In many rural and remote Aboriginal communities, aged care services need to support consumers who are transient.
Transient consumers are those who may be absent from their home from three to four days at a time or longer, in some instances four to six weeks and upwards. Some consumers simply drift between communities; spending time with different family members and friends or attending cultural activities. Others are forced into a transient lifestyle due to family dynamics or health crises. A recent brainstorming session conducted at one of our workshops highlighted some of the reasons for transience amongst consumers in the Northern Territory:
- Cultural festivals (e.g. Wave Hill Walk Off and Garma Festival)
- Mainstream festivals and shows such as the Alice Springs and Katherine agricultural shows or the Art shows and festivals such as the Beanie festival
- Football and sports carnivals held on various communities
- Sorry business (Aboriginal ritual during the time of mourning)
- Cultural ceremonies (e.g. Men’s and Women’s business)
- Church gatherings (Easter festivals)
- Royalty meetings and Land Council meetings
- Changes in family support or dynamics
- Medical visits to major centres such as Adelaide or Cairns for the consumer or those they support (grandmothers caring for young children or those with a disability)
Although this list relates to consumers living in remote settings in the Northern Territory, providers of care to consumers living in remote settings in Western Australia, Queensland and South Australia will also be able to relate to these triggers.
In a mainstream setting we note that there are also consumers who are transient. Consider the senior who moves between family members over the year in a shared care arrangement. Then there are those who, for health or personal reasons, choose to divide their time between the southern states of Australia in the Summer and the Northern climates in the winter.
The reform process can benefit transient consumers.
The changes to the Home Care Package program are a boon for many of these people as they will now be able to take their package with them; the challenge however will be in ensuring that package funds are not lost through excessive exit fees and that the individual receives the on-going support they need. So how will this be done? By using brokerage arrangements.
The benefits of brokerage services
Whilst some consumers will receive their services from multi-national organisations, (those organisations who have businesses across the country) and can benefit by accessing their support in areas where their approved provider operates, it is unlikely that these organisations will operate in some of the smaller rural and remote communities. However, by negotiating and setting up brokerage arrangements with service providers in other locations, most organisations will be able to continue to support transient Home Care Package consumers as they move from one location to another.
It does need to be noted, that brokerage arrangements often incur a higher cost, and this will need to be factored into a consumer’s individual budget. This higher cost may result in a lower level of direct care support, however, in some cases, this may be offset by an increase in support from family or other services.
The cost of brokerage arrangements are also offset by the saving on exit fees that would normally be applied against a consumer’s package if they were to move their package from one approved provider to another.
Let’s look at an example transient consumer and how an approved provider might support them.
Consumer at Home / Location One
Janie lives on a remote community in the Northern Territory. She has a level 3 Home Care Package and her care plan includes delivered meals, laundry (clothes and blankets), shopping, transport, as well as social support and case management. These services are provided primarily by the organisation managing her package.
Consumer visits Location Two
Janie travels to another remote community outside of her normal service area to attend Sorry Business. Janie intends to remain at Sorry Camp for up to four weeks. To avoid an exit fee charge, Janie’s service provider makes an arrangement with location two’s aged care program. The aged care program will provide an equivalent level of services and support according to Janie’s care plan. They will invoice location one at the end of Janie’s stay or on a monthly basis if she remains longer than four weeks. The invoice will cover the cost of providing brokered support whilst Janie is visiting the community. Janie’s social support services and the case management component of her package continue to be managed by her original service provider.
Consumer visits Location Three
Janie travels to a major town outside her normal service area to visit family. Janie intends to stay with her family for up to six months. Janie’s service provider negotiates brokered services with a number of agencies in order to support Janie’s care needs while she is staying with family. The support that Janie requires changes slightly over this time as she doesn’t require meals or laundry services while staying with family, however her transport needs increase as their home is located some distance from the shops and there is no public transport close by. Case management support continues to be managed by her original service provider and they identify an organisation who can provide regular weekly transport for Janie. They negotiate and manage the delivery of a package of services to Janie remotely over the six month period. Janie continues to pay her fees to the original approved provider no matter which brokered service provider she uses.
Consumer visits Location Four
Janie travels to a family outstation where there are no specific aged care services or providers. The outstation is located 80km from the original community and has minimal supports however, residents of the community receive a twice-weekly visit from the health service and a weekly visit from an employment support agency who run an activities program for eligible outstation members. Janie’s service provider visits the outstation on a weekly basis to check up on her and provide some of her direct care needs. The service provider has trained one of Janie’s granddaughters in caring for Janie and meeting her needs. The granddaughter provides regular support to Janie while she is living on the outstation. The service provider also negotiates the delivery of meal packs and other requirements to the outstation with the health service and the employment agency. Although the level of direct care support is lower, the case management aspects of supporting Janie on the outstation is higher and is reflected in the time to visit Janie and negotiate her care supports. Janie’s care plan and individual budget will also reflect these variations.
Continuity of Care
In all of the above situations one Approved Provider continues to manage Janie’s package of care. This allows Janie to continue receiving the support she needs, although the service types may vary slightly at each location dependent on support services at that site. Support services may also need to be modified in recognition of the changes in the physical and social structures around Janie at each location. The main takeaway here though, is that there is continuity of service provision for the consumer.
The focus of this post has been on supporting consumers through brokerage arrangements. Do you have these arrangements in place? If not, think about what you need to do to set them up. Who do you need to contact? Do you need to develop a memorandum of understanding with other approved providers? Additionally, your organisation might be asked to provide services to a visitor to your community – do you have your brokerage price list established? It’s far better to have thought through this process before time rather than wait until events unfold, particularly if you have a number of consumers that you know will be transient.
In her spare time, while she ages gracefully, she helps out with kids theatre, rides an electric bike and drags her husband off to explore the world as often as possible.
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