Nobody has looked at her feet: nail care, the five subsidised podiatry visits, and the slippers causing the falls

The problem nobody looks at

She is walking less. She goes to the dining room less often, holds onto furniture, shuffles. Somebody calls it decline, somebody else calls it fear of falling.

Before accepting that, do something almost no family member does: look at her feet. Not through a slipper — take the socks off and look. A surprising share of the time you will find toenails months overgrown and thickened, an ingrown corner, a callus that hurts at every step, and slippers two sizes wrong.

This is not cosmetic. Foot pain changes how a person walks, an altered gait costs balance, and the fall is what changes everything else. Feet are one of the very few serious problems in an older adult that can be fixed in half an hour.

Two different things that get muddled

Get this straight, because it settles most conversations with a provider.

Ordinary foot hygiene — washing, drying between the toes, moisturising, and trimming a normal healthy toenail — is personal care. It is what the home is there to do and it is part of what she pays for. If you are told nails are not their job, ask to see that in the policy.

Podiatry is different: thickened or ingrown nails, fungal nails, corns and hard skin, deformity, and anything at all on a diabetic foot. That is clinical care, and providers are right that care staff should not be doing it.

So ask two questions: who trims her ordinary nails and how often — and who do you call when the nails are no longer ordinary?

The care plan that unlocks subsidised podiatry

Here is the part most families never use. If your mother has a chronic condition — and at her age and with her diagnoses she almost certainly does — her GP can put in place a chronic disease management plan. That plan unlocks a set number of Medicare-subsidised allied health visits each calendar year, and podiatry is one of the eligible services.

Three things to know about it:

• It has to be set up by the GP, and then reviewed periodically. In residential care this is exactly the step nobody triggers, because it is nobody's specific job. Asking the GP directly is usually all it takes.
• The number of visits per year is limited and shared across all allied health under the plan — so if she is also seeing a physiotherapist under it, that comes out of the same allowance. Worth planning rather than discovering in October.
• There may still be a gap fee depending on the provider, so ask what she will pay before booking.

Two other doors: Department of Veterans' Affairs cardholders generally have podiatry covered more generously than the Medicare route, and it is among the least-claimed entitlements; and public community health podiatry exists in most states with waiting lists that prioritise high-risk feet.

Diabetes changes the whole article

In a diabetic foot, sensation is reduced: a small injury does not hurt, is not noticed, becomes infected, and the chain from there is one everyone knows. Three things to insist on:

• Daily foot checks as part of her care, documented, not on request.
• No improvised nail cutting and no over-the-counter corn removers. On a diabetic foot, that is how it starts.
• A current foot risk assessment and a same-day escalation route for redness, a blister or any break in the skin. Here the difference between today and next week is the whole prognosis.

The slippers, which nobody checks

The most neglected part of all. Many residents spend the day in slippers bought years ago, stretched out, with no fastening — or walk in socks on a smooth floor. Footwear is a documented falls factor: a fastened, well-fitting shoe with a non-slip sole and a low heel is safer than a soft slipper.

Feet change with age and with swelling: her size from ten years ago is not her size. If she has orthotics, ask when they were last reviewed — worn or outgrown orthotics are worse than none.

The link to falls

If she has fallen and nobody examined her feet and footwear afterwards, that review is incomplete. Falls prevention is something providers are accountable for under the quality standards, and this belongs in it. Raise it in writing and get it into the care plan.

Six questions to ask

1. Who trims her toenails, how often, and is it included?
2. Which podiatrist visits here, and how quickly do they come?
3. Does she have a GP chronic disease management plan, and has podiatry been included in it?
4. If she is a veteran, has DVA podiatry been arranged?
5. Do her shoes fit and fasten, and when were they last replaced?
6. After her last fall, were her feet and footwear assessed?

If you get nowhere

Put it in writing to the facility manager with the distinction between personal care and podiatry set out plainly — that distinction unlocks most cases, because on the first point the provider has no argument. For the care plan and the referral, the GP is the person to ask, and you can ask directly rather than through the home.

If that does not resolve it, the Aged Care Quality and Safety Commission takes complaints from family members, including anonymously, and a diabetic resident whose feet are not being checked is a clinical care issue rather than a comfort preference. Free independent advocacy is available through the national aged care advocacy network.

Where to start

On your next visit, do one thing: take her socks off and look. If the nails are pressing on the end of the slipper, or there is a reddened callus under the ball of the foot, you have found the reason she is walking less — and it is not inevitable decline.

If you are still choosing a home, ask how foot care is arranged and how often a podiatrist visits. Few families ask, and the answer says a great deal about the general level of attention.

If you would rather not run it alone, we can. For A$109 we take down your mother's situation, look for the homes in your area that answer these questions properly, and report back what they told us, with names and dates. Start here

This article is for information and does not replace medical advice on your own situation. If she has diabetes, do not cut nails or treat corns yourself and do not use over-the-counter corn removers — ask her GP or a podiatrist. Medicare care plan arrangements, visit limits and DVA entitlements change: check the current position with the GP. Curalune does not allocate beds and does not guarantee availability.

Paying less is mostly a paperwork problem

The advertised room price is only part of the picture. What a family actually pays is set by the income and assets assessment at Services Australia — it decides the means-tested care fee and how much of the accommodation cost the government covers. Lodge it before a room is offered, not after: doing it late costs weeks at the worst possible moment. Two things families miss: if paying the fees would cause genuine hardship you can apply for financial hardship assistance, and the choice between a lump sum (RAD) and a daily payment (DAP) can be changed within the first 28 days after entry.