Key considerations when negotiating package spending

From dog grooming to roof repairs, providers are receiving a wide range of consumer requests for home care spending.

From dog grooming to roof repairs, providers are receiving a wide range of consumer requests for home care spending, reports Linda Belardi.

Home care providers say they are fielding a growing number of out-of-scope purchase requests under consumer-directed care, which is raising a number of dilemmas.

While promoting choice and flexibility, consumer-directed care is also challenging service providers to consider and negotiate a wide range of uses for package funds.

Industry peak body Leading Age Services Australia recently surveyed its home care members to identify the types of requests providers were receiving.

Examples listed ranged from everyday household appliances such as TVs, fridges and dishwashers to lounge room furniture, the installation of blinds, outdoor landscaping and the purchase of Chinese medicine.

LASA warned in a competitive environment, where providers were driven by the desire to retain clients, rules could be bent. In its February 2017 report on the Increasing Choice in Home Care reforms released on the anniversary of the changes, LASA says:

“Providers have reported observing the inappropriate use of package funds by consumers and competing providers.”

The peak body says the issue should be closely monitored.

Home care provider CEOs tell Community Care Review some consumers are threatening to switch providers if their requests are not met.

While it’s only a small number of cases, it’s happening at an increasing rate, they say.

A growing trend in the proportion of funds being spent on goods rather services is also bringing this issue to the forefront.

Tracey Silvester, executive manager at Envigor, says the situation presents a moral dilemma for providers.

“I have been seeing requests for things to be paid out of people’s home care packages that I don’t view as reasonable.

“For example, we have had people ask us to fund repairs to their plumbing in their backyard, to repair an antique clock that held high sentimental value to the client and to air condition a person’s whole house. While there are valid arguments that can be made, is that what the program was intended to fund?

“The families of consumers have been incredibly forceful in asking us to fund some of those items,” she says.

“It comes down to a moral judgment and that is quite difficult because you don’t want your client to go to another provider. Morally, we have said no to a few things and people have moved on as a result.”

The Quality of Care principles set out what a home care package can and can’t be used for. Items identified as excluded include food, rent or mortgage payments, holidays, entertainment, gambling, home modifications or capital items not related to a person’s care needs, and care or services already subsidised by the government.

While there are clear objectives that guide the program and specific items that are not allowed, there is a large grey area in the middle that providers must navigate.

Key considerations

When considering consumer requests, Sabine Phillips, a partner with law firm Gadens, says providers should keep in mind the fundamental principle of home care package funding, which is to enable a person to remain in their own home.

Sabine Phillips

She says approved providers are ultimately accountable for how government funds are used and if expenditure is allowed on items that are out of scope, they could be in breach of their obligations under the Aged Care Act.

An increase in reporting and compliance action around this issue is possible as competition for customers in the sector intensifies, she says.

Discussing some of the cases she has advised on, Phillips says a provider was asked to fund expenditure on a costly and unproven elixir that claimed to treat Alzheimer’s disease.

Another challenging scenario for a provider was the discovery that an iPad intended to support the social goals of a client had been gifted to a family member.

In response to providers seeking advice in this area, Gadens has developed a guide to help organisations when considering consumer requests.

Phillips says there are four questions a provider should ask if they are unsure about whether a consumer’s expenditure request is allowable. These are:

  1. Does it support a care recipient to live at home?
  2. Can it be provided within the resources available?
  3. Is it consistent with the care recipient’s personal goals that are detailed in their care plan
  4. Can the service be provided in a way that ensures the provider complies with its obligations?

Unless a provider can satisfy these requirements, then the answer to a request should be no, she says.

Client circumstances

Jacki Attridge, Uniting’s head of home and community care operations, says the context of an individual’s request, such as their location, is important to consider.

“For example, a lawn mower may not be a reasonable request for a city dweller, or even someone living in town.

“It may be appropriate for someone on a rural property for the purposes of fire protection to clear the land around the home. Uniting’s support advisors will ensure that the context of the request is clearly understood.”

She says good communication with a client is important to understand the reasons behind a request and to avoid making assumptions.

The organisation attempts to be as flexible as possible, balancing the needs of their clients with their responsibilities as an approved provider, says Attridge.

The Department of Health says the types of care and services provided under a home care package will depend on the person’s assessed care needs.

A package should help older people to stay at home, provide tailored services and cover a person’s care and safety needs.

If a package is used to contribute towards the cost of items within a consumer’s home, the impact on a person’s individual budget, capacity to deliver other care and services and responsibility for any maintenance should be considered, the department says.

What’s needed?

Silvester says government regulation is not the answer. “If you stifle creativity then it will reduce the capacity of providers to respond to the different needs of clients.”

Instead, she argues for greater consumer education of the objectives of the program and excluded items.

LASA chief Sean Rooney agrees clear communication between providers and consumers is essential to ensure the appropriate expenditure of home care funds and highlights the role of education.

Sean Rooney

“Providers understand the importance of consumer choice in promoting independence, autonomy and quality of life at a time when support becomes more important.

“However, consistent information is needed for both consumers and providers to understand the principles for how package funds can be used.

