Residential care
Residential care is care provided in a rest home, private hospital or dementia facility. You may consider it when someone you care about has poor physical or cognitive health and can no longer live safely at home. The decision can be difficult for all whānau members.
What residential care is
Residential care is care provided in a:
- rest home
- private hospital
- dementia facility.
Publicly funded permanent residential care must be accessed through Health New Zealand | Te Whatu Ora. People can enter residential care without going through Health New Zealand, but this means they must pay the full cost of their care.
Residential care can seem very complex, but the key steps are:
- getting a needs assessment
- visiting possible care facilities
- understanding the costs, including fees not covered by public funding.
It can be a great relief for everyone when suitable residential care is found. Carers can still choose to be involved as much or little as they wish.
If you are considering the need for a rest home or hospital, it is a good idea to have as much information as possible.
Where to start when thinking about residential care — New Zealand Government (external link)
Eligibility for publicly funded residential care
To be eligible for publicly funded residential care, the person must first be:
- eligible to receive the full range of public funded health and disability services in Aotearoa New Zealand.
The person must then also have:
- a needs assessment to determine their needs and the level of care required to meet those needs — it may be the person can receive care services in the community or supported living environment, and that residential care is not required.
Needs assessment for residential care
The Needs Assessment and Service Coordination (NASC) agency in your area is responsible for needs assessments. Your healthcare provider can refer you for a needs assessment or you can refer yourself. It is sometimes also called an 'interRAI' assessment.
Needs assessment service (internal link)
The assessment will determine:
- whether or not the person has a condition that can be reversed
- whether or not the person can be safely supported in the community
- if the person needs long-term residential care indefinitely, what level of care is required — in a rest home or a continuing-care hospital.
A needs assessor will visit — at home or in hospital — and ask to talk about:
- preferences
- tasks the person finds difficult
- available family, whānau or social support
- services that could help the person stay at home
- whether the person meets the criteria for long term care.
A needs assessment is helpful in other ways — it can also make sure you:
- are aware of community support services that would help the person remain in their own home
- have access to rehabilitation and specialist medical advice that may improve the person's health
- have help with making the critical decision — it is difficult for the person to return home once they move into care
- know the costs of residential care and the assessment criteria for public funding.
If it is not possible for the person to stay safely at home, the needs assessor can authorise entry to residential care. The decision on which residential care is suitable considers both the needs assessment (interRAI) and a clinical assessment (to determine the level of care needed).
To access the Residential Care Subsidy you must have a clinical assessment by a needs assessor recommending long-term care.
Choosing a residential care facility
Choosing a rest home or hospital is an individual choice for a person and their whānau. Care facilities often have a website to view. Eldernet lists all rest homes nationally, and which ones have vacancies.
- Residential care — Eldernet (external link)
- Certified rest home providers and audit information — Ministry of Health. (external link)
Levels of care
There are different types of care — all certified by the Ministry of Health and contracted with Health New Zealand.
Rest homes
Rest homes provide 24-hour care to older people who cannot live safely at home. Residents may be able to do some daily tasks themselves but might need help showering, dressing and moving around.
There is a registered nurse for some hours each week and at least 1 care staff on-duty at all times. Further staff will depend on the number of residents.
Dementia rest homes
A person with dementia does not necessarily need care in a dementia rest home, but it may be the assessment recommendation. Residents are often confused and require specialist care in a secure environment. Staff are trained in dementia care.
There is a registered nurse for some hours each week and at least 1 staff member on duty at all times, with another readily available on site.
Private hospitals
Private hospital care is for older people who need nursing due to illness and disability. These long-stay 'hospitals' are very different from public hospitals. Doctors are not on duty 24 hours. Residents tend to be immobile and many are confused.
Private hospitals have 2 staff on duty at all times, 1 registered nurse and 1 caregiver. Staffing is according to residents’ needs.
Specialist hospitals
Residents in specialist hospitals — also called ‘psychogeriatric' hospitals — have high needs and, often, challenging or noisy behaviours. The behaviour may be due to dementia or a combination of age-related disability and a mental health condition. Staff are trained to manage this type of behaviour.
Specialist hospitals have a minimum of 2 staff on duty at all times, 1 registered nurse and 1 caregiver. Larger facilities with several units on site may share registered nursing cover from 10pm to 7am.
Care suites
Some villages offer care in serviced apartments or care suites. These are purchased like any retirement village property. The apartment is certified by the Ministry of Health and contracted to Health New Zealand to provide residential care (usually rest home or hospital care) in the apartment. You pay for care privately or using the Residential Care Subsidy.
Viewing the facility
Making an appointment to view a facility ensures the manager is free to talk. Or you may prefer to arrive unannounced, but avoid first thing in the mornings and mealtimes, as these are the busiest for staff.
Ask whether premium room fees apply when you visit. Premium room fees of around $10 to $85 a day are common. There is no public funding for these fees. Your choice will be limited if you cannot fund these fees privately.
Day care or short stays can be a useful way to get to know a facility and its staff, if the facility offers this.
If you need to move in urgently, as can happen, and you plan to transfer later, make this clear from the beginning. Try to negotiate a shorter period of notice in the admission agreement to avoid paying both facilities during the transfer.
