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.
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 a 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 whichever package provider or model they want.
You have 3 choices about how your home care package will be administered.
- 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, physios 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 clinical support too.
Many people are attracted to the idea of self managing for two main reasons.
1) they prefer to choose the people who are supporting them in their own home and
2) the administration fees are less than fully managed, meaning there is more available funding to use for the actual support.
What option is right for you will depend on your situation.
Let's take a look at what you'll need to consider when choosing between fully managed and self managed.
If you're the kind of person who likes to drop into a local office and talk with the admin staff, then self management won't be an option for you.
Self managed providers don't 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 email as your main form of communication.
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 package 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.
Mr and Mrs S 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 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 S wanted to take their invoices into a local office and speak with the local staff...there just wasn't an office in this town.
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.
Mr and Mrs N lived in a rural area, one hour's drive from a major city.
Mr N was previously with a fully managed provider who were taking significant administration fees but falling short on delivering the services and support.
This provider signed Mr N up and essentially stopped communicating with him and his wife.
Mrs N moved her husband to self management.
She managed her husband's home care package on his behalf.
The savings in administration fees were welcomed but she found it difficult to source support workers and services.
Mrs N was unable to source someone to mow their yard, attend the home to undertake maintenance and modifications and there were very limited in the number of carers available locally, being only two in fact.
Tradespeople they engaged from the city didn't show up when they said they would.
No one could be bothered to travel an hour from the city to support this older gent.
Support was inconsistent and this left Mrs N feeling increasingly distressed and frustrated.
Because of this, Mrs N moved her husband back to fully managed, albeit with a different provider.
I moved my mum to a self managed provider a few months ago and the most difficult aspect of this related to finding a good 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.
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 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.
Given some of the considerations for choosing self management as an option for your or your older loved one's home care package, the benefits are worth it.
Fully managed package providers will charge around 30% in admin fees to manage your home care package.
Some charge more, a few charge slightly less than 30%.
This means that 30% of your funding will be consumed by the provider.
A self managed provider will charge around 13-15% in admin fees.
The saving to you then is significant.
If you're someone who prefers continuity of support workers or you have cultural or lifestyle needs and you want someone supporting you who understands those needs, then self management will give you greater choice.
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 it.
Again, 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.
And these days, providers are obliged to ask you for all of your support workers Covid vaccination certificates as well as police checks and sometimes insurance.
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.