What do I do if I need more support at home?
Contact My Aged Care and ask for a review for yourself or an older loved one should occur when you recognise that your needs, or your older loved one's needs, have increased and the support they are receiving is not enough.
My Aged Care is the contact point for initially registering to apply for government subsidised services and support. It is also the contact point when you're requesting a review of current approvals.
This is known as a Support Plan Review.
A Support Plan is not a Care Plan. A Care Plan is the document developed by your home care package provider, in consultation with you.
How does this work?
The RAS assess for entry level services under the Commonwealth Home Support Programme. Services approved by the RAS are fragmented, meaning any number of providers may be delivering those services.
If you've been approved by the RAS for domestic assistance, lawn mowing, social support and group exercise classes, you may have four different providers delivering these services.
Funding for these services sits with the provider, not you.
The ACAT approve for support under the Home Care Package program. This differs from CHSP, as the funding is allocated to you, meaning you get to shop around and choose which provider is right for your needs.
You are under no obligation to sign up with your previous CHSP provider for your home care package.
Home care packages begin at level 1, which supports very basic needs, through to a level 4 which is the highest level and provides more funding aligned to complex needs or higher support needs.
As your needs increase, it is accepted that you'll need to move up to the next level of support.
If you are receiving CHSP services, you'll need an ACAT assessment to be approved for a home care package. If you've already been assessed by the ACAT and are on a lower level home care package, you'd need a Support Plan Review to have your home care package upgraded.
When do I do this?
One of the challenges people become aware of when they realise they need more support, is doing something about it in a timely manner and contacting My Aged Care.
People don't realise that, at any time, when needs increase, it is possible to have a Support Plan Review, even if an assessment was fairly recent, as things can change in a heartbeat.
The other challenge is understanding that this conversation with My Aged Care needs to be well thought out by you so you can clearly articulate your increased needs, which, if a carer, must include telling My Aged Care that you are experiencing carer stress or worse, nearing carer crisis.
Other big red flags My Aged Care need to know about at this time is if your caring role is becoming unsustainable. Any older person at risk of prematurely entering an aged care facility or worse, being admitted to hospital because a carer cannot extend themselves any further will make both My Aged Care and the RAS or the ACAT sit up and take notice.
Upon triggering this contact with My Aged Care, they will forward your request, this 'referral', to your previous assessment workforce.
If you or your older loved one thinks your needs are reflective of a home care package and you are seeking approval for this, then your request will firstly go to the RAS and must be 'released' and forwarded to the ACAT.
What people don't realise is that this process takes time.
Real Story -
I assessed a lady recently. She had needs reflective of a higher level home care package. I completed my assessment, uploaded my report via an online request in My Aged Care and waited for the RAS assessor to call me.
After a week I began contacting the RAS assessor. It took another week of leaving messages for her to return my call. She explained that she had 300 Support Plan Reviews to do. She didn't need to tell me this as I had already realised it, but she said she was unlikely to ever get on top of her workload.
Because I contacted the RAS assessor and explained my client's situation, the RAS assessor was able to act on that immediately, rather than wade through those 300 files and she released my request for a Support Plan Review to the ACAT straight away.
What happens when I submit my request for review?
When your request or 'referral' for a Support Plan Review arrives at the ACAT, they will triage the request against all the other requests coming in. Depending on where you live in Australia, you may be one of hundreds awaiting a Support Plan Review or you may be one of thousands.
If you're seeking an approval for a home care package then this will be fairly straight forward, once the ACAT have triaged and assigned an assessor to your file. If you've already been assigned a home care package and are seeking an upgrade, you'll need to have your reasons for the request prepared, in detail.
A request for an upgrade of a home care package could also be triggered by your existing package provider. If this is the case, the ACAT will likely ask to see the care plan your provider has developed (in consultation with you or your older loved one) and they may ask to see a statement or budget detailing package funding expenditure.
ACATs may suggest the care plan be reconfigured to remove some services to allow other support to be covered by the existing package.
And if you have a significant amount of unspent funding and are seeking an upgrade, you're likely to be declined, unless you explain you're saving up for something big, like a bathroom modification or purchase of an expensive item like a mobility scooter.
Real Story -
I was involved with a lady who was seeking an upgrade of her home care package from a level 3 to a level 4. When the ACAT reviewed her care plan and budget expenditure and considered her reason for wanting an upgrade, they declined and did not approve the level 4 home care package.
The reason cited for the non approval was that she was using most of her package funding to cover manicuring of her small backyard. Three hours every week for yard maintenance. She had a beautiful back yard.
Whilst yard maintenance is an acceptable expenditure, through the eyes of the ACAT three hours was excessive and the ACAT went back to the package provider and suggested they review the care plan to reduce some expenditure on the yard to allow the lady to free up some funding for other support.
Some good idea's to speed things up when you need them
When you're assessed by the ACAT, for a home care package, it is also advisable to have all the approvals completed at once. These approvals would be for residential respite as well as permanent entry (into an aged care facility).
Having these approvals in place doesn't mean you need to use them, but they are there in case an urgent situation arises and you need to act quickly. It is only the ACAT who approve for residential respite and entry.
ACATs are very busy, so they usually like to do all the approvals at once. Once you've had your Support Plan Review, the ACAT will note those approvals as medium or high priority. The priority reflects the wait time until you are assigned a home care package or that upgraded package.
A medium priority at present is around 3-6 months and a high priority is around 1-3 months. You cannot ask for the priority rating. This is entirely at the discretion of the ACAT.
Again, it is important that you have all information ready and be candid with the assessor. Being stoic won't help you get that upgrade you're seeking.
The process for people who are self-managing their home care packages is the same as people who are with a fully managed provider, when seeking a package upgrade.
There is more onus on the person who is self-managing though to instigate a Support Plan Review themselves, rather than have their provider trigger this.
The reasons are fairly obvious. Self-managed providers don't have offices in local areas and communication between you and your self-managed provider is essential in getting the right level of support with the right level of home care package.
Self-managed recipients can make that request for a Support Plan review themselves, but it should involve a discussion with their provider as it is still possible the ACAT will ask to see the care plan and budget.
A Support Plan Review is the process whereby people move up from CHSP services to a home care package or, if already receiving a home care package, can be upgraded to a higher level.
Recognising you or your older loved ones' needs are increasing and your current services aren't enough to support you is the trigger to action a Support Plan Review.
You can start this process yourself, by contacting My Aged Care or, if you are already receiving a home care package, your package provider can action this process for you.
Just don't to leave it too late, until you really need the increased support, as the months of reassessment and then being assigned the upgraded support may not be allocated in time.