Increasing Choices in Home Care – Myth Busting

Increasing Choices in Home Care, do you understand all the changes that are on the horizon? Do you have some concerns about what you have heard? Perhaps some of those concerns have no firm basis. This week we look the myths that are circulating and bust them.

At the end of last year, the CDCS team were running workshops aimed at helping remote services to be ready for the changes which are coming on the 27^th February 2017. In preparation for, and during the workshops, it was interesting to note the common misconceptions that people have about aspects of the reforms. Generally speaking, this is not a reflection on the capacity of the organisations or the individuals attending, but rather it reflects the way information is reaching (or not reaching) remote service providers. This is compounded by the unique issues that rural and remote coordinators face, working to coordinate the day to day operational side of their role as well as complete the essential administrative aspects of their service. Faced with this workload, something has to give and usually that is keeping up with the latest reform information. So what were some of these common misunderstandings and let’s see if we can put the record straight? 

Myth #1 – From February 27^th 2017 the consumer can opt to have their package funds deposited directly into their bank account and can manage their own care.

Truth – Although the Home Care Package will be ‘attached’ to the consumer they won’t handle the funds.

The consumer will ‘take’ their package to an Approved Provider of their choice to manage. They can change Approved Providers at any time and can direct aspects of their care, such as choosing who delivers the actual hands on care or support and the time that any services are provided. The cost of providing the services, either by the Approved Provider or other brokered agencies are then applied against the individual’s Home Care Package.

Myth #2 – Consumers can take their package to anyone to manage.

Truth – Consumers can only take their package to an Approved Provider to manage on their behalf.

An Approved Provider is an organisation that has applied for, and received, approval to provide Home Care Package support.

The process to become and Approved Provider has become easier / or will become easier after February 27^th 2017. This will more than likely lead to an expansion in the number of organisations offering to provide support to individuals in receipt of a package, or to case manage their package on their behalf.

Myth #3 – Consumers might keep changing Approved Providers.

Truth – there are processes in place that deter consumers from changing Approved Providers at the drop of a hat.

I think that some organisations are concerned about experiencing manipulation tactics from consumers. They worry that they will be coerced into giving individuals what they want, even if this is not an assessed need. However it not quite like this. Consumers will have more say in who provides their services, but it will still be linked back to their assessed needs.

Additionally, under the Charter of Care Recipients Rights and Responsibilities – Home Care, consumers have a responsibility to tell their provider if they intend changing their service provider. The consumer and their current Approved Provider have to mutually agree to the date services will stop, and this must be done before they can change to another provider.

Some people worry that individual consumers might try to secretly transfer their package to another provider, however, for someone to transfer to another provider their referral has to be re-activated on the My Aged Care system. This must be done to allow another service provider to be able to accept them as a client. The original service provider will receive an email notification about this reactivated referral.

Additionally, consumers will be aware of the exit fee to their package, should they choose to move to another provider. This information will be in their agreement and on the My Aged Care website. The existence of an exit fee will be a deterrent to consumers changing service providers frequently and for petty reasons.

But don’t be lax. It does mean that service providers need to be aware that consumers could look at moving to another provider. If a consumer feels they are not receiving value for money or their services in a way they that suits them, they may walk. Service providers should also ensure they seek regular feedback from individual consumers around satisfaction levels and deal with any consumer complaints as they arise.

Myth #4 – As long as it is identified in their care plan, consumers can use their package funds to pay for items such as fridges, televisions and air-conditioners as these items will make their lives better.

Truth – The Home Care Package Operational Manual (December 2015) clearly states what is considered an excluded item.

While there might be good reason for considering items that would normally fall outside the intent of package funds, this should be approached with care and be well documented.

A remote area example might be a request for a personal fridge. How would you handle this?

If the request came from someone who lives in shared accommodation, where it is likely that the fridge would be used by a number of people and there is no medical or assessed need, the answer will most likely be no.

If however the request came from an individual who is bed-bound, they have their own room. They request a small fridge to sit beside their bed to store their medications safely and provide access to cold water in the summer months. This request is more likely to be approved, particularly if the individual had no other means of paying for the item.  

The excluded items list also makes it clear that consumers are expected to pay for the ingredient portion of their meal, even if they are on a package and have received a client contribution fee-waiver advice.

Myth #5 – When a client exits the program (dies or no longer needs a Home Care Package) any unspent funds can be used to support other clients waiting for a package.

Truth – Sorry, but all unspent package funds need to be returned to the Commonwealth Government. Any unspent consumer contributions need to be returned to either the consumer or their estate. This is why it is really important for organisations to ensure that individual consumer budgets are up to date and accurate.

All new Home Care Agreements must contain a statement that describes the handling of any unspent package funds or consumer contributions.

We’ll discuss the handling of unspent Home Care funds in a future blog post as it can be confusing and you need to get this information to your finance department. Your finance department will also need to be across the timeframes around forwarding unspent funds to another provider in the case of an individual who has changed Approved Providers and informing the Commonwealth of unspent funds for those people who have left the program permanently.

Myth #6 – A consumer who has had their client contribution fee waived is not paying anything toward their care.

Truth – Consumers on a package are considered to be contributing to (paying for) their care through their Home Care Package, even where they are not paying a basic daily fee.

To make things clearer, all consumers are expected to contribute to their care where they have capacity. Many of the consumers in rural and remote areas are on pensions and have a reduced capacity to pay additional money towards their care support. The basic daily Home Care Package fee is often not applied in remote settings; often it is waived by the organisation, with only the recovery cost of ingredients for meals being charged. This essentially means the consumer is not paying a client contribution fee – note the guidelines state that service providers may ask a consumer to contribute to the cost of their care not that they have to.

Recognition of the consumer contribution via their package needs to be highlighted in their agreement and in any client information such as client handbooks or brochures.

Note, even if a consumer receives a letter stating they have received a waiver for their fees, they still need to pay for the cost of their meal.

Myth #7 – Anyone who is currently sitting on a lower level package than their assessed level will automatically be moved to the higher package level on the 27^th February 2017. Eg. From a level 2 to a level 4 HCP.

Truth – Unfortunately a person won’t automatically be assigned, immediately, a higher-level package on the 27^th February however, if they are already receiving care at a lower package level they will automatically go on the National queue.

The consumer’s place in the queue will be reflective of their assessed needs and circumstances as determined by the Aged Care Assessment Team (ACAT) and the date they were originally approved for care at that level.

When the consumer reaches the top of the queue they will be assigned a package from the National Inventory. They will receive a letter advising them that they have been assigned a package. This letter will include their referral code and the date they must enter into a home care agreement to prevent the offer from lapsing.

Some other questions we have been asked:

Will there be any additional packages released by the Commonwealth Government on the 27^th Feb 2017?

There will be no additional packages released on the 27th of February, although additional packages will be released over time band these will be added to the National Package Inventory.

What is the National Inventory?

The National Package Inventory will be made up of all current packages whether used or unused at the 26^th Feb.

What happens to unassigned packages on the 27^th February 2017?

Any packages that are not attached to consumers on the 27^th February will be returned to a National Pool and will be distributed out to consumers in the queue.

Is there any change in the way we make a claim for payment for packages?

All claims for Home Care Package payment will continue to be made through the Department of Human Services Aged Care Payment System – Medicare. We suggest that where possible organisations change over to the on-line claims process if they have not yet done so.

Prefer to listen to this information? Kell and Carrie discussed this topic recently over on the Care Directions Podcast, episode CD006 – Increasing Choices in Home Care – Debunking the Myths