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Home care: the good, the bad, and the ugly

The Good

In February 2017, Home Care Packages underwent major reform, giving consumers the ability to choose their home care provider, direct funds to the services they want and need, and wield the ultimate consumer power – the ability to move from one provider to another.

Without a doubt, the best thing about Home Care Packages is that they enable people to stay in their own home and community, whether that is a family home, an apartment, a caravan park, a retirement community, a granny flat, or other living arrangement.

For the most part, Home Care Packages are affordable. The Basic Daily Fee is set at 17.5% of the age pension, or $10 per day. The need to contribute beyond this amount is based on the person’s income with the fee calculated at 50c per dollar in excess of the threshold and capped at $10,627 per year. For people of limited means (or good negotiating skills), the Basic Daily Fee can be negotiated with the provider.

(For more details on the fees applicable to Home Care, see ‘Home is where the care is’).

The Bad

With the increase in choice and control comes an increase in responsibility to understand the fees and charges that apply, potentially negotiate some of them, and pick a provider. While this may seem fair and reasonable, the fee schedules can be mind-boggling with call out fees, different rates for the same service at different times of the week or day, and minimum periods. The fees and charges vary from one provider to the next, and for consumers who want to compare one provider with another, it can be an almost impossible task.

In addition to the cost of their ongoing care, consumers need to be aware of and factor in the cost of an exit fee if they move from one provider to another. Many providers don’t charge exit fees. Some providers, however, charge an amount that covers the cost of the administration involved usually around $500, while at least one has an exit fee in excess of $4,000.

The funding provided through a Home Care Package is based on the level of the package the consumer receives, as shown in the table below.

Home Care Subsidy Daily Rates (1 July 2017 – 30 June 2018)

Additional supplements are paid for people with special care needs such as oxygen and enteral feeding.

Home Care Funding is simply an allocation of monies, but the money may not cover the cost of care. In many cases, people find that they need to ‘top up’ their package with private care.

The Ugly

Unfortunately, many consumers still view Home Care as a ‘slippery slope into a nursing home’ and delay accessing services. The expectation is they will get it when they really need it. The reality is that demand is increasing and the number of people waiting for a package is greater than those receiving one.

Between March and September 2017, the average number of approvals jumped from 401 to 497 per day. The majority of approvals are for people with higher care needs (Levels 3 and 4).

These approvals are adding to the growing number of people on the national prioritisation queue, which was up from 88,904 on 30 June 2017 to 101,508 on 30 September 2017.

Of the 101,000 in the queue, around 41,000 have an interim package which is below their assessed care needs. The other 60,000 are waiting with no interim package at all.

While 101,000 people are waiting, only 72,000 are actually getting a package and the queue is growing (data from the Reference Home Care Packages Program Report, Department of Health).

The bottom line is that the wheels turn but in some cases, they turn very slowly. Consumers can expect to wait for the ACAT assessment (to determine eligibility and package level), wait for the approval, and then wait for the Home Care Package. At the end of it all, maybe a Home Care Package lower than the assessed need may be made available.

The role of the adviser has never been so broad or so valuable. Crunching the numbers on the contribution to the Home Care Package is possibly the least valuable component. The real value is in the knowledge the adviser has of the system and helping the client navigate the various aspects and to come out the other end with access to the care they need that is also affordable.

 

Rachel Lane is the Principal of Aged Care Gurus and has co-authored a number of books including ‘Aged Care, Who Cares?’ with Noel Whittaker. This article is general information only.

2 Comments
Felix
February 09, 2018

I had a recent experience with a Home Care Package with my mother. It was great overall, as it allowed my mum to live with us for two years before it was no longer workable due to her worsening dementia.

However, a big negative about them is that they don't provide the ongoing monitoring and medical assessment that you get in a nursing home. In my mum's case, with severe Diabetes as well as Dementia, the at home workers would visit, give her medication, make her a cup of coffee then leave. There was no blood sugar monitoring, etc. During this time she deteriorated and it was only when she went into full time care at the nursing home where she is monitored every day that we realised how bad it was and how badly managed her diabetes was during the Home Care period.

With my partner and I working full time we really hoped the Home Care package could take care of my mum medically, but apart from some social interaction and keeping an eye on her, this achieved very little.

Anon
February 10, 2018

Glucose monitoring, BP checks, wound care, insulin injections etc is available if requested by GP or carers. The issue here is that your mother may not have had sufficiently detailed GP supervision to look after her and guide you through this care maze.

The sequence of events is:
1. Medical mishap causing disability and need for care
2. See GP to assess. Fix it or refer for ACAT help.
3. ACAT assessment to provide a funding letter.
4. Use funding letter to pick a provider with the help of a Social worker
5. Wait for care provider to become available.
6. When available, access help from provider.

Then wait for next medical mishap/disability. Start from above all over again until uo die or get admitted to a nursing home.

Waiting is inevitable and there is no way to skip the queue except to get yourself admitted to hospital on the grounds that you are unable to look after yourself without help at home. This way it costs the State hospitals a massive amount of money and forces the Hospital to put you in a facility called Rehabilitation or Care Awaiting Placement until a Care provider is available.

Just providing the stark reality.

 

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