What's the difference between a fully managed and self-managed home care package?
Choosing a provider for a home care package (HCP) is something we are often asked about. The most frequently asked questions are:
“How do I choose a provider?”
“Can I self-manage?”
“What’s the difference between a fully managed provider and a self-managed provider?”
"What should I have included in my care plan?Different providers offer different models:
1. Fully managed
2. Self-managed
3. A hybrid of the above two which is referred to as supported self-managed or part-managed.
Let’s take a closer look at all these models and discuss what you need to know before you choose a provider.
Firstly, no matter which model you choose, you must sign up with a provider. The HCP funds are never paid directly to the recipient. They must be managed by a provider who is responsible for management of your package funds, preparation of monthly statements and quality assurance and compliance activities.
For this, a package management or admin fee is charged. The rate of management fee varies between providers.
Fully managed providers.
The package provider, in addition to managing the package, will also manage the care and clinical needs of the client. For this, a care management fee is charged. This is in addition to the package management or admin fee.
Care management means the package provider will set up and co-ordinate your care and services so that you receive the appropriate level of support to meet your current care needs. This should be planned with you and consider your personal goals.
The care manager should also ensure your care and service provision remains within your package budget. There should be regular review to ensure your care and services continue to meet your needs, with referral back to My Aged Care if your needs are exceeding your current level of support.
Self-Managed Providers.
These providers will take care of the administration of the HCP as described above. You, the client, are responsible for sourcing your own support staff, your own clinical staff, and for notifying your provider if your health declines or your situation changes.
Supported self-managed or Part-Managed providers.
This is a hybrid of the above two, whereby the provider administers the package as previously described, but will also have a team member or someone who is sub-contracted locally to support you with your choices and sourcing your workers.
The provider also shifts the responsibility to the client to notify the provider if there have been any changes to the client’s health or circumstances. They do not provide clinical oversight.
This is a general overview of the package management types and fees, but there are other fees to be aware of.
Basic Daily Fee (BDF)
This is a daily fee, currently between $10.88 and $12.14 depending on your HCP level, that a provider may charge the client for the services they receive. This is not a compulsory fee and is negotiable with the package provider.
Some package providers advertise lower package fees but will charge the BDF. The value of the BDF cannot be taken from the HCP subsidy. It is paid by the client in addition to the value of the HCP.
Other providers may charge higher package fees but will waive the BDF. Ensure you know what you are being asked to pay.
Income Tested Fee (ITF)
This is a compulsory fee, determined by Services Australia through an income assessment. It is different for everyone and is based on a person’s income. Typically, full pensioners do not have to pay the ITF, but self-funded retirees may meet the threshold to do so.
The ITF is considered a “contribution” towards the cost of care. The value of the HCP subsidy is reduced by the amount of the ITF, so that the person still receives the same total value of the HCP, but they are contributing towards it.
Package Level
Daily subsidy
Annual subsidy
BDF (negotiable)
ITF - variable- up tp max/day
1
$28.14
$10,271.10
$10.88
$34.84
2
$49.49
$18,063.85
$11.50
$34.84
3
$107.70
$39,310.50
$11.83
$34.84
4
163.27
$59,593.55
$12.14
$34.84
Which Model is right For You?
Here are some considerations...
Time
If you self-manage, do you have the time to source support staff, interview them, get reference checks and police checks, and ensure they have an ABN?
You will also need to submit your receipts to your provider on a regular basis to ensure you are reimbursed. The fully managed provider takes care of all of these tasks for you.
Digital connectedness.
If you self-manage, are you sufficiently confident to deal with your provider via phone or email? Many self/part-managed providers have an office in only one major city, so you can’t just pop in to an office and talk to the staff. Fully managed providers tend to have offices in regional towns as well as the cities.
Continuity of Workers
If you employ your own support staff, you control who supports you and when. However, if your support staff take holidays or become unwell, who will fill this role?
With a fully managed provider, staff absences are covered by the provider's rostering team. Rostering of staff may mean that the provider is unable to guarantee you the same staff every time, and this is an important consideration for many people. Some providers discourage continuity of staff.
Understanding the system.
Do you understand what services and supports you can utilise through your HCP? Do you feel sufficiently knowledgeable to advocate for yourself (or your loved one) if you believe you could access certain services and the provider says otherwise?
Do you know what else you're able to access in addition your home care package? For example, the Continence Aids Payment Scheme, a GP Management Plan or Team Care Arrangement or applying for the Carer's Allowance.
Summary
Understanding your situation or that of your loved one and acknowledging your ability or capacity to self-manage a home care package, is key to ensuring services and support are delivered in a way that suits you. Some people prefer to have a provider take care of everything for them, and some are very independent and want to have as much control and choice with service provision as possible.
Your HCP is there to support you in your own home. Think about the type of care you need, if your needs are complex, if you have medical conditions that need monitoring (for example stoma care, wound care, incontinence, cognitive decline) and if you are in a position to manage your own package or not.
Your decision about which model you choose and which provider you sign up with must consider all aspects of your health and support required and shouldn't be determined on cost or fees alone.
By understanding your needs and the type of support that would best help you to continue living in your own home, you will be able to make a more informed decision about the model of package management that would be most suited to you.