Episode 2: You get what you pay for

Welcome to Let's Get Acquainted, a modern guide to ageing well at home. Today we're going to talk about something that everybody wants to know more about, money and the costs of ageing. When it comes to aged care there's an assumption that you either use the free publicly funded at home support programme or move to residential care and residential aged care isn't free either as homes range from basic to luxury with varying price points.

There is another option which you may not have considered, luxury aged care in your own home. I'm your host Julie McBeth and I'm joined by Fiona Somerville, Managing Director of Acquaint, a premium in-home aged care service. Fiona let's address one of the questions you must get asked all the time, do you have to be rich to access quality home care? Well it depends on how much care you need.

We've kept people at home with as little as three hours a few times a week to three hours every day and then we go all the way through everything in between that all the way through to 24 hours a day, seven days a week live in care and even more than 24 hours a day care when we might have double up of staff or things like that. So yes if you're looking at the 24 hours a day, seven days a week live in care, yes that does require significant funding however people are quite surprised often at what it does, what it may cost to really keep somebody at home. Everyone's default is often oh mum needs to go into a nursing home and the instant answer is oh so we need to replace that with 24-hour care because she doesn't want to move and often the answer is not necessarily that people do need 24-hour care, we find that happens quite a lot.

When you say Acquaint offers premium care, what does that actually mean, what are people paying for?

Fabulousness, look what people are paying for with us is knowing that when they call we know who they are, a human answers the phone, we're not shoving people around press one to get to this department, press two to get to that, we're not speaking in government funded jargon.

All of our employees, our staff we vet and recruit very carefully and we keep really close, we're very clear in our policies and procedures with our staff, we get feedback on every single shift, every single staff member does so.

And then in the office it's a nurse led clinical overlay for all of our clients in that any time we do get a report or a question or we're talking to our staff we can read between the lines so we often will identify “hang on a minute we need to investigate that a little bit further” or maybe this person needs a bit more help or we need to talk to the family about X, Y, Z if it's the family that are the contact point as opposed to the client themselves directly.

So there's a lot that we do and we've prevented people from going back to hospital because we've identified things early and quickly and dealt with stuff so that's really important.

I think you've described it as the difference between business class or first class and economy in terms of service levels.

Absolutely and that comes back to also not just knowing who people are when they call us and having really great relationships with our clients and their families. But also the teams that look after and support our clients are very much hand-picked so the first thing we look at when we get a brief from a client we meet a client and we go to their home to meet them and make sure that we really get a full understanding of their needs.

And also the little things what's going to make the household run more efficiently or what's going to make life more fun for somebody as an example so then the first thing we look at is the clinical. So what's the skill set that we need to help support that person living at home and we'll have people that have got a very diverse range of medical backgrounds and clinical needs and mobility issues and all sorts of things so we get that skill set right. And then we look at the personality, the interests, the likes even down to you know, I always think of you know if somebody's very quiet and reserved yes you don't want somebody kind of bursting into the house singing show tunes! You know that's not going to work! They're going to overwhelm that client and that's never going to be a really good match. So we have hand-picked very small number, the smallest number of people in a team as we possibly can, and generally it would be more than one person we like to have at least two often so we can cover things like leave and unplanned absences and things like that because our staff don't want to work 365 days a year oddly enough.

Why not?

I don't know call me crazy! So we do we've got a lot of checks and balances and things that we put into place to then make that longer term engagement and that longer term relationship as beneficial for everybody as possible. And so we get really strong commitment from our staff but we also have a strong commitment of working collaboratively with our clients and their families.

So how does this compare to the government funding?

That's really interesting actually at the moment. There's been a number of changes in November 2025 to the Aged Care Act and that's impacted how home care funding has really been altered. What we're seeing in the market is that people who are self-funded or partially funded retirees, so at that higher end of the market, they're being asked to contribute a lot lot more to their what used to be called a home care package is now called Support at Home programme, which is the government funded programme.

So in some instances people are being asked to contribute up to 80 percent of the cost of the services that they're getting under their “free” programme.

Right. so the government's only paying 20 percent of that they're paying nearly all of it.

Nearly all of it yes.

So and what would that be for?

Services for that where people are contributing up to 80 percent of the cost that's for things like gardening and cleaning so just services that you know you would pay for ordinarily. So we're seeing people go oh my goodness you know I'm being charged 190 an hour for a cleaner! I mean can you imagine paying that in the normal no day-to-day market?

