Support at Home? First they came for the young people, now they come for the old

“Self-management is the best kept secret.” Doctor Sarah Russell explores the government’s new Home Support scheme and finds the ‘ka-ching’ for private providers.

The Aged Care Royal Commission has been outspoken about some aged care providers breaking home care packages.

In their final report, the royal commissioners found that the average Level 4 home care package, at the time worth around $52,000 a year, was nine hours a week support for the elderly.

Meanwhile, seniors who manage their own home care package can purchase more than double the support (about 20 hours per week).

And now we learn that the Albanian Labor Party government has allowed aged care providers to receive an even larger share of the aged care budget; this time through self-administered Home Support.

Self-management has always been a well-kept secret.

Most seniors choose an elder care provider to manage their support workers and providers. They don’t know that they have the option of managing home care themselves.

Pay per shower: Fully funded elderly care turns into market-driven elderly support

Although the new Home Support program allows seniors to self-manage, the rules have changed significantly. So are the payment processes.

In the past, invoices from support workers and suppliers were sent to the self-managed provider. The provider paid these bills from the client’s home care package.

New Home Support – Personal Management Information Form He explains that self-management can include “paying bills for services and getting reimbursed.” As a result, some providers require seniors to pay support workers and providers out of pocket. They are then refunded.

This policy assumes people have the cash to pay for home care services.

Provider-managed and self-managed care are two fundamentally different approaches to home care. Provider-managed, elder care puts the provider in the driver’s seat. In contrast, self-management is based on shared decision-making between the older person, support workers, and the self-managed provider.

In my 2021 research Consumer opinions on self-managed home care packages seniors identified “choice, control, and costs” as the main reasons for switching from provider-directed management to self-management. They also appreciated being treated like adults.

Through self-management, older people were not only able to choose who worked in their home, when they came and what they did, but they were also able to negotiate directly with their support workers about how much they would be paid.

Home support package is expensive

The financial benefits of self-management with a Home Support program will be much less. Starting July 1, 2026, seniors will no longer be able to negotiate lower prices with support workers or services outside the government-approved pricing plan.

In addition, self-administrators will be charged overhead costs for third-party service.

This overhead charge was capped at 10 percent; customers were encouraged to “negotiate” this fee based on how much work the provider had to do before paying an invoice (for example, ensuring the third-party supplier met labor requirements). Unsurprisingly, some providers charge their customers a 10 percent “processing” or “loading” fee on every invoice, regardless of how much business they do.

Another important change is the mandatory joint contribution. With the new system, providers are similar to debt collectors who are responsible for collecting government contributions.

complex fee festival

To ensure providers stay out of pocket for this shared contribution, some require their self-managed customers to pay for support services out of pocket and then provide proof of the amount they paid. The full amount they paid is then refunded, minus the contribution amount.

Some providers have changed the payment process for all customers, both grandfathered (in home care packages) and new customers (under Home Support).

Take, for example, an 88-year-old retiree with a Level 4 home care package. Lives in a remote location with no local aged care provider. His only option is self-government. It employs local support workers and suppliers, all of whom are registered with a provider.

Previously, bills for the registered nurse, support workers, and suppliers were sent to the provider. These bills were then paid in full from the home care package. The provider charged a monthly management fee.

Since the recent launch of the Home Support program on November 1, the provider has changed its payment process to ensure it collects co-payments.

Even though this man’s home care package is grandfathered (so he doesn’t pay co-pays), his provider recently asked him to pay for monthly support services out of his own pocket. The provider will then reimburse these costs.

To put it bluntly, a retiree is being asked to pay approximately $5,000 a month for support services, money he or she does not have. As a result, she ends up with a home care package that she can no longer afford to access.

Fortunately, his registered nurse acted as an advocate. The provider agreed to continue paying monthly bills. However, there will undoubtedly be other older people living in remote areas who are assessed as needing support but cannot afford to access it.

The Home Support program has made self-management a much less attractive option.

As a result, providers, not seniors, regained control. Ka-ching.