Two ways of managing aged care yourself
Rather than outsourcing a care package, it can be simpler and cheaper to run it yourself.
Given the wait time for a government-subsidised home care package, anyone receiving the “you’ve been assigned” letter could be forgiven for thinking they’d won the grand prize.
Success comes in the form of a letter stating that a level one, two, three or four package has been assigned and you have 56 days to choose an approved provider to manage it.
There is likely to have been a 6-12 month gap between the initial Aged Care Assessment Team (ACAT) assessment to determine your eligibility, a subsequent letter of approval and the green light for you to choose an approved provider to manage your package.
Unless you’ve done some research into what a home care package would cover and the likely costs involved, you may be disappointed.
The first shock, particularly for a self-funded retiree, is discovering that depending on the package level and the fees you can be asked to pay, there may be little or no financial advantage to accepting government help.
In addition to a basic daily fee, you may be asked to pay an income-tested fee.
For a fee of at least 25 per cent of the package, a provider will manage care, administer the funds and assist with providing the help you need.
A self-funded retiree assigned a level two package – about $43.50 a day or $15,878 a year – could be contributing $10.44 a day as a basic fee and $31.55 a day (or $11,517 a year) as an income-tested fee.
Depending on the provider fees, the amount of support available on a level two package might be two to four hours a week.
It starts to look more attractive for the level three and four packages, with subsidies of $94.66 and $143.50 a day respectively, but even then, the level of support might be only eight to 12 hours a week and you could be doing most of the case management.
Find your own private support
Depending on your care needs, you could be better off using the $11,517 a year you may have paid as an income-tested fee to hire support workers privately.
For many people, the greatest needs are for a house cleaner, a bit of gardening and the occasional lift to a medical appointment, with family and friends offering a range of other supports for free. A two-hour weekly clean on the private market might cost between $5000 and $7800 a year.
On the other hand, a package may future-proof your care needs to some extent.
How a home care package works is that depending on your care needs, you will be assigned a level one to four package, which provides an amount of money to assist you to remain living independently in your own home.
It’s then up to the individual to choose an approved provider, who will administer the money and provide a case manager to assist with finding support workers for services such as cleaning, shopping, transport, personal care, home nursing and equipment such as wheelie walkers.
When you do choose a provider, there is no guarantee they will provide services tailored to your needs and at times that suit you, or can assign workers who meet your expectations.
Most people want more choice, fewer fees and greater control.
It’s no surprise that self-managing a package is gaining momentum – with five organisations vying for billions of government home care dollars.
Some providers may offer self-management as an option and reduce the fees accordingly.
Find a provider to administer the care subsidies
Other providers specialise in self-management. For an administration fee only (10-15 per cent of the overall package), they will administer the care subsidies from the government on your behalf and pay your workers, but it is up to you to build your workforce.
You find your support either through friends and family (there are strict rules around employing family) or employment platforms, including Mable and Careseekers. They are required to have an Australian Business Number and police check. Workers providing personal care require a Certificate 3. Liability insurance may be required, or it may be covered by the employment platform for a fee.
Public health researcher and aged care consumer advocate Sarah Russell recently surveyed 30 home care self-managers about their experiences.
The main reasons for using self-management were choice, control and costs.
Her paper, Consumer experiences of self-managing a home care package, concluded that participants, having undertaken many complex negotiations during their professional and domestic lives, said they were capable of choosing and negotiating with their support workers.
Interestingly, of the 30 participants from urban and rural Australia, only nine self-managed their care; 21 managed for a partner, parent or friend.
One participant managed for her mother and father.
For most, it is more of a co-managed arrangement.
Improved transparency of home care package pricing
Median prices for common home care services, care management and package management
The Combined Pensioners & Superannuants Association likens home care self-management to driving a car unregistered and uninsured.
Everything can be going along smoothly until it isn’t. And then you can be on your own – managing support workers, seeking additional and appropriate help and then sorting everything out for yourself if anything goes off the rails.
In a move to improve the transparency of home care package pricing, the Department of Health now publishes national median prices for common home care services, care management and package management.
The median price for care management of a level four home care package fully managed by the provider is $299 a fortnight – compared to $142 for self-managing the package. That makes the annual care management fee 15 per cent of the package.
The median package management or administration fee for a level 4 package is $198 a fortnight – another 10 per cent of the total package funding.
Half the operators charge 25 per cent of the recipient’s total funding in care management and package management fees – but half charge more.
There is no readily accessible way to compare providers on key factors, including quality of service provision or value for money. That applies to provider-managed and self-or co-managed care.
As the National Ageing Research Institute recently pointed out in its position paper on transforming the system of home care for older Australians, the fact that home care users can’t access information to evaluate the quality of services from providers to make informed choices is a major problem.
This article was written by Bina Brown, director of Canberra-based aged care solutions company Third Age Matters.