Residential Care: answers to common questions

Are you thinking about moving into a rest home, or helping somebody else to make the move? This page provides you with answers to some common questions about residential care. 

1. How is residential care provided?

Residential care in New Zealand is provided by private companies and not-for-profit organisations.  In most cases the cost of care to the individual is subsidised by government funding known as the Residential Care Subsidy.  Residential care falls into four levels: rest home care, long term care hospital, dementia care, and psycho-geriatric care. Some homes provide all the levels of care and some do not.  NB: In the following information, the term 'rest home' is used to refer to all these levels of care. 

2. What determines whether I can move into a rest home?

To be eligible for government-subsidised residential care you must first be formally assessed as ‘needing care’. The assessment, called a ‘needs assessment’, must be carried out by a Needs Assessment and Services Coordination agency (NASC).  Your GP can help arrange for an assessment to be carried out. 

The bar for entry to residential care is higher than many people expect.  You are likely to be eligible for residential care if you have ‘high’ or ‘very high’ needs, and cannot be safely cared for at home. For more information about needs assessments contact your local NASC

3. Do I have to move?

Deciding to move into a rest home is a major decision involving many factors that you will want to weigh up.  The end result should be an improved quality of life. Older people often tell us that the move into a rest home is easier when the decision is ultimately their own. 

 For more information about how to make the move easier see the booklet A question of Care.

4. What can I do to find a rest home that suits me?

 You can get a list of rest homes in your area from the District Health Board, your local Age Concern, or the Needs Assessment and Service Coordination agency.

Age Concern recommends shopping around,visit the homes and compare them.

These are checklists available to help you:

Consumer magazine: Rest home checklist
Alzheimers New Zealand Residential Care Checklist is a great website that gives further information about what you need to know about the aged care process: from how to get an assessment through to entering into a rest home or hospital.

It is a good idea to start looking as soon as you think you might need a rest home, as it may not be easy to do so once you actually need the care.  When you find a home you like, ask to have your name put on the waiting list.  You can do this even if you have not yet been assessed as needing care. If the rest home of your choice doesn’t have a vacancy when you need it and you have to move into another home instead, ask to transfer to the home you prefer as soon as a suitable place is available. 

The Eldernet website lists rest home vacancies nationwide.

5. What government funding is available to help with the costs?

Once you have been assessed as ‘needing care’ the person who carried out your needs assessment will explain how to apply for the Residential Care Subsidy.  Government helps to fund the cost of care through this subsidy. It is means tested and depends on the level of your assets and income. 

If your assets are equal to or below the asset threshold, you will qualify for the subsidy to pay for most of the cost of your care. The income test then determines what you will have to contribute to the cost of your care from any income you receive.  To get full details about the Residential Care Subsidy and find out if you might qualify, contact the Work and Income Residential Subsidy Unit. They can also be contacted on 0800 999 727

If you don’t qualify for the subsidy, you will have to pay your own way.  However you can ask for a review of your means test at any time if you think you might have become eligible for the subsidy.

6. I don’t qualify for the subsidy – how much will it cost?

If you have been assessed as needing residential care, and  move into a rest home that has a contract with the District Health Board, you will pay no more than a maximum weekly amount set by the District Health Board to cover the care you have been assessed as needing.

This is known as the ‘maximum contribution’.  If you had not been assessed as ‘needing care’, there would be no restriction on how much you could be charged for your care and you would not be able to apply for the Residential Care Subsidy.

This limit is set every year by the District Health Board. You can find the most recent limit in your area here.  

The maximum contribution covers the care that you have been assessed as needing and must include: 

• Accommodation
• Food
• Laundry
• Nursing and care
• GP visits
• Prescribed medication
• Continence products
• All health care prescribed by a GP
• Transport to health services

7. Can I be charged more than the ‘maximum contribution’?

Yes, but only if you choose to receive extra services or facilities over and above the care you have been assessed as needing. 

Examples of extra services or facilities MAY include:

• A ‘premium’ room e.g. with en-suite facilities, a good view, garden access etc.
• Specialist visits (that are not publicly funded)
• Transport to other services or to outside social events
• Toll calls
• A private phone or cell phone
• Newspapers, books or magazines
• Personal toiletries
• Recreational activities that are not part of the normal programme
• Hairdresser
• Dietician, podiatrist, or other services that have not been prescribed by a doctor, and are  not publicly funded
• Glasses, hearing aids and dental care

You have the right to refuse all the extras, or you can negotiate to find an arrangement that suits you.

Extra charges are something to be careful about. Problems over fees can be very stressful if they come to light after you have moved in. 

When visiting rest homes initially, ask them to: explain their fee structure, what happens if you change your mind later about an extra service and what would happen if there are changes to the fee structure or conditions after you move in.  It is a good idea to take a blank copy of their Admission Agreement home to read.  If you do decide to receive extra services that incur charges, the rest home must  specify these in your Admission Agreement.  If, at a later date you choose not to receive the extra service, inform the manager of the rest home and your Admission Agreement will be amended. 

8. More about the Admission Agreement

Information about what services the rest home will provide, and what you have agreed to pay are written into your Admission Agreement. This is the contract you sign with the rest home before moving in.  Take your time before signing this agreement.  Treat it as you would any other legal document or contract. Have someone you trust look over it. Don’t be afraid to negotiate and don’t sign up to extra services and charges if you don’t want them.  For more information see the Ministry of Health’s booklet Long term residential care for older people.

9. What are the rules about giving away assets?

There are rules about giving away assets (gifting) before moving into residential care.  Currently (2014) there is a gifting limit of $6,000 per year which applies for each of the five years before applying for a residential care subsidy.  Gifts of more than $6,000 in each of the five years before moving into a rest home are taken into account when eligibility for the residential care subsidy is assessed.  Also, gifts of more than $27,000 per year, made before the five year gifting period, may be added into the assessment. Find out more about gifting here. 

10. How is the quality of residential care monitored?

Rest homes must meet the Health and Disability Services Standards NZS 8134:2008 (read the full document here), and be certified to operate by the Ministry of Health.  They must also meet the requirements set in their contract with the District Health Board.  The Ministry of Health arranges both regular and ‘spot’ audits of all rest homes to ensure they are continuing to meet both the Standards, and the District Health Board contract requirements.  The District Health Board and the Ministry of Health will carry out additional inspections if needed.  Summaries of audits for all residential homes are available for the public.

11. How are complaints made?

If problems arise once you have moved in, don’t be afraid to raise your concern or to make a complaint. Every rest home is required to have a written complaints procedure.  Start by talking to the rest home manager.  You have a right to have a support person/advocate with you such as a friend or family member.  If you are not satisfied, then there are other agencies available to help:

• Your local Age Concern for information, advice and support, or specialist elder abuse prevention services.
• If the concern is about the quality of care, contact your local Health and Disability Advocate (part of the Nationwide Health and Disability Advocacy Service) 0800 555 050
• You can also contact the Older People’s Portfolio Manager at your local District Health Board
• If the concern is about financial issues that you cannot resolve with the rest home, we advise you to contact the Disputes Tribunal
• You can also contact the Ministry of Health on their Information Line 0800 737 777

12. Who will make decisions for me if I can’t?

Age Concern recommends that everyone should set up an Enduring Power of Attorney – the earlier the better and at least before moving into a rest home.  This enables you to appoint the person of your choice to manage your affairs and make decisions on your behalf if necessary.  If you do not do this yourself, and you needed someone to look after your affairs, the Family Court might have to appoint someone for you.