Taking choice and control a step further

A growing number of operators in the market are facilitating older people and their families to manage their own package, writes Ross McDonald.

The choice and control now given to home care package recipients is a welcome game changer. However, the program doesn’t offer quite as much independence as the National Disability Insurance Scheme.

In the NDIS model, individuals can choose to self-manage their funding, with or without administrative support. And with limited exceptions, the NDIS has no mandatory requirement for a coordinating organisation.

So, what does a self-managed home care package look like?

The key features exist for home care packages to be consumer-led. For example, individuals with a home care package can currently choose:

• their provider and whether they wish to change providers at any stage;
• how they want to spend the monies, in a manner significantly more flexible than the NDIS as the money is not allocated to specified areas;
• who and when services are delivered, and
• how much they pay.

However, pure self-management, where the consumer manages their own care plan and budget, has not yet happened. There are a number of elements holding this development back. These include:

• the custom that providers ‘package’ administration and case management services together
• the legacy of many providers using their own staff for services
• the legislative duty of care put on providers of home care packages and subsequent staffing and risk management overheads
• limited integrated technology options, incorporating scheduling, invoice approvals and payments.

Some providers are currently offering ‘bare bones’ home care management services. The assumption being that the care recipients will not be requiring frequent support and will largely manage the care delivery themselves within the agreed budgets. In return, the case management fees are significantly lower than other clients who require higher levels of care.

But even the bare bones home care management services still have management fees. These include administration and case management amounts that in some cases exceed 20 per cent of the funding. However, this is still significantly below an approximate industry average of 30 per cent with some operators charging above the 50 per cent mark.

Change to pure self-management in the industry is no longer an if, rather a when. Developments in the industry are already visible with:

• New entrants. These new home care providers aren’t necessarily following the industry script around administration and case management charges. Many are simply costing in one management fee and others are charging only for administration. If case management is requested, this will be added as a cost or an independent case manager will be sought.
• Organisational cultures are changing. Many service providers are making their case managers more independent to that of their direct care staff, to the benefit of the care recipient. Providers are becoming more flexible with the ability to use other organisations where there are service and price benefits compared to in-house options.
• Home care provider duty of care is increasingly being supported by advances in technology. Some examples include online care worker verification services that provide reference, qualification and police checks, client wellness monitors via clockout processes, telehealth, personal alarm/trackers, home sensors, and carebots (friendly interactive robots).
• Software is appearing that claims full integration of home care provider administration requirements.

What we will see in the future will be similar to the deregulation of the superannuation industry.

The superannuation services started providing a range of options from self-managed to more premium offerings. Changes in super were also the result of government deregulation and technology advances.

It won’t be long before providers appear in the marketplace with pure self-management options. They will allow care recipients and their informal carers to:

• have a single low administration fee. For example, a fee of 4 per cent of the total package value is being charged by Local Guardians, related to Capital Guardians, which requires complete self-management or clients to either competently be their own case manager or bring in an external case manager
• manage with or without case management services
• select their own case manager, as approved by the provider, and most likely an external provider who has demonstrable strengths in care and governance
• bundle up the offering with easy-to-use software and an integrated care and financial management tool
• get value added freedom with debit cards, and other similar types of cash out options.

The only question remaining is whether it will be months or years before these solutions are standard.

Ross McDonald is the founder of Capital Guardians, a provider of financial management services to aged care and disability operators.

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

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