Time for providers to consider self-managed home care

Self-management of home care packages can be beneficial for consumers and should be considered as a component of the new aged care system set to come in next year, a researcher says.

Dr Carmel Laragy of the University of Melbourne led a nine-month study into home care self-management in 2018-19 and the results are published in the journal Health and Social Care in the Community.

The research, sponsored by COTA, involved seven home care service operators and 100 clients who were able to find their own support with the help of a provider.

“You can think of self-management as your money, and how would you spend that money to get the best life that you can within rules and boundaries,” Dr Laragy told Community Care Review.

“The service provider is responsible for doing police checks and ensuring that the person employed is fit and proper for the job described.”

Embraced by older people

Dr Laragy says the findings show that self-managed home aged care is an efficient option that maximises self-determination and reduces reliance on service providers.

“A lot of people really like it,” she says.

Clients in the study gave the thumbs up to self management  because it meant they paid lower fees and had more money to spend on services and support. They also got more personalised care and increased autonomy.

Dr Laragy says she hopes self-management has a place in the new  Support at Home system which will replace the current CHSP and HCP structure from July 2023 .

“I think this should be on the table as one of the policy options to consider for those who want to do it, and to make sure there is appropriate support and oversight,” she says.

Business opportunity

Dr Laragy admits there could be some pushback from providers who see self-management as taking away from a their core operations and reducing revenue from fees.

But the research showed others viewed self-management as a business opportunity, she says.

“They saw it was a business opportunity and maybe the way things will go in the future. Some of providers say they’ve been inundated by requests (for self management) and see a market for it.”

Cultural shift

Self management represents a major cultural shift for the sector, Dr Laragy says.

“It is a different approach, it’s a different mindset. It’s a huge cultueal step to go from ‘I’m the provider, I’m the professional, I’ll assess what you need and send in staff’, to holding someone’s hand and saying what do you want.”

But providers who do get on board have to be committed to ensuring a client is getting the support they need, and that it’s genuine support.

“The service provider has to make sure that they have an annual review,  that they check the person’s ok,” she says.

“All the invoices need to go through the provider so they can see where the money’s going.”

Traditional service providers who pivot to self management will have to manage “profound organisational change” when transitioning to consumer-controlled self-managed services, she says.

“ They need to learn new roles as facilitators and supporters and develop new financial and data management systems to manage individual accounts.

“It’s hoped that our findings will assist this transition.”

Risks

Dr Laragy says the Royal Commission was “petrified” about the risks of self management and counsel assisting took an “incredibly conservative view” of it.

She agrees it’s important to have oversight for self management to work and prevent abuses and exploitation.

“But I don’t think that the fact that there can be exploitation is enough justification to say you can’t have any flexibility and you have to go through a registered provider,” she says.

There was no evidence of fraud or increased risks throughout the trial, the study notes.

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