Ensuring your needs are met through your package provider
When people have their home care package managed through a traditional, fully managed provider, part of the provider’s fees are for care coordination or care management. This means that the provider should be responsible for delivering and coordinating the client’s services and support.
They should be monitoring the client’s situation, acting in a timely manner in response to declining health, increasing frailty, or a need for more support, and referring back to My Aged Care for a Support Plan Review if there is a need for a package upgrade.
Sadly, this is not always the case and older people may be left with a care plan that has not been reviewed since they signed with their provider. The provider is expected to review their clients at least annually, or sooner if there has been significant change in the older person’s health or function. In my experience this doesn’t always happen, and it is the older person whose quality of life is compromised.
Recommendations from the Aged Care Royal Commission
Recommendation 31 in the Final Report from the Royal Commission into Aged Care Quality and Safety discusses Approved provider’s responsibility for care management.
- From 1 July 2022, a person’s approved provider must assign a care manager to the person unless an assessment team has assessed the person as eligible for home care and, in future, ‘care at home’ without the need for any care management.
- In the case of home care and, in future, ‘care at home’, if the person has more than one approved provider, the person’s lead provider must assign a care manager to the person.
- Care management should be scaled to match the complexity of the older person’s needs and should be provided in a manner that respects any wishes of the person to be involved in the management of their care.
- The care manager should:
a.have relevant qualifications and experience suitable for the range and complexity of the care needs of the people to whom the care manager provides care management
b. consult with the person and, if applicable, their carer, to develop a comprehensive support and care plan, including activities to promote various aspects of health and wellbeing and to enhance their ability to live or participate in the community and address their strengths, capability, aspirations, and goals
c. implement, monitor and review the support and care plan, and adjust as appropriate
d. meet the requirements for care management set out in the person’s care plan and (if applicable) personalised budget for home care and, in future, ‘care at home’
Why were these recommendations necessary in the first place?
One would ask, if home care package providers are taking fees for care coordinating or care managing at present, why have so many older people not received the support they need? Why has it taken a Royal Commission to identify and recommend how coordinated care within home care packages should be delivered?
Because care coordination or management is the exception and not the norm across the industry. Too many providers sign people up to deliver their home care package and then the client is not reviewed again.
I know this is a bold statement, but I’ve seen this situation so often and it happened to my mum too.
With the advent of both self managed and part managed packages, the responsibility for advising the package provider of a deterioration in health or a change in circumstances has been transferred to the person receiving the package, and is not the domain of the package provider. In other words, if something changes, the client must inform the provider. This takes a certain degree of health literacy to understand what a significant change is and what isn’t.
So, what can we hope will be a good model for a new workforce of care managers?
The Support at Home Program Overview (January 2022) notes care management being a service type within this new model.
“Care management would be offered to senior Australians who have a more complex mix of services and need oversight and coordination of their care. Funding for care management would be restricted, so that people are not able to swap their care management for any other service”.
What this statement means is that under the new Support at Home Program, people will be approved to receive funding for care management, if the assessor believes they need a care manager. Not everyone will be approved for the care management service.
It also means that if someone is approved to receive funding for a care manager, that service cannot be interchanged with domestic assistance or lawn mowing or personal care, the funding for care management is to be used solely for care management.
There is currently quite a bit of debate about
1. Who should fulfil the role of care managers – clinical or non-clinical staff?
2. Who should have access to a care manager – only those with complex health needs or a wider cohort?
I am an advocate for registered nurses fulfilling the role of a care manager.
Registered nurses bring a holistic approach, understand health conditions and medications, and can reasonably predict the trajectory of complex and chronic health conditions that will impact on a person’s wellbeing and independence.
Understanding a person’s health conditions, knowing what that means in the context of threatened independence and being able to liaise with the older person’s GP, package provider and allied health clinical support team is essential to ensure comprehensive care planning and management.
I also believe that everyone should have access to a care manager. This will ensure that the older person’s needs are met and the programs that sit outside of a home care package, that many people are unaware of, can be explored and applied for if the older person is eligible. Sound care management gives the older person a better quality of life, as their changing needs can be addressed in a timely manner.