Can Remote Services support level 3 and 4 Home Care Packages?

This is a question we are asked often.

Actually, the question is usually posed as ‘remote services can’t provide level 3 or 4 Home Care Packages, can they?’ as if there is no way that remote services could even think about daring to offer level 3 or 4 package services. My response is of course – yes, they can. Supporting a client on a level 3 or 4 Home Care Package (HCP) really relies on understanding the needs and goals of the individual and working effectively with other providers and/or services in the community.

Let’s look at a typical level 3 or 4 consumer living on a remote community and their needs. We’ll call him Danny.

Danny is a 77 year old Warlpiri man living with extended family on a remote community. Danny has been receiving care through the local aged care service for a number of years on a level 2 package as the service did not have any level 4 packages available before February 27^th 2017.

Danny is becoming frailer and requires prompting to take his medication, transport to attend the community-based dialysis three times a week and would like the opportunity to spend more time on country collecting wood to carve boomerangs and spears, however he needs someone to take him out and accompany him to ensure his safety.

Back at home, Danny enjoys sitting by the fire, both for warmth in winter and for the comfort it gives him, reminding him of the time he was a stockman and growing up out bush. Unfortunately, he can't collect firewood anymore and is always running out of it.

Danny has just been allocated a level 4 home care package and the coordinator is not sure whether they have the necessary skills and services available to provide care for a level 4 package. Do they have the right staff? Doesn’t the service have to have a nurse employed to offer level 4 Home Care Package support? Should they suggest Danny seek out another external provider?

Whoa, let’s think about this!

• First and foremost, a service does not have to employ a registered nurse to offer support to level 3 and 4 Home Care Package clients, although they do have to assist the person to access nursing support if they require it. Organisations who previously supported Extended Aged Care at Home (EACH) level care were required to provide nursing support; the EACH packages became the current level 4 HCP with the introduction of the Home Care Package program.
• The service has most likely been providing a high level of personalised care and support to Danny over the years. They will know his needs and preferences.
• Danny’s requirements for additional support are for more transport and social support, not nursing care.
• Danny receives his clinical care from the local health clinic as a member of the community; this is similar to an older person living in a mainstream setting going to visit their local GP.
• An outside provider is likely to broker the services from the current aged care provider as the staff will be culturally appropriate, trained and often there is little accommodation on a remote community for outside staff.
• The local coordinator or case manager may be more responsive to Danny’s requests and needs, adjusting the services delivered according to his requirements.
• The local coordinator will know about, and can work in with, other agencies or services in the community who can provide support such as firewood collection and supply.

Additionally, can I remind you that all Home Care Packages, regardless of the level, also include the requirement for nursing care, if the consumer requires it.

In a remote setting, general nursing health care is provided through the local clinics for all community members. The service can support a consumer's health plan by providing additional transport to the clinic or to community-based renal dialysis if required, supporting the client to attend allied health or specialist appointments or provide medication ‘prompting’ (reminder to take medication) and alerting the clinic if they have concerns about an older person.

So, if a client receives a Level 3 or 4 Home Care Package, don’t panic! Ascertain the needs of the consumer and what their goals are and look around to see how you can best meet their needs. After all, it is the consumer’s choice to continue to live on community, even where there are fewer options for services.