Hidden (and not so hidden) traps of community aged care
FEBRUARY 27, 2017 saw the implementation of probably what is the most significant change to hit the community aged care sector since the Home and Community Care Act was first introduced in 1986.
Back in 1986, the majority of community aged care was offered by service providers auspiced by frequently church based, not-for-profit organisations - many of which had been providing such services to their communities for a long time using funds obtained from charitable donations.
The changes of February 27 have been a long time coming, with many of the policies associated with these reforms first mooted as far back as 10 years ago.
So why the fuss?
In a nutshell, for the first time in the history of community aged care service provision, service providers are required to display a high level of transparency and accountability to consumers for the funds they spend on behalf of the consumer for the provision of home and community based care services.
What used to be block funding provided directly to organisations is now notionally allocated to the consumer for use as the consumer sees fit, and to meet that person's care needs.
To almost add insult to injury for those providers who would prefer that nothing changed (privately, if not publicly), the consumer is no longer tied to a provider and beholden to that provider for their care services.
In a move that has rocked the sector in terms of individual providers coming to terms with the implications of the changes, Home Care Packages now belong to the individual consumer, and can be moved as the consumer moves.
Unspent client contributions must now be returned to that person (or their estate) when they exit a package. Historically, providers were entitled to keep these funds to expend as they saw fit, and not always on care either.
There have been a number of media articles in recent weeks where the revised service arrangements for consumers have been criticised for being too complicated. These criticisms have been accompanied by reports claiming that some providers are charging anything up to $4000 in exit fees, and using bullying tactics to force people to continue to use them as their service provider. These articles are partly true, but quite significantly are lacking in the detail that consumers need in order to make an informed decision about their care.
First of all, there has been commentary about the fees and charges associated with the administration of a home care package. Some of this commentary is accurate, with many providers charging in excess of 35% to a person's package for services that do not include direct contact with the consumer, and can be considered an overhead cost for the provider. Many providers also charge other fees to consumers such as travel or trip fees, "service support" fees and fees to complete administrative tasks such as making phone calls and liaise with other providers, GPs etc.
Secondly, there has been commentary about the charging of exit fees by providers should a consumer wish to transfer to another provider. Consumers should understand that this "exit fee" is only payable from the balance of the package held in trust for the consumer by the provider to cover what are called "contingencies" in regard to that person's care needs.
If the exit fee set by the organisation is higher than the amount of funding held in the package for contingencies, then the provider is entitled to receive these funds from the contingency fund. If insufficient funding is available in the package for payment of exit fees then the provider is only entitled to take that part of the balance that will cover the fees.
Finally, there are the reports of bullying tactics being used by providers in an effort to stop people taking their package elsewhere. My advice to these providers is to stop these behaviours now. I heard this week of a person who was told by their carer that if they took their home care package to another provider, then their care staff will lose their jobs. This is not acceptable behaviour by a sector that purports to have the needs of older people front and centre in its thinking always.
Similarly, stories abound at present of providers who agree to a person receiving services from them but the person concerned then has to wait some months to receive a service. This is not OK at any level.
Consumers deserve the right to make decisions about their care to the capacity they are able; interference by others is likely to confuse the issue further.
My advice to consumers is to do your homework and shop around. When you meet with a potential provider, take along your statements from your current provider, and as with any market driven service, ask the new provider to provide you with a quote for their services. You wouldn't buy a washing machine, a car or a fridge without doing your homework; why would we assume that choosing a care provider shouldn't be done with the same degree of caution.
The more consumers become appropriately and accurately informed by what is possible from their care package, the stronger the community aged care service system will become. Informed consumers exist in all other aspects of life; it is time for this knowledge, and capacity to choose to infiltrate community care.
Finally, if consumers are not happy with their current provider, then moving their Home Care Package to another provider is quite easy. Even in areas where workforce is a challenge, organisations that support their staff, pay them well and act as role models for the staff will flourish and prosper in a Consumer Directed Care service environment.
Consumers should ask these questions of their provider and assure themselves that the care budget developed by the organisation is being used as was intended, and that relevant staff can be available to respond to questions in a timely manner.
If the person still wants to move their package then the new provider should just complete some paperwork and as a provider, the process of registering someone on the system is quite easy.
I know that much of the content for this article is a repeat of what has been previously made available to consumers and their families. However, the financial situation in which an older person finds themselves in regard to their Home Care Package is such that accountability and transparency by the provider with the funds in a package is essential in a market driven service sector.
Similarly, if a provider does not provide a consumer with a budget for their care plan that describes in detail all the expected income and expenditure and/or if the consumer is not provided with a monthly statement, and if line items on the statement contain service types that are unclear, then that consumer should first discuss their concerns with the provider.
If the provider does not address the concerns of the consumer, then it is likely that they are not as serious about Consumer Directed Care as they pretend to be, and the consumer should be looking for another provider.