Exactly and you could get that. I’d expect my cleaner to walk in with a tiar at two hundred dollars an hour.

Yeah

Yeah so and then things like personal care that at the moment is attracting a 50 up to 50 contribution. So self-funded retirees are being asked to contribute up to 50 percent of that cost. We're seeing providers out there in the market that have pretty much almost doubled their pricing because of the way that the fees that they used to be able to take out up to 35 percent of the government package in fees.

Right so which is a lot to run their programmes.

And so they've kind of that's capped at 10 percent. The costs and other things well not hidden they've been asked to account for all the costs in their hourly rate.

Right.

So to break it down that's cost of sales in any other business. So that's where we've seen the prices just completely go through the roof. I'm embarrassed to say I almost feel like sometimes we look like we're cheap at the moment with what's going on out there in the market in the government funded land.

The other issue that's impacting people is the waiting time to get an aged care assessment.

So that's taking a while and we're seeing government reports on you know they're saying average of 27 days to get the aged care assessment. You then get the assessment. Then you go on the national waiting list to get the home care supported home programme package assigned to you and that's taking people 6 to 12 months to get. So 6 to 12 months is a long it's a really long time to be assessed and then have to wait that long. You might need another assessment by the time you actually get to your place. Well people are often getting assessed at a lower level package and I know you know plenty of old people - they don't want to admit that they need help. So absolutely you know the assessments are often a bit lower than what people really need because people are quite rightly quite proud. And I understand that however then what's happening is when they're getting assigned they're kind of only now getting up to 60 percent of their funding equivalent for some reason which is a bit odd. And then they're having to wait a really really long time.

As somebody rang we had a gentleman ring the other day on behalf of his mother. He said look she's been assessed and we're on the waiting list. And he said but at 94 I can't afford for her to be on the waiting list for 12 months. We know we need help now and he said and I just realised this is just ridiculous. And he said and I haven't even got to the centre link stuff yet.

Exactly.

And we've all dealt with government departments and having to go through boxes and wait. They’ve got a really hard job to do, it's just that often it's not made easy for the end user.

Exactly. So then how does private home care then fit in and around this public system? What should people think about when they're thinking about getting it?

I think for look it's not for everybody obviously for people who really really need help and don't have the means to pay there is the government support programme and that plays a really really important role. We cannot forget that. That is absolutely and also people with the greatest needs and who don't have that funding sort of go to the top of the list. That's really good. It's not just you're on the list and over time means that you get to the top. It's very much based on needs and the the level of support around somebody. And you know and any other issues that might impact on their ability to stay safely at home.

So what we're seeing is yes for people who have the means to pay we're getting lots and lots of calls of people completely frustrated with the system not wanting to to wait but also wanting a premium service. So we're also seeing people calling us because they're frustrated in the system which is at stretching point.

We've got a national labour shortage out there in home care package land or supported homeland, you've got clients that are getting maybe one hour of care here and there. We're a premium service. We're a minimum of three hours and for good reason so we feel that that's the right amount of support that somebody might need to help stay at home. And it also means that our staff are happy and committed. And they're not driving from one end of Melbourne to the other to pick up an hour's work here an hour's work there and two hours here.

The reports that we get from people is I am just sick of the revolving door of staff. A lady rang the other day and she said I can't even get to speak to mum's case manager for 21 days.

21 days?

Yeah she was told she had to wait three weeks and she was outraged. She said this is just ridiculous.

It's bordering on the ridiculous.

Well particularly when you're dealing with vulnerable older people who exactly kind of need to be checking in on.

Yeah so and look not everybody is needing high-level clinical care. We've got I mean we're fortunate enough with many of our clients they're using us to really maintain their independence while they're still pretty fighting fit. And still want to be socially engaged. They might have given up driving. They might be having difficulties doing you know some of the tougher things around the house. We say you're CEO of the household. Yes let's talk. What is it that you need? And that's I think with people who as we get older they really want to maintain that independence don't they? Fiercely. Yeah absolutely and often you know there's there's people trying to to push them down a road of perhaps going into a residential care. But maintaining their independence in their own home with their things, with their gardens, with their pets, whatever it might be.

