Choosing the right home care provider…

Seven steps to help you choose the right home care provider

First published February 27, 2017 12.29pm AEDT, written by Associate Professor Lee-Fay Low, for The Conversation.

 

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 to 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 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 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 that 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.

What changes?

From today, 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 for 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

The system is confusing. Apart from one useful website, there is not much consumer-friendly information about the packages. This makes it difficult to make good choices.

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.

Particular challenges

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.

 

11 thoughts on “Choosing the right home care provider…

  1. Kate you are right it is so complicated. I am not living with dementia but find it very hard to understand all the little pitfalls in the system. My mother’s package is currently being charged 300 per week for admin and co-ordination !! They do a roster and send it out, it never fits with my times or my mother’s. I guess they may have a carer’s meeting every week or two. Contact is so long winded and restricted. I have to ring Brisbane ( I am on the Sunshine Coast as are the carers) and then deal with someone who knows nothing about my mother to send a message to her immediate carers.
    Recently I was sent a letter that detailed a range of exit fees should we wish to change once the final stage came in today. For a level 4 package they want $1000 before I can change to a different provider, which I think is an extraordinary amount for the paperwork necessary. Last year her “contingency amount” was over $4000 and I had to negotiate and get very insistent to access those funds. I was told I couldn’t use them with care arrangements that were ongoing. Obviously their concern was to leave at least $1000 in the kitty.
    I have recently come across a new organisation called Five.Good.Friends, which appears to be the way of the future for those living at home with and without dementia. I am going to switch to them as the hourly rate is greatly reduced and the admin is restricted to a $35 per week membership, which is the equivalent to what my mother pays currently as her co payment. It is App driven with contact through the app for the carers and their clients and for family to contact through. I like the fact that they encourage communication directly between the client and carers via the app. Their hourly rate is $35 of which $31 is paid direct to the carer, which is great. This means an extra 7 hours per week for us in direct face to face care.
    The best thing about this is that it allows for lifestyle quality such as social events.
    I hope it all works as well as it sounds, the community care network is where the changes need to happen to keep the aged people living well within their own homes.

    Regards
    Adrienne

    • It is indeed a very complicated system, and the same stories from those using it continue… having to talk to people who know nothing about you, or the person you are supporting, lack of trained staff, lack of services especially at time you need them, and Consumer Directed Care, just like Person Centred Care, is aspirational, but not really in action, from what I experience, hear from others and see…

      • Thanks for your response Kate. I recently began volunteer visiting in a local aged care home, and have been feeling bad that I do not think I can continue with it. In my studies on dementia care and my personal experiences with it generally, I can’t help feeling that all I am achieving is to enable to shareholders of the care organisation concerned in the Care home, to employ inadequate numbers of staff. I feel sick in my stomach when I see people with dementia who are stuck in rows in front of TVs and left to an activity that “ticks a box” for the care home. I have been conflicted as to whether I should stop visiting and just start up more activities within my mum’s village . In my heart of hearts I believe that community care is where it needs to start so as to enable them to live in their own homes well. It is incredibly sad to see all these elderly people with no visitors or real meaningful activities. Most have families too.
        I’d be interested in your opinion of the dilemma I seem to be faced with as I have been feeling guilty about wanting to stop visiting the home .
        Thank
        Adrienne

  2. I was just thinking the same thing.
    It is so dependent on where you live and the ‘grey’ areas that the care providers don’t mention, and that those new to this sector are not always aware of.

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