Understanding Home Care

Understanding home care

Everything you need to know about different types of home care

If you’ve been researching care options for your loved one, you may have come across a lot of new language – such as care management or case management, assessed needs, fully versus self-managed care, and levels of home care.  What does it all mean?

Home care: In the beginning

Let’s start at the very beginning. You might have noticed that your loved one isn’t managing quite as capably as they once did, or perhaps mum or dad are calling more frequently to ask for help, relying more heavily on you and the family to manage things for them.  There is support available to help your loved one continue to live safely and independently at home, and to allow you to retain your role as son, daughter, or other family member on a more social level.  Aged care support at home is available to Australians over 65, and over the age of 50 for people of Aboriginal and/or Torres Strait Islander origin. The first step is registering with My Aged Care My Aged Care to understand the services available and arrange an assessment.  The government is currently reviewing the assessment process to consolidate assessment for aged care programs into a single assessment which will come into effect in July 2024.

An aged care assessment

An aged care assessment might be arranged by your GP or hospital staff after a stay, but you or loved one can request an assessment by visiting the My Aged Care website and completing an online form, or phoning 1800 200 422.  It’s important to be aware that there will be a waiting period for the assessment depending on your loved one’s care needs and the availability of assessors.  You can help speed up the process by providing details of care needs and any medical conditions. The assessment will ideally take place in your loved one’s home, although some are completed online or by phone, and may take two to three hours. It’s wise to attend with your loved one if possible, to encourage them to open up about tasks they are finding difficult, and so you can discuss the care that you’ve been providing. The purpose is to understand health and care needs and any support that’s already in place to determine if your loved one will receive government funded care, through which program and at what level.

Different types of care

Aged care in the home may be “entry level care’’ delivered via Commonwealth Home Support Programme (CHSP) or the more complex care delivered by Home Care Packages. Commonwealth Home Support is for those who need help with only a few things around the home or garden or limited allied health and is provided as subsidised care.  Your loved one will be asked to contribute financially to each service which may be $10 for a cleaner and $15 for a podiatrist. Home Care Packages are provided at four different funding levels depending on assessed care needs, from Level 1 at $10,271 to Level 4 which delivers $59,934 to allow for low to high, complex care needs. The care is co-designed with your loved one to meet their needs and fees are paid from the package.  At present, there is no income assessment required for Commonwealth Home Support, but all recipients of Home Care Packages will be required to complete an income assessment with Services Australia, formerly Centrelink. If your loved one is not a full pensioner, it’s likely they will be asked to contribute to their Home Care Package, anything from a few dollars per day to $35.95 per day if they have a high income.  The income tested fee has an annual and a lifetime cap of $13,087.39 and $78,524.69 respectively.  The cap applies to both home and residential aged care.

Smiling senior grandmother with her granddaughter paying online
Smiling senior grandmother with her granddaughter paying online with credit card

Care management vs case management

Care management and case management tend to be used interchangeably, however, care management is the more usual term.  Care management is a service that must be provided to all Home Care Package recipients and is a key distinction between “entry level care’’ delivered via Commonwealth Home Support Programme (CHSP) and the more complex care delivered by Home Care Packages. Care management is a mandatory service for all Home Care Package recipients, whether the home care organisation (also called a ‘provider’) fully manages your loved one’s package, or they opt to self-manage.

If you loved one receives a Home Care Package, you can support them in finding an organisation to manage their package (normally called a provider) and deciding whether they’d prefer to self-manage or have their package fully managed. The fully managed option can cost up to 35% of the total home care package.  Organisations that provide fully manages care will likely prioritise their care workers over others you might prefer to choose, such as your existing cleaner or gardener, and may not offer as much choice with timing of the services. If your loved one would prefer to self-manage, they’ll need to do a lot of their own organizing, however will benefit from having more choice in care workers and they’ll save on fees paid to the home care provider. Not all providers offer self-managed options so you will need to shop around if this is something you and your loved one are interested in.  There is a third option offered by a few providers which may be called “supported” care which is somewhere in between fully and self-managed care.  If you are exploring this option, be very clear on what is expected of your loved one and what they can expect from their provider. Where possible, when supporting your loved one with these decisions, be clear on the support you can offer on an ongoing basis and prioritise social visits over tasks and errands.  Social experiences are important too, and caring for a loved one should not be overwhelming for you or mean that you are consumed by care tasks.

Care management, what is it and who does it?

Care managers are professionals and are usually degree qualified in social work, allied health, or nursing, and are able to offer you and your loved one expert advice on the best care options to meet your needs.  The ultimate purpose of a care manager is to work with their clients to understand care needs and goals and co-design the care services, including provision of any aides or home modifications, that will enable the older person to meet their goals.  A care manager’s role includes regularly assessing your loved one’s needs, goals, and preferences, ensuring their care and services align with other supports, partnering with the person receiving care and their families or carers about their care. A good care manager should have knowledge of all the services and products available in your area to tailor and optimise your loved one’s care.  While you may have spent hours researching care options for your family, a skilled care manager will be able to link you to a greater range of services to help the person live safely and independently at home for as long as possible.  Some examples of care options you may not be aware of are: assisted shopping (which includesthe  supermarket, pharmacy and a favourite butcher or fruit shop), dementia day programs or support caring for your pet.  Ideally care managers can also make you aware of social events and activities that may be free or low cost in your loved one’s community, perhaps with the inclusion of some assistance with transport. Care managers can also ensure care and services are culturally safe and respectful.

How is this achieved? 

Every Home Care Package recipient must have a care plan written at least annually or more frequently if the older person’s care needs change. For example, following a fall or injury, a new significant medical diagnosis or the death of a spouse.  A care plan is a written document which outlines your loved one’s assessed care needs and how their care manager will help meet those needs to help them remain at home[1]. The plan should be co-designed with the care recipient to respect their goals and preferences. You can also be involved, if agreed, which allows you the opportunity to discuss the care that you have been giving your loved one, and set up support within the Home Care Package.  This will allow you to reclaim your time socialising with your family rather than racing around to do all the jobs that need to be done.

How much does care management cost?

Care management costs vary by provider and they may also vary by Home Care Package level.  Care management costs vary from 15 to 25% of the Home Care Package and must be expressed in $ by each provider on the My Aged Care[2] website so that you are able to compare providers.  Many providers also publish their costs on their websites although some providers prefer you may an enquiry first. The other significant cost is package management which can vary from 10 to 15% of the package, and covers the compliance and reporting costs associated with home care.  Care management and package management together cannot exceed 35%.

[1] Home Care Package costs and fees | My Aged Care current as at September 2023

[2] Access Australian aged care information and services | My Aged Care

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