That's kind of where I think you know Acquaint is really amazing at connecting the carers to the backgrounds of the people as well. We've got some fantastic um examples of that. Absolutely. Yes so it's really important when we do that because then we find all the amazing surprises. You know one of our ladies is a divine absolute fashionista. You should see the handbag collection my goodness! Anyhow I digress. However one of the ladies that goes to see her has done further study, she used to work in retail. You know they've tjushed the wardrobe the other day. They went through everything, worked out what was going to be worn next season, all this kind of stuff. The capsule wardrobe. Totally, the client completely adores it. She really appreciates having somebody who's got that eye. Yes and gets it. It's not just someone.

Our staff aren't just going in and doing tasks. Yeah and they'll think of things like that you know the really great cooks on our team yeah highly sought after! Because we've got people you know that oh really so they don't have to get the you know insert name of boring food brand here they'll get much more interesting things or we'll work with them and we've got some really interesting partners that do some great stuff so that's fantastic. So we help find the I guess the nicer things in life.

Yes and you take people, the carers take people out to musicals or the opera or the tennis or whatever it might be of interest. Absolutely yes. Off to the footy, off to the races, yeah the national gallery, all sorts of things like that so it's really lovely.

It just sounds to me like such a way that I would want to.

It's just living your life this is what I want.

Exactly. Oh dear so let's talk about the families then because we are discussing money and finances. But you know how do families consider in-home care and what do they usually focus on in terms of costs?

It depends on who's asking. Look some people just want to get straight to the bottom line and they just want the cheapest thing for the most you know for whatever. And you know but you get what you pay for so there are plenty of options for people.

They can go direct and they can hire people directly. We had a client recently who had tried that and then started using us for services and then rang and just went oh my goodness I'm so sick of managing staff it's just a nightmare, people call in sick and then I've got no one for mum. She needs 24 hour care she just has basically outsourced to us because she knows she started off with a few days a week and then she went oh so with you just everything happens perfectly. We're like the duck on the water analogy. They don't see all the legs running underneath and we just make sure that we take away all those pain points for people.

Exactly.

Because employing people independently you've got to consider so many things as well. Well you want to make sure they're not an axe-murderer for a start. That's right that's the starting point yeah and then as you say you know some people are not that reliable. Perhaps you might have to have a number of different people that you're relying upon.

Or we see a scenario where people, the cleaner is all of a sudden doing extra shifts and the cleaner isn't qualified to be out as people age. And they need more clinical expertise that, they're probably put in an awkward position where they've worked with that person for a really long time.

Or we've heard of particularly in the family office space where they're really worried about privacy and the financial side of things as well because there's often significant amounts of money that we're talking about.

So making sure that staff are properly vetted and they're kept an eye on and you know we're just getting that constant feedback and we're making sure you know we're not doing the wrong thing. I guess we're doing the right thing due to the way that we actually manage a lot of situations and have got that experience. It's it's due to that experience and we've had horror stories where people have said oh you know so and so had this person and they used to come in every single day and then all of a sudden we noticed that the grocery bills were going up to six hundred dollars a week for somebody living on their own. Now there's a big problem there but they hadn't noticed because this arrangement had been going on for a long time. And then when they really dug down they were just being fleeced.

So I mean unfortunately that's the world we're living in today you have to really keep an eye on things.

And I know you do that in an ongoing way. So what are some of the important costs or trade-offs that tend to be overlooked in those early comparisons because I know there's things like insurance for example that people need to be aware of.

Well again you know you can hire people directly and they may have an hourly rate you need to be mindful of things about working conditions and you know in this country we have minimum working conditions for a range of roles a minimum across the board we've got fair work we've got awards and things like that. You've got state, federal what there's lots of different things that you've got to be across. Our work cover is minimal thankfully because you know we look after staff we send right people into the right situations. And we make sure that we've got the right equipment for example. So there's a lot of things that can alter as people are ageing and you know we wouldn't want to put anybody at risk. However in those independent contractor situations or you know the niece or the neighbour or the cleaning lady those kind of situations who's supporting them. Who's helping them? Who's making sure that they're not working. You know people think oh 24 hour a day care well I can just get them to do work all day and it's like no you can't do that. They can't be slaving away for 24 hours. That just kind of doesn't work in this country.

And now let's just consider also the choices families make whether to put whether to go into residential care as opposed to stay at home.

It's because there are quite a bit of costs associated with going into.

Look there is and again with everything with we saw this many years ago there was an aged care roadmap established in well over 10 years ago. And changes that have slowly happened over the last decade and more where people with the means to pay are being asked to pay. And we've got an ageing population. We've got a decreasing tax base. There's only so much money in the pot.

