Home Care Package Changes: More choice for elderly

Consumers are used to shopping around for the best electricity and phone deals.

Now people who receive aged-care services in their home will be able to do the same. Recipients have a far greater control over which provider delivers the services they need, in a manner they are happy with, cost effectively.

Under Increasing Choice in Home Care reforms that started February 27, if someone with a home-care package is not happy with the service they are getting from a provider, they should be able to switch more easily than under the previous regime.

The changes mean funding for a home-care package is allocated to eligible consumers and follow the consumer, replacing the old system where home-care places are allocated to individual approved providers to deliver services in a particular location.


Barbara Leonard with her husband David who had a stroke and professional carer Rosa.Barbara Leonard with her husband David who had a stroke and professional carer Rosa. Photo: Steven Siewert

In theory, consumers should have true choice as to what services they get to help keep them at home, as long as it is done through an approved provider and fits within the budget. Consumers can top services up using private funds.

For Barbara Leonard, 73, the ability to change providers to get the type of care needed to keep her husband David, 78, at home following a massive stroke couldn’t come soon enough.

Since December 2016, David has been entitled to a level-four home-care package, which covers a range of services including specific equipment, physiotherapy and personal care.

While there was nothing particularly wrong with the initial provider they engaged, it was unable to deliver the choice of carer they so badly needed.

“A friend of mine told us to get out the iPad and look at bettercaring.com.au [an online market marketplace that connects consumers directly with local, independent care and support workers]  where we could choose our own carer. David immediately chose Rosa and she has been fabulous,” says Barbara.

“Choosing who comes every day gave David more autonomy and control and that has made a lot of difference to him,” she says.

Where one provider was unable to provide the flexibility needed to access a service like bettercaring​, the other was willing to find a solution.

More competition

The reforms have also opened up the home-care market to new approved providers as a way of offering greater choice for consumers who can receive care packages with budgets between $11,693.65 and $52,545.40 a year depending on a person’s care needs.

Ku-Ring-Gai Neighbourhood Centre (KNC) is one of a hundred or so new approved providers, having changed its status from a community support provider.

KNC chairman John Bagley says the new system allows for a more flexible and cost-effective case-management fee for consumers and greater choice of care.

“Clients’ needs can vary from high care or needing to remain socially included with friends or attending long-standing commitments, such as theatre subscriptions, church or hobbies – all of which are as valuable to the client as domestic assistance,” Bagley says.

A Department of Health spokesman says people approved for a home-care package by the Aged Care Assessment Team from July 1, 2016 will automatically be placed on a new national queue for home-care packages.

Consumers who have an approval before  July 1, 2016 will need to opt-in to the national queue by advising – via the Government website myagedcare.gov.au or the contact centre on 1800 200 422 – they are actively seeking care.

A person’s place in the queue will be determined by their needs and circumstances and the time they have been waiting for care.

Consumers must personally advise My Aged Care if they want to go on the national list, unless they have nominated a representative such as a family member to make inquiries on their behalf.

Under the reforms, the four levels and types of care and the required assessment to access home-care packages will remain the same, as will fees, supplements and the existing consumer-directed care model.  Details are available on myagedcare.gov.au.

In addition to a basic daily rate of $9.90 a day, package holders are income assessed to determine what further contribution they could make to the package, if any.

With reports of case management  and administration fees costing up to 45 per cent of an individual’s package, many consumers are keen to see these charges drop and service delivery rise.

Canberra resident Helen Ryan**, 81, has been on a level-two home-care package for seven months.

With her care needs rising, she is awaiting a letter to confirm she has been allocated a level-four package under the new system before she makes a final decision on whether to look for a new provider.

Her complaint is not with the services she has been getting but the lack of transparency around costs of services.   Her 12 hours of cleaning and a few trips to the shops is costing about $986 a month including administration and advisory costs even though she elected to self-manage her package.

“I know I am not paying it, the taxpayers are, but having always carefully budgeted my own money I feel these costs could potentially be the difference between good or just average care,” Ryan says.

It is difficult to have faith in the system when the cost for changing a small light fitting was $220, she says

“That equals about four hours of my care. If I really had control of my package I would be given the opportunity to accept that charge or find someone else myself who could do it cheaper. Now I might have to miss out going to the shops or getting some transport,” Ryan says.

Exit fees

One thing to watch is the newly introduced exit fee, which a provider can deduct from a client’s unspent funds to cover administrative costs if they choose to move providers. These must be disclosed in the Home Care Agreement and displayed on the My Aged Care Website.

So far known maximum exit fees range from $0 to $1000. The concern is they could deter someone from moving.

“There is no real issue if the fee is a basic sum of administration, but if it is of a size that it is a deterrent to someone who wants to change providers, then that is unconscionable,” says Council on the Aging chairman Ian Yates.

Sydney University associate professor in ageing and health Lee-Fay Low says to pick the best home-care provider package holders must first figure out their needs – for example, a language other than English or a specialty in dementia – and then look for a provider who meets those needs.

Low also suggests looking for providers whose staff have higher levels of training and to ask about the average percentage of government subsidy available for clients to spend after fees.

Bina Brown is a director of aged care solutions company Third Age Matters.

** Name changed to protect privacy

This article first appeared in: http://www.smh.com.au/money/planning/more-choice-for-elderly-to-receive-aged-care-at-home-20170310-guv45v.html