“We are aware that the Australian Competition and Consumer Commission is currently developing information resources for consumers to support their engagement with home care package providers,” he says.

A spokeswoman for the Department of Health says it does not routinely monitor subsidy expenditure but works with the Aged Care Complaints Commissioner to resolve issues that are reported.

She confirmed no compliance action has been taken against a provider in relation to expenditure on a non-allowable item or service.

“The department responds to general queries from providers about permitted uses of home care package funding and provides advice in some exceptional cases,” she tells CCR.

This article appears in the current Autumn edition of Community Care Review magazine.

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9 thoughts on “Key considerations when negotiating package spending

  1. This is a very timely article, and confirms what we have been reporting to the Department for the last two years or more, in the context of home maintenance and home modifications. The providers of these services are required under the CHSP to strictly adhere to program guidelines, and whilst these should not be constricting they do guard against misuse of government funding and can achieve some level of consistency in the way that services are delivered to people across the country. The article mainly focuses on clients with packages, but there is story also about the experience of CDC within CHSP, with clients having very specific expectations of what they expect from home maintenance services (eg re-roofing a house, removal of trees, regular hedge trimming) accepted in principle at the My Aged Care intake level, only to have referrals rejected by providers who are required to prioritise work that falls within the scope of CHSP, within limited block-funded grants. Whilst the bulk of home modifications and home maintenance occurs within CHSP, and there are guidelines around those service types, there should be adherence to these for packaged care funds as well. In short there needs to be consistency in the spending of government subsidies on these services, regardless of whether they are received through a package or via CHSP.

  2. Thanks Linda for a great article that raises a number of interesting points. At Care Connect, our belief is that the Quality of Care principles are a great “line in the sand” in terms of what is out of scope. The trick is that everyone is an individual and their needs can be quite unique. The most important thing is that a capable case manager has reviewed the situation, there is a quality care plan with clearly articulated independence goals in place and the item in question is directly supported by those independence goals.

    A bigger issue we see emerging, is the potential for elder abuse within CDC. I have been struck in recent times by the number of anecdotes of family members calling with “we’re considering moving our parent’s package, but only if you’ll let us buy X” where X seems to have no connection to their parent’s independence, but may well benefit others. Last month we chose not to accept two level 4 packages in one family for this exact reason. In order to help the Department continue to evolve policy to protect against elder abuse, it would be good to see a follow up article examining this key issue.

  3. Supporting people at home within a CDC philosophy embedded in HCPs can be tricky. I agree that increasing controls could stifle creativity to assist people to remain at home. I also agree that a clear correlation between goals and purchases is important. However, people’s needs change over time, even within a contract year. Strengthening education of a HCP subsidy utilisation and its purpose is critical at every stage from assessment through to review of a client. And then we have the other end of the spectrum where people are inadequately assessed at a level much higher than their needs, posing a challenge for a provider to utilise a subsidy for the best outcomes and within guidelines.
    It is still an interesting environment to work within to create the best outcomes for a person to live at home.

  4. Thanks Linda. We were early users of CDC and are hopefully emerging from 4 years of arguments over the choice of service sub-contractors. It’s hard enough being diagnosed with a dementia, trying to maintain one’s life, only to be “told” that no, you can’t continue to employ your favourite gardener or cleaner….and then to discover that your package has been charged double the going rate!
    There are shark contractors of domestic services out there who obviously see dollar signs when Aged Care is mentioned and unfortunately they seem to nab the big contracts from some aged care home & community providers.
    “Bottom-line” education is sorely needed, for both service providers and clients, on what is NOT generally allowable expenditure under CDC. Then we clients/consumers will shop around for those providers that do add value worth the % that they take for “case management” & administration costs It’s 35% in total, in our case. We’d much rather employ people directly, but of course there have to be safeguards against abuse.

  5. Is the dog getting groomed helping stop you from going into permanent care? Is this reasonable to ask a taxpayer to fund a cost you would ordinarily be paying? These are the types of questions we consider and why an approved provider will always be holding the funds… For one person, this dog may help with vision impairment, and promotes their independence and for another, this is a reasonable cost they have always paid and should continue to pay as part of the responsibility to remain at home… I’m sure you can appreciate how complex and individual CDC truly is… Here’s my tip, work with your case manager, in consultation, do your research on excluded items and don’t treat it like a free for all.

    This is taxpayer funding provided to enable people to remain at home, not to supplement your income.

  6. How important is the dog in the family and to a person? We have a couple where full time care of a spouse with dementia is overwhelming enough. Supporting the couple with maintaining their dog with grooming could be considered a reasonable expense under CDC irrespective of the dog being maintained prior to illness by its owners. CDC is a complex philosophy where dog grooming, as an example, needs to be understood in the context of caring for a person to remain living at home.

  7. I help my parents with their package having moved from a supposed cdc package where they were charged enourmous onboard fees if want to use own worker and works provided by pakcage being paid far and above award (not the worker the package) .. anyway we are with better team now but bloody hell it is difficult to work out what is able to come from the package especially around home maintenance.. clearer guidelines would help all.

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