeah, to dot all those i's,
(23:50):
cross those t's before signing any residential agreement and moving
into residential aged care.
Jean Kittson (23:55):
Um, we've talked about how to look at all the
different aspects and how to get the right advice and
get independent advice, but always, I guess always, it's really
important to come back to sitting down. And as you say,
having these conversations earlier rather than later checking out a
(24:17):
few places. So that's no fear. No one's going to
put you in a home. No one's going to make
you sell your family home. But if the time comes
when you can no longer manage and that's your decision,
when you no longer want to manage all the things
that go into a family home, the constant upkeep and things,
(24:39):
then these are your options. And you've already had a
look at them and you've had to think about them.
You've chatted to them and there's no fear involved.
Brett Lafranchi (24:49):
And I will always encourage because when you age, you
become fiercely independent of the remaining independence that you have.
And I see it with people giving up driving licences,
their licences they've had since they were a teenager. Um,
it's incredibly challenging. I'll always encourage families to plant the
seed and it can sometimes take years. It's a slow burn.
It's not a it's not a knee jerk.
Jean Kittson (25:10):
It's not one conversation.
Brett Lafranchi (25:11):
No plant the seed. I leave information. I've had the
same challenging conversations with my family, my parents who were interstate, um,
and I provide with them with the information that I
think they can read through in their own time. If
I push, they will push back, so they'll draw back.
So I leave it. They have to read through it
in their own time. And, you know, it's effectively they'll
we'll get to their end where we want to. But
(25:34):
they feel that the choice, the respect, the decision has
sat with them with the support of the family, not
the other way around where the family has made the
decision on their behalf.
Jean Kittson (25:42):
Thank you so much. Thank you Jane. So Brett is
Australian Unity's national general manager of residential aged care. So
it's going to be a breeze with your parents, right?
Brett Lafranchi (25:51):
I hope so, um, fiercely independent, but, um, yeah. Small steps.
I've started those conversations a couple of years ago. So
all going, all progressing well at the moment.
Jean Kittson (26:00):
Well, you can still stay independent. That's what I'm hearing.
Brett Lafranchi (26:03):
Absolutely.
Jean Kittson (26:04):
So yeah. Yeah. Well that's a huge step. And well
thanks for sharing. Wonderful. Thank you Jane.
Brett Lafranchi (26:09):
It's been a.
Jean Kittson (26:09):
Delight. Thank you. Thanks. Yeah. Ditto. Okay. What have we
learned from this episode? One of the most important key
takeaways is have the conversation about the family home and
the possibility of having to move out before you need to.
Don't wait for a crisis. You may even start this
conversation one, two, five years before your parents need to
(26:31):
move out of the family home. And maybe they never
need to move out of the family home. But the
earlier you talk about it, the more you understand what
the choices are, and the more you talk about it
with your parents, the more control your parents will have
in the decision that whatever decision they need to make,
retirement communities offer independent and assisted living options. With lots
(26:56):
of different levels of support and different packages available, it's
important to consider what sort of support and independence you
want now and in the future. I mean, we all
want independence in the future. Another key takeaway is that
a move to a retirement community or residential aged care
involves in going ongoing and outgoing costs. So make sure
(27:19):
you understand what those costs are and you seek independent
advice to help you work out how to finance a
move and what it's going to cost, and what your ingoing,
ongoing and outgoing costs will be. Another thing we've learned
is that residential aged care standards are so much better
now since the Royal Commission, much higher standards, and these
(27:43):
facilities have to be much more transparent and much more accountable.
But you will still need to do your homework on
these facilities. You'll still need to look into them, tour
them multiple times, just drop in unexpectedly to try before
you buy. Your loved one could go into a government
funded respite option and stay for a couple of weeks
(28:07):
and see how it feels. You can also check the ratings.
There's star ratings now. You can make comparisons with other
residential aged care facilities. And of course, as I said,
just ask those questions. Ask as many questions as you can.
Thank you so much for joining me for this podcast series,
Parenting Up with Australian Unity. I've really enjoyed chatting to
(28:31):
all these wonderful experts, and I hope their knowledge and
experience has helped you to support your loved ones and
make sure they are healthy, safe, independent and most importantly,
happy for as long as possible. Thank you. The information
(29:00):
provided in this episode of Parenting Up is general in
nature and does not consider your personal circumstances. Australian unity
accepts no responsibility for the accuracy of any opinions, advice,
representations or information contained in this podcast. Listeners should rely
(29:20):
on their own independent advice and inquiries when making decisions
affecting their own or their loved ones finances, health, wellbeing
or other interests.
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