That's right.

And it needs to be divided up however it's divided up. Now look I'm not going to comment on government policy however there's no magic other pot of money where people are going to get free aged care. So we are seeing a lot of stresses in the system and providers of residential aged care looking to work out in some instances how they can actually break even and stay afloat. And if you look at the returns on some organisations they're very small. And if I looked from the outside you'd say oh would I go into that business? Would I want to invest in that and get that return? Probably not. People do it for the love in most instances however it's a really tough industry.

Exactly and I mean I remember years ago my grandmother's nursing home being taken over and then all of a sudden they went from having meat and vegetables to party pies for dinner.

Like people are going to oh no no but I'm saying some places they're looking to cut margins.

Yes yes and they look at everything like that.

And it was just really and look we saw awful things in the aged care royal commission.

Exactly.

So yes so look there are significant costs. There's you know refundable accommodation deposits to be paid if you can afford to pay them. There's safety nets for people who can't afford to pay. It's probably the people in the middle that are in the position because they may be assessed as having to contribute you know significantly to the cost of their care and you know they may be asset rich cash poor there could be a spouse still living in the house and things like that so it can be challenging.

Obviously good financial advice is really important at that point. And probably good planning particularly if you've got a couple and particularly if you've got someone living with dementia to you know really make sure that you've got things set up early and that there are i guess checks and balances in place to make sure that maybe the the spouse who hasn't got dementia knows what's going on and has got access to you know even simple things like bank accounts.

You'd be surprised at what kind of gets ignored for a really really long time and then all of a sudden somebody you know one of the spouses has got limited capacity and then that really it hinders decision making.

So what should families be comparing when they're weighing up their options in terms of care at this stage?

I guess they should be talking to the person who's going to be receiving the care and ask them what they want what they want. We over the years I've seen, you know, there's a lot of uh inheritance anticipation sometimes and.

That's a very nice way of saying it inheritance anticipation. I think we all understand what you're talking about.

Yes so look it's like with my mum I just go whatever you want that's your call you make the choice it's your money. It's your decision what do you want to do. And so number one what does the person who is recipient of any kind of service what do they want? Number two what are my options? So how do I think about this? Yeah um like the chap who rang about his 94 year old mother. Look it's nothing any of us want to plan for but it is something that we probably should very much. So you know I even, look I've got an advanced care directive. And people oh but you're only 40. I'm only kidding. Okay I won't say how old I am. You look like you're. I'm a child.

So but you know it's prudent to have that to have any kind of my wishes yes down in in writing. So if something did happen to me. I got run over by a bus. Well people are pretty clear on what I would want.

So everyone thinks that all this stuff should just happen when it happens but if I think of it like an insurance policy. Yes get organised. Start thinking about things. There are plenty of resources out there to start thinking about it.

Probably the most important thing is once you have weighed that up and if you don't want to wait for government funded services and you don't want to be contributing you know most of the costs to that government funded services. You've got that fiercely independent you know and everybody that rings, it's hilarious. People go oh my mother's fiercely independent and she's this and she's that no we just chuckle. You sound like every single one of our clients. You know like we're all the same and we're going to be as fiercely independent if not more when we're older.

So it's if you have got that option it's just probably worth then exploring.

Okay well what you know vet the companies out there have a look and see what kind of feedback people are providing about them. Is it really mixed? Is you know is it good, is it average, is it, you know, has there been multiple changes of ownership in that organisation. How long have the staff been there what are their expertise? Ask a lot of questions because the dollar sign on the bottom of the rate sheet is part of the picture. But we all know when we go shopping you know we can get something that costs five dollars. In a t-shirt that costs five dollars and you wonder where it was labour was you know contributed to the cost of that. Or you can spend a little bit more. Think of the Australian made campaigns and businesses. We know it's made in Australia we know it's well made we know yes we'll pay a little bit more but you get what you pay for.

That's absolutely right. Well Fiona thank you so much I think that's really incredible information for a lot of families who are out there at the moment even thinking about what

might be happening in the in the space.

The bottom line is probably don't panic there's always going to be an answer. We're all here to help and sometimes the situation that you think is the situation that you need it mightn't be as bad as all that.

That's great well thank you. And if today's conversation has made you think about the kind of care you or your parents might want we hope this episode helps you to start having those conversations about resources and planning now our next episode is about what happens behind the scenes.