New Australian Government commissioned research by Dr Sarah Russell, Kristy Siostrom, Iain Edwards and Velandai Srikanth shows tighter regulation of providers of home care packages is one of a number of things needed to improve people’s experience. The research, Consumer experiences of home care packages, is published in the Australian Journal on Ageing.

The study aimed to explore consumers’ experiences of receiving a home care package (HCP). The researchers held face-to-face interviews with 37 older people approved for a HCP and their family members. They found that effective consumer-directed care depends on access to reliable information.

Participants who reported satisfactory experiences had:

• providers that charged reasonable fees
• case managers who delivered person-centred care
• support workers who were consistently assigned to them
• a family member for support and advocacy
• ongoing community engagement.

The researcher’s overall conclusion was…

“Positive consumer experience requires tighter regulation of providers and policy attention to fees and minimal standards of staff training. The policy of full cost recovery restricts consumers’ access to local government services.”

Older Australians prefer to remain in their own homes as they age. This is common sense but is also borne out in research and the experience of my elder law team at Catherine Henry Lawyers in conversations with our clients and their families. Research also shows that ageing in place, as opposed to a residential aged care facility, is one of the hallmarks of a best practice aged care system. This is why research into improving the experience of home care packages and in home other support services for older Australians is important.

What are home care packages?

The Commonwealth Home Support Programme (CHSP) and home care packages (HCPs) are designed to help people stay in their home, rather than move into an aged care facility. There are four levels of HCP, ranging from Home Care Level 1 (basic care) to Home Care Level 4 (high care).

The Federal Aged Care Act 1997 and associated Aged Care Principles set out the legislative framework for the provision of HCPs.

People receiving HCPs may also access services under the CHSP. Clients on HCP 1 and 2 are charged a subsidised rate for CHSP services (e.g. meals, transport, nursing, social activities). Clients on HCP 3 and 4 are charged on a full cost recovery basis.

In June 2015, the Australian Government introduced the Increasing Choice in Home Care reforms. These reforms were designed to increase consumer choice and flexibility and to create a more competitive and innovative market for providers of home care. Consumer-directed care aims to provide older people with greater control by allowing them to make informed choices about (a) the types of services they access and (b) the delivery of those services, including who will deliver the services and when they are delivered.

Participants said…

The research has some very valuable patient and family comments to inform best practice. Here are a sample of key findings from the interviews. Many of the findings have been made before, including regulation, information provision and data collection, staffing and training, in other reports and inquiries.

Participants described the Home Care Agreement as ‘too long and complicated.’

Participants described feeling ‘overwhelmed’ by having to choose a provider from ‘hundreds of different providers’ listed on the My Aged Care Finder website. They described comparing providers as time consuming. Some participants chose providers purely on cost because they did not know how to determine which providers had a good reputation.

Participants described providers’ advertisements about what services they could deliver as ‘misleading.’ Some participants questioned why the government was giving HCP licences to companies with no expertise in the delivery of aged care services. Participants were also concerned some providers accepted too many clients without hiring enough staff.

There were significant differences between providers in both case management and administration fees, ranging from 9 per cent to 53 per cent of the government subsidy. Participants said it was difficult to know how much a service and equipment should cost without any benchmarks.

Some participants were surprised by the small number of hours of support they received. For example, a participant with a Level 4 HCP (approximately $50,000 per annum) received 14 hours of personal/domestic support per week. She said that she believed far too much money that was intended to support older people at home went ‘into providers’ pockets.’

Participants wanted clear financial statements that accurately reflected the services provided. Not understanding the financial statements was stressful for older people and their families. In addition, participants were charged for services they had not received.

Participants described the case manager as integral to the quality of the service, particularly in the early days of receiving an HCP.

Participants want sufficient time to be allocated for support workers to undertake tasks required. Participants said it as upsetting to have a large number of different support workers (strangers) who were sent to work in their home.

Participants said an essential component of delivering person-centred care was good communication with providers, case managers and support workers.

Participants suggested staff should receive specific training in person-centred care and consumer-directed care.

Participants stressed the importance of access to social activities and community life. Participants on lower-level packages were able to access CHSP services at the subsidised rate. However, participants on Level 3 and Level 4 HCP said they were required to pay the full cost of Commonwealth-funded community social support activities. Participants described the policy of ‘full cost recovery’ as preventing them from being involved in as many community social activities as they were prior to accepting a higher-level HCP.

What needs to happen?

The researchers best sum up the key things Government and home care providers need to consider to improve the experience of staying at home for older Australians.

“Although the Commonwealth Department of Health reviews suitability of prospective providers against criteria stipulated, the findings suggest HCPs could be improved by tighter regulation of HCP providers, clear and regulated fee structures and simplified information statements to make comparison between providers easier, defined level of training for staff, consistent case managers and support workers, consideration of funds to ensure social engagement and review of full cost recovery. The policy of full cost recovery limits access of older people to social and community activities that they previously received under CHSP, which may increase their risk of experiencing social isolation.

Rather than have funding for HCPs capped at a certain level, HCPs could be funded to reflect the client’s goals and individual needs. This would remove the need for clients to choose between receiving allied health, personal care, home care, home modifications and equipment and social support, which often results in clients being socially isolated because they are not able to afford social activities.”