Older people needing extra help to live at home, whether that’s help with bathing, gardening, transport or physiotherapy, now have greater choice when it comes to the types of subsidised government care they receive.
From today they can change the service provider that provides their home care package, meaning they can choose a provider that better suits their needs, has better customer service, or is better value.
While added choice puts people (and their families) in a stronger position to negotiate with the current provider, not everyone can easily exercise this choice.
So how do people choose the right package for them or a family member? And what are the barriers to getting the right services?
What is a Home Care Package?
A home care package is a tailored suite of services, subsidised to a set amount by federal funding, to help older people live in the community.
The federal government funds a set number of home care packages. In 2016 there were almost 80,000 packages funded at a cost of A$1.49 billion.
Home care packages are consumer directed. This means people choose the services that make up their package rather than being told what services they are going to be given. Some people may prioritise having a clean home or taking their medication, others want help to exercise and socialise. Some may have special language or cultural needs.
Consumer direction means much more than just choosing from a list of services; people can ask for services not on the list, as long as they would help them live independently, safely and well.
Before now, the government allocated home care packages to service providers. Once signed up, it was difficult to change providers if the person moved or if the provider wasn’t meeting their needs (such as not having staff that spoke their language) because most providers’ packages were filled and had waiting lists.
From yesterday, after approval by the Aged Care Assessment Team, people are placed on a centralised waiting list for the next available package. We don’t know how long the wait will be, but in the past, waiting times for some places were over a year, particularly for people needing higher levels of care.
Newly approved applicants then choose a service provider from the outset, while those already with a service provider can change providers.
How to Choose?
So, how do you choose a new provider? Here are seven points to consider when making the switch.
#1 Beware Exit Fees
Check your existing home care agreement so you understand any exit fees your current provider may charge.
#2 List What you Need
List the things you are looking for in your new service. These may relate to staff (gender, language, culture, consistency), availability (day, weekend or evening service), or range of service provided (physiotherapy, occupational therapy, gardening). Some providers provide certain services more flexibly and cheaply than others.
#3 Find out what’s available nearby
Identify alternative providers in your area by calling myagedcare on 1800 200 422 or by using the improved search function on its website.
#4 Do Your Homework
When interviewing and comparing providers, ask about:
fees: how much the provider charges for administration and case management fees (these can vary widely from 15-45%); the hourly rates for cleaning, personal care, allied health visits etc; average percentage of government subsidy available for clients to spend; ask for an example of a monthly statement to see how clear it is and how it shows accrual of unspent funds
staff: whether service providers employ their own staff or use agency staff; the level of training of their care coordinators (some have university degrees, others might have minimal training); the level of training of their care staff (some require certificate III or certificate IV, others might have speciality training in dementia)
communication and relationships: how often care coordinators visit and speak with clients; how regularly care plans are reviewed; how service providers ensure you will get consistent care workers.
#5 Negotiate, negotiate
When you’ve chosen a new provider, or if you’re going to stay with your existing provider, negotiate a home care agreement. You can also negotiate your daily fee contribution (some providers charge less than the maximum allowable amount).
Decide what you will use your package for and what you may pay for privately. For instance, it’s often cheaper to pay for cleaning and gardening privately.
#6 Set a date to switch
Agree on a date to switch to your new provider and notify your old provider the date from which you will no longer be using its services. Make sure your current provider tells you how much unspent home care you have, and make sure this is transferred to your new care provider.
#7 Use your referral code
Give a referral code to your new provider. This is on a letter sent to you by the Department of Health at the end of 2016. Your new provider needs this code to make sure the subsidy is paid to them; you can’t switch providers without this. If you don’t know your referral code, call myagedcare on 1800 200 422.
Yes, the System is Confusing
This compounds the difficulty for older people, who tend to seek out less information and take longer to process that information when making complex decisions.
Added to the confusion is that not all home care providers will be ready for this change.
Some providers are more consumer-focused than others; some have been having trouble shifting from the traditional “list of services” model to a more individualised, flexible and innovative approach.
They will also not have had to sell their services directly to consumers before. They might not have the information you want easily available online, like their fees. They may have also not had to administer stopping a client or starting a new one before. So, expect teething issues.
Some groups will find it particularly difficult to exercise this choice.
People from culturally and linguistically diverse backgrounds have been able to use the government’s translating and interpreting service to set up their home care agreement, care plan and budget, as well as to discuss their budget each month. But translating and interpreting costs during care delivery are paid for from their package. Under the new scheme, it is not clear who will bear the costs associated with investigating and negotiating a new service.
People living in remote areas may also have fewer choices of a service provider.
People with dementia who are no longer able to make complex decisions often need a family member or friend to advocate their needs.
Giving consumers choice is meant to create market forces that drive innovation and enhance service quality. However, until older people become aware that they have choice, are given information to help make choices, and start acting on their choices, we might not see much change in the standard of home care.
Lee-Fay Low is an Associate Professor in Ageing and Health at the University of Sydney