The growing case for self managing home care

Self-management is emerging as an important and sometimes only option, to deliver aged care under the myriad reforms to the sector introduced since 2013.

Bob Campbell was grateful when, after a 12-month wait, he was assigned an interim level one home care package. The 89-year-old had received approval for a level two home care package but was happy to get any financial help.

Under the interim package, the government would subsidise his care by up to $24.46 a day, or almost $9000 a year. Bob soon realised that he was going to have to pay extra for daily help in dressing and getting ready for the day.

The hourly rate for the carer via the package was $70 during the week and $120 on a weekend. Almost half of the subsidy would be swallowed up in case management and administration fees.

Accepting a reduced service of a half-hour visit offered a way for Bob to soften the financial impact, although that presented different issues when most days brought a different support worker and left Bob constantly explaining his preferred routine.

Rushing in for 30 minutes and sometimes less within a two-hour window left Bob feeling that it was becoming more the support worker’s routine than his. Essential tasks went undone. The frustration of having a stranger helping him when it suited them, rather than when he needed help, slowly grew.

Bob could have been paying $18,000 a year towards the total annual funding cost of $22,000 – covering care hours plus case management and administration fees. This needed closer consideration.

Generally, the daily subsidy increases as a person is assessed as needing more help, with the highest amount being $141.94 a day or almost $52,000 a year for a level four package. As well as paying a daily contribution of about $10 a day, package recipients may pay an income-tested fee of up to $11,234 a year for additional help.

Bob’s options were to reject the package he’d been offered in favour of the Commonwealth Home Support Program (CHSP).

From there he could look for another provider charging less for case management and administration, or find a provider prepared to let him self-manage and not charge for case management, or self-manage completely and wait for his approved home care package to move to a higher level.

Though highly subsidised and a relatively cheap option, the services offered through CHSP come with many of the same issues as the package. The support workers came when it suited them and with a fixed idea of how they could help within half an hour.

Even with dozens of approved providers to choose from, the fees and charges didn’t vary enough to make it worth signing up for a slightly cheaper provider when the outcome would still only cover about 90 minutes a week of help compared to the minimum of six hours of care that Bob required.

Finding a provider who just charged the admin fee and kept abreast of the finances from the government side but left Bob to find his own support workers was looking like a good option. As was rejecting the package and self-managing until a higher level was assigned.

This brought Bob to, an online platform designed for older people and/or their family to directly engage people based on their needs. Once he’d registered with Mable, a search within his area identified about 20 willing and able workers, many happy to negotiate the hours they worked, the jobs they did, and the rate they charged based on Bob’s preferences.

By self-managing the package, Bob got more than six hours of help a week for half the cost quoted by package providers while personally paying about $5000 a year instead of $18,000. Importantly, he and the support workers were happy.

Not surprisingly, the option to self-manage a home care package isn’t highlighted anywhere on the My Aged Care website. Nor is it talked about by the aged care assessment teams approving subsidised home help or offered by the majority of approved home care providers.

The recommendations by Counsel Assisting to the Royal Commission into Aged Care Quality and Safety propose an overhaul of the entire system under a new rights-based Aged Care Act, but they fail to specifically mention consumer-directed care or self-management as an important option.

Yet self-management is emerging as an important, and sometimes only, option to deliver aged care under the myriad reforms introduced since 2013, including the consumer- directed care model introduced in 2015 and mandated for all Home Care packages since February 2017.

A home care package essentially gives a person a budget for a provider to administer for purchasing support services.

The individual can either work within the budget, or not, depending on service needs. If an individual wants more help, they have to either pay for it themselves, rely on family and friends, or go without.

But budgets are like diets – they don’t work for everyone. Like a diet, a budget shouldn’t just be about giving things up but finding what works for you.