Do I still need to choose a provider if I self-manage my home care package?
You've received your letter advising you've been assigned your home care package.
You have 56 days to choose a provider for your home care package.
What now?
Firstly, being assigned a home care package doesn't mean the funding is deposited into your bank account.
The package funding is assigned in your name, but the conduit for the funding must be via an approved home care package provider.
Why is this? Because there are many strict reporting requirements relating to the use of home care package funding and the responsibility for meeting these reporting criteria lies with a package provider.
Historically, people receiving home care package funding had little choice, and the only option was fully managed, but now that the funding is allocated to the person rather than the provider, recipients of home care packages can choose their provider, as well as how much involvement they want with arranging support within their home care package.
The option of self-managing your home care package has become an attractive model for people who prefer greater choice, control and flexibility.
Let's take a closer look at the models a provider can offer with service provision and your home care package.
- Fully managed means that the package provider does all the work for you, sourcing your support workers, your cleaner, your lawn mowing person and any clinicians who you might need to support you as well (think nurses for a continence assessment or wound care, physiotherapists for pain management, exercise physiologists for enhancement of mobility or an OT for assessment of your home).
- Part managed, meaning you still have a package provider to administer the funding, but your bear some responsibility for choosing some of your support workers.
- Self-managed, meaning your choose all your support workers, your cleaners, the person who mows your yard and you have to find your own clinicians, meaning nurses and allied health practitioners too.
What option is right for you will depend on your situation.
Choosing the provider for your home care package essentially comes down to how much involvement you want to have in coordinating your day to day support and services.
If you want to have complete control and choose your own support workers, which day they come to your home, how flexible they are at short notice and how well they align with your values, religious beliefs or culture, then self-management will allow you greater choice in this instance.
If it doesn't bother you who comes to assist you, from week to week and you're happy to let someone else choose your support workers, then fully managed might be the right model for you.
Self-managed providers don't usually have offices outside the major cities.
All communication with self-managed providers is done via the phone or email.
In relation to this point, you'll need to be comfortable with technology, as email will be your main form of communication as you'll be emailing invoices to your self-managed provider or uploading them to the provider's portal.
When you've received an invoice from a service, say your lawn mowing person, you will either need to pay for the service up front, then scan and email the invoice to your self-managed provider or you can ask your lawn mowing person to forward the invoice to your provider, on your behalf and the provider will pay for the service from your package funding.
The responsibility for ensuring your services are covered by your monthly package subsidy is your responsibility, with self-management, if you choose a fully managed provider, the provider manages the budget for you.
Real story 1.
Mr and Mrs Smith both received letters advising their home care packages were assigned.
After talking with them at length about their needs and how the funding is allocated, they both decided to try self- management.
They are both very resourceful people and reasonably active, but they don't use the internet, including email.
We tried to develop a 'workaround' where we had someone collecting their invoices at the end of each month, but Mr and Mrs Smith wanted to take their invoices into a local office and speak with the local staff...there just wasn't an office in this town for the self-managed provider they were considering.
This was a deciding factor for them, and they opted to go with a fully managed provider.
Finding your support workers or carers can be a challenge.
There are some great websites that list these support workers in your area, but if you're in a rural area, there may not be anyone available.
Reliability of these workers can be a challenge too.
If your support worker or carer is sick, or wants to take some time off, you'll need to find another support worker or carer to cover this time.
Conversely, under a fully managed home care package, the package provider will have support workers and carers already employed.
Real story 2.
I moved my mum to a self-managed provider after being frustrated at the length of time it took for the provider to arrange support for my mum as well as monitoring her needs as they changed.
I was chasing the provider all the time, just to get simple things done.
The fully managed provider mum was with hadn't reviewed her care plan for nearly 3 years and was relying on me to report back to them her changing needs and how her care plan should be updated. I was doing all the work, but they were charging significant fees to administer mum's home care package.
The most difficult aspect of moving mum to a self-managed provider was finding a cleaner.
I contacted 7 cleaning companies and no one could take on any more work.
I then managed to find a company who had capacity to clean for Mum, and they did a good job, but then they began reducing the time the cleaners had at Mum's place but kept charging for the quoted 3 hours.
On the last day, before I suggested they didn't return, they only spent one hour cleaning Mum's place, but still charged her for 3 hours.
Dealing with this situation while working and being busy with my own family was an added layer of stress, but we pushed through and eventually found a reliable and trustworthy cleaner.
To get to this point took me 3 months.
I don't regret moving mum to a self-managed provider, it's the best thing I did, and now that we've got a reliable cleaner and have all the other services in place, there's not much more I have to think about.
What about clinical support?
Clinician support is something many people don't think about when self-managing a home care package.
When people are with a self-managed provider, the responsibility for knowing when clinical support is needed or alerting the provider to any deterioration in health falls to the individual, not the provider.
I work with a couple of self-managed providers and within my networks I'm able to source other nurses, physios and occupational therapists (OTs) for people who are self-managing.
Again, there are websites that list registered nurses and there are companies that offer physio and OT support, but health professionals are always in demand and you may have to wait (often many weeks) for this kind of support.
What kind of clinician support might you need?
You'll need a registered nurse to complete a continence assessment or make an application for continence schemes outside the aged care program.
You'll need a registered nurse to complete the screening for the dementia supplement or for wound care.
You're likely to need an OT for home modification recommendations before you engage a builder to renovate the bathroom and you'll need a specialised OT to assess and recommend for any modifications to a car or to complete a driving assessment.
Sourcing your own clinicians is achievable under self-management, just be aware that it takes time and tenacity to find the health professionals available in your area.
Bear in mind too, that supporting an older loved one with complex health needs or dementia, with the self-management of their home care package is a big ask.
Not impossible, but certainly not easy.
My dad had a level 4 home care package that was fully managed by a traditional package provider.
At that time, I was working full time and raising my own children and although I supported my mum to care for my dad, there was no way Mum or I could take on self-management.
We were physically exhausted and emotionally depleted from caring for Dad.
The fully managed provider did a great job of alleviating the additional stress of finding carers and sourcing equipment for Dad.
Fully managed was right for my dad and our family in this situation.
Another important factor in self-managing your home care package, is that it is up to you to provide your package provider with your health history (a GP summary and any letters from specialist doctors), demonstrate your functional limitations and mobility impairment and be descriptive about what your needs are, so they can be incorporated into your care plan .
Your package provider's 'sign off' on your requests for funding expenditure is only possible if you supply the provider with as much detail as possible, to reflect what your needs, which in turn are written into your care plan.
Self-management is a great option that will provide greater flexibility with the kind of support or services you want to engage within your home care package funding and you will have more available funding to use for your care.
I recommend self-management if you're able to manage your own day to day services and support. It's not for everyone, but self-management offers what many people are seeking, greater choice, flexibility and control.
Don't go into self-management solely focussed on cost saving.
Be realistic about the time it will take you to research and interview your potential carers, support workers or service staff.
If you are computer literate, and good at articulating your needs and you have the time to find and manage your own support workers and tradespeople, then self-management could be a great option for you.