If you move in and then decide it is not the right place, you can move again. Contact the NASC agency again to begin a transfer process.
Useful questions to ask when viewing a facility — Seniorline [PDF, 258 KB]
Admission agreement
This is a legal document that protects the resident and the rest home or hospital. It is a requirement which sets out the responsibilities of both. Take it away with you, read it carefully and seek advice.
You can try to negotiate a different arrangement and change the agreement to reflect this. In the end, both parties need to agree or 'initial' changes, as in any other legal document. There is no charge for providing an agreement.
An admission agreement must include issues such as:
- liability for damage or loss of residents’ personal belongings
- staffing, resident safety and security policies
- transport policies
- procedures
- costs including any extra charges — signing means you agree to pay these
- complaint processes
- circumstances when a resident may be required to leave a facility.
Aged residential care provider agreements — Health New Zealand (external link)
Providers cannot charge you for services that are already funded such as general practitioner visits, medications and continence products.
Care plan
This is a separate but important document covering the care needs of the resident and how care is delivered.
Care plan details should be written together, with the person and their whānau. If you have specific dietary requirements or if whānau want to be notified if you have a fall, the care plan is where you record this.
Later on, if you want to change part of your care, the plan forms the basis for discussion. Care plans should be reviewed every 6 months or when there is a change in health status.
Your admission agreement and care plan — New Zealand Government (external link)
Residential care fees
Residential care providers charge different amounts. Contact the care provider to find out what they will charge if you move into their rest home or hospital.
What you pay each week is written in the admission agreement you sign with your rest home or hospital.
Contracted care and the maximum contribution rate
If your residential care facility has a contract with the government, there are lifestyle, health professional and accommodation services they:
- must provide
- cannot charge you extra for providing.
This is called 'contracted care'. These services are covered by fees known as the 'maximum contribution rate'. The fees are capped and apply at all levels of residential care, and for subsidised and privately paying residents.
Additional fees must be in the admission agreement
Extra fees can be charged for items or services outside of 'contracted care', by negotiation. The admission agreement for the facility must specify details of any additional fees that apply to these additional services.
- If agreed, a private paying resident can be charged a premium room fee on top of the maximum contribution rate, for example.
- For high levels of care, such as hospital or dementia level care, the cost is greater than maximum contribution — this is covered by a top-up subsidy, with application made by the needs assessor. The residential care provider is paid this directly.
- Care facilities cannot charge for services included in the 'contracted care'.
More information on services offered in residential care — New Zealand Government (external link)
- Accommodation, meals, cleaning and laundry.
- Nursing and other care.
- Doctor or nurse practitioner visit on admission, then monthly and as clinically indicated, or every 3 months at the doctor’s discretion.
- All prescribed medication costs (Pharmac-approved) plus packaging, for example blister packs.
- All dressings and supplies used in treatments.
- Continence products to meet assessed need.
- Equipment and mobility aids for communal use.
- Activities that are part of the regular programme.
- Dietitian advice, physiotherapy, speech therapy and podiatry, if prescribed by a doctor or nurse practitioner.
- Temporary absences — in any year, subsidy continues to be paid during a brief absence. Up to 14 days at a time to a maximum of 28 days, or 21 days if you are admitted to a public hospital, and longer if approved by needs assessment.
Transport for health reasons, for example to and from a local public hospital. - Someone to accompany a resident to a health appointment if no family or friends are available.
Many services are outside of the contract. This is not a complete list, but it includes things which often have an extra charge:
- premium rooms, for example with an ensuite bathroom
- vitamin and supplements, unless Pharmac-approved and prescribed by the doctor or nurse practitioner
- services of dentists, opticians and audiologists
- private specialists
- x-rays
- private medical appointments you have made without the knowledge of the rest home or hospital
- personal items such as hairbrushes, razors, TV, radio, cigarettes and batteries
- personal clothing and drycleaning
- basic toiletries such as soap, shampoo, toothpaste, toothbrush and talcum powder
- hairdressing
- wheelchair for your exclusive use
- insurance of personal belongings
- entrance fees to shows and concerts
- private telephone, toll calls, internet or Sky TV.
Paying for residential care
You are responsible for paying for your own residential care but you may qualify for government help.
To pay for residential care you can:
- apply for help with payment through the Residential Care Subsidy — you must have had a needs assessment first. The subsidy is paid directly to the care facility and the amount for you to pay depends on the assessment of your income.
If you do not qualify for the Residential Care Subsidy you will need to:
- pay all of the fees privately.
If you still need help with paying for your care privately and you own your home:
- you can apply for a Residential Care Loan.
Residential Care Subsidy — Work and Income (external link)
Residential Care Loan — Work and Income (external link)
Paying for residential care — New Zealand Government (external link)
Private payers
Private payers pay their own fees, which are limited to the maximum contribution for contracted care services. This applies to all levels of care — rest home, hospital and dementia facility care.
Wheere high levels of care are needed, such as for hospital or dementia level care, the cost is greater than the maximum contribution. This cost difference is covered by a top-up subsidy, which applies to all needs-assessed clients requiring a high level of care, including those paying privately.
Private payers continue to receive New Zealand Superannuation.