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Meet Mary
Mary is 82. Her husband died 5 years ago, and her 3 children have all moved away. Her hearing is getting worse and has been diagnosed as being in the early stages of dementia by her GP. Her GP has said she can get help through My Aged Care, but Mary thinks this means she will have to go into a home so has not called. She speaks to her children regularly but is not willing to admit she is having trouble keeping the house clean and has not told them about what her GP has said. She is less connected with her community than she used to be and is no longer confident to drive. She does not know how to use a computer or have access to the internet.
Time for a care finder:
- When Mary next visits her GP, the GP asks if she would like to be contacted by someone called a care finder who could help her get some support to stay at home for as long as possible. Mary says OK.
- The care finder calls Mary and introduces themselves as the person the GP said would call and arranges a time to visit to talk about how she could help.
- The care finder visits Mary, and they have a chat over a cuppa about how she might need help at home.
Registration & Assessment:
- Mary says she could do with help to keep the house clean and tidy, and the care finder says they might be able to get some help with cleaning. The care finder asks if Mary would like to see what she is eligible for. Mary agrees.
- They complete the apply for an assessment online form together on the care finders iPad and Mary is happy to nominate the care finder as her ‘agent’.
- The care finder asks Mary if she would like them to be there at her assessment and Mary is keen to have them there. She is assessed as eligible for transport and social support.
Providing support and going through next steps together:
- Mary completes the means test form with support from the care finder at her home and they call Services Australia together to work out answers to some questions.
- They look for local providers together on the My Aged Care website and make appointments for them to visit. The care finder helps Mary choose providers and understand the agreements she needs to sign.
- They also call the National Dementia Helpline together and learn about a local support group for people living with dementia.
Checking in to see if services are still in place and meeting client’s needs:
- After a month, the care finder calls Mary to see how things are going.
- Mary says the transport to the social group is working well but doesn’t like that she gets different care workers each visit and they don’t come at the time they say they will. Last week she cancelled the service.
- The care finder arranges a time to visit Mary and they talk about Mary’s concerns. Mary says she is having trouble with keeping the house clean and tidy.
- The care finder suggests they could talk to the provider about the issues and Mary agrees.
Follow up support if needs change or services have ended:
- They call the provider, but they can’t resolve the issue.
- The care finder asks Mary if she would like to be put in touch with an advocate to help but Mary doesn’t want to talk to anyone else.
- The care finder suggests Mary could change to a different provider and Mary agrees.
- They call one of the other providers in the area who promises to send only 2 different care workers and to be on time. They set up the service together.
- The care finder checks in again a few weeks later and all is going well. She checks in around every 3 months after that.
Meet John
John is 66. He has experienced mental health issues all his life, has not been able to work for many years and lived with his sister most of his adult life. His sister is in her seventies and has recently moved into residential aged care and given up her rented flat. He doesn’t have any financial support from the Government as he is afraid of them knowing his business, but his sister can no longer support him. He has moved in with an old friend as a short-term solution, but she doesn’t have much space.
Time for a care finder:
- John’s friend calls the local council and explains John’s circumstances, without giving his name, and asks about how he can get more permanent housing. She is given the number of a local care finder organisation.
- She calls and describes the situation. A care finder called Pete calls her back and offers to talk to John if he agrees.
- John agrees to talk on the phone and is reassured that Pete says he doesn’t need to give any personal information if he is not comfortable.
- After many conversations, John says what he wants most is help to visit his sister at her care home regularly.
Support to access aged care connect with supports:
- Pete says John can get transport through My Aged Care but, while they are arranging that, a volunteer from his organisation can drive him there.
- John is happy about this and soon after agrees to go to his GP for a medication review. A few weeks after seeing his GP, John is feeling well and is interested in accepting more help.
- Pete helps him apply for financial support through Services Australia and social housing. This takes some time as John remains fearful of providing information.
- Eventually John moves into a social housing property.
Registration & Assessment:
- Pete suggests John might benefit from further support, such as help with cleaning and a social group.
- John is wary of people coming into his home but acknowledges he would like the help and to have more company.
- They apply for an assessment on the My Aged Care website together and Pete promises he will be there when the assessor comes. Pete makes sure the assessor is aware of John’s fears before the meeting.
- After the assessment Pete helps John contact local providers and over a few months gets the services organised.
Checking in to see if services are still in place and meeting client’s needs:
- After a couple more months Pete calls John to see how he is going.
- John is still living in the apartment but is no longer getting cleaning or going to the social group.
- Pete offers to come round to talk about it. When he gets there, John says the cleaner stopped coming and he doesn’t know why.
- Pete calls the provider and is told the apartment is too cluttered and dirty for the cleaner.
- John says he only went to the support group a couple of times because he had nothing in common with the other people.
Follow up support if needs change or services have ended:
- With John’s consent Pete arranges a deep clean of the apartment through a hoarding and squalor specialist provider and they work with John on strategies to avoid getting into the same situation.
- Pete also talks to the cleaning provider about coming more frequently and helping John to decide what to throw away at each visit.
- Pete explores other options for community support and puts John in touch with a local Men’s Shed. John thinks this will be a better fit for him.
- Pete stays in regular touch with John and helps adjust his support as needed.