Home Care Packages
Consumers receiving services that exceed Package budget
At the March NACA Home Care Packages / CDC Advisory Group it was discussed that in
the lead up to July 2015, providers needed to transition consumers in receipt of services that
exceed their package budget to being within budget. The Department representatives
indicated that they were aware of the issue and agreed that packages need to be provided
‘within the funding stream available to them’.
The Department representatives requested feedback about the scope of the issue.
Therefore, in order to get a representative sample in a short time frame, a survey of ACS
/ACSA Community Advisory Committee members was conducted1.
The survey was conducted focusing on Level 2 and 4 packages on the assumption that
Level 1 and 3 packages are being delivered within budget as they are all required to be
operated as CDC.
Responses to survey
33 responses were received in total, with 1 provider delivering services across four States /
Territories. The distribution of responses is below:
States / Territories where HCP are provided
ACT
2%
WA
13%
VIC
10%
NSW
24%
NT
3%
TAS
29%
SA
16%
QLD
3%
Level 2 Packages
The 33 providers who responded to the survey deliver between them 6,433 level 2
packages. Responses were received from organisations delivering from 13 to 1173 Level 2
packages.
Of these 6,433 packages they estimate 966 (or approx. 15%) to be currently receiving
services that exceed the budget available for their package.
Home Care Packages - Consumers receiving services that exceed package budget
1.
Of these 966, they estimate that 91 (or approx. 9%) of these will be unable to continue to be
supported at home on reduced service provision and may need to consider residential care.
The distribution of packages and those which exceed budget are below:
Level 2 Packages with services exceeding budget
1400
No. of pakcages
1200
1000
800
600
over budget
400
packages
200
0
1
3
5
7
9 11 13 15 17 19 21 23 25 27 29 31 33
Provider
One provider explained why some consumers receive services that exceed budget - ‘there
has been a significant shortage of level 3 & 4 packages for many years, hence organisations
… took on clients who were assessed at EACH or EACHD onto a CACP. These people had
the greatest priority of need and a level 2 HCP was better than nothing for them, hence used
the ‘unders and overs’ method to support them. We work collaboratively in this region with all
service providers including HACC and identify those in greatest need’.
Another provider stated ‘clients receiving above recommended hours generally have no
family support, CALD background, have complex needs and require day to day assistance
with managing and monitoring of basic tasks e.g. nutritional needs, organisation of medical
appointments etc’
Availability of Level 3 and 4 Packages
The alternative to residential care for consumers on Level 2 packages would be to transition
to Level 3 or 4 packages. However 91% of respondents said there are not sufficient Level 3
or 4 packages in the area to accommodate these consumers and a further 6% said they
were ‘not sure’ if there were sufficient higher level packages available.
The following is a sample of the comments made by providers in relation to the availability of
higher level packages:
‘More Level 3 & 4 packages are required in South Australia. Provider waiting lists for
these levels are approx 50 plus. Also Level 2 consumers have been waiting for
higher packages for 2 years and up’
‘More Level 3 and 4 packages required urgently’
‘The L3/4 ACAT waiting list for the South of the State (Tasmania) is close to 200.
Several people have been waiting in excess of 600 days’
Home Care Packages - Consumers receiving services that exceed package budget
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‘There are only 6 level 3 & 4 packages available to a LGA population greater than
40,000’.
‘Impact of the industry all converting at the same time and attempting to access
higher level packages is causing significant bottlenecks’
‘I have been trying to source packages to transition for the past 18 months to no
avail. The lack of level 3/4 packages in our rural /remote area is of concern especially
with the aging population and growth for community services’
‘There are currently 500 clients waitlisted for level 3 or 4 packages’.
‘Even if we optimistically assume that half could be picked up by other agencies
(which we believe is very optimistic) it would result in more than 20 people having to
leave their community as there are no residential facilities within the area’.
‘Not enough packages available and we have 240 potential clients on the Level 4
waitlist’
Level 4 Packages
Of the 33 providers who responded, 5 do not deliver Level 4 packages and 1 provider did not
respond to the question. The other 27 providers deliver between them 1,920 Level 4
packages. Responses were received from organisations delivering from 2 to 463 Level 4
packages.
Of these 1,920 packages they estimate 343 (or approx. 18%) to be currently receiving
services that exceed the budget available for their package.
Of these 343, they estimate that 189 (or approx. 55%) of these will be unable to continue to
be supported at home on reduced service provision and may need to consider residential
care.
The distribution of packages and those which exceed budget are below:
Level 4 Packages with services exceeding budget
600
No. of packages
500
400
300
over budget
200
packages
100
0
1
3
5
7
9 11 13 15 17 19 21 23 25 27 29 31
Provider
Home Care Packages - Consumers receiving services that exceed package budget
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‘We have had requests from clients on high packages to exclude nursing reviews and
assessments and to drop the case management fee (those clients have high CM
services due to their complexity) so that they can have more services’.
Transitioning
46% of providers surveyed reported that they have commenced transitioning consumers to
services within budget, 42% said they have not yet commenced and 12% said it was not
applicable to them.
The following is a sample of the comments made by providers in relation to transitioning
services to be within budget:
‘We have allowed for a long lead time for conversions (24 months plan) to enable
natural attrition, negotiation regarding frequency and type of services, ability to
transfer to a higher level prior to July 1 2015 and accessing other community
supports. This is thus far working well. We have not therefore had to reduce services’
‘One client has reported that they will be contacting the CIS to complain’
‘We are trying to reduce where we can but are facing some backlash from the clients
who believe they are entitled to the care they need, many feel they have paid their
taxes all their lives and it is their entitlement .The $ allocated to packages have not
really kept up with rising costs to provide the care’
‘Without doubt carer stress will increase and burn out will occur, with clients ending
up in the hospital system’
‘We are working very hard with clients to be creative in reducing hours without
reducing services. Most clients are understanding of this and are working with us or
taking charge and working it out for themselves. However there are a few exceptions
where clients are not happy to reduce services. We continue to negotiate the best
strategy possible’
‘We have experienced complaints to the Scheme that (are really) about policy issues
such as not enough funding not about the service being delivered. I believe that the
Scheme have a problem identifying the issues’.
‘All our sites have been provided with a draft CDC calculator and budget to use for
client who are not currently on a CDC package. This allows (them) to work to a
budget, with clients, regarding services and other resources such as aids. Initial
discussions have commenced at reviews or when clients are on a high number of
hours. This has initiated at least one complaint to the Scheme and several internal
complaints which have been addressed’.
Our care managers are proactively working in partnership with all our clients that are
over budget through: 1. Helping clients understand the Home Care Packages
Guidelines and the move to individual budgets 2. Giving our clients control in
prioritizing services ( balancing what's important to them and for them) 3. Offering the
option to purchase services not within their budget that they wish to maintain or have
Home Care Packages - Consumers receiving services that exceed package budget
4.
in addition to that funded within their budget 4. If assessed as eligible for higher level
packages, when packages become available, they are prioritized.
‘There have been lots of discussions held with clients who are receiving more hours
and they are on one hand very concerned but on the other hand they know it's July
2015 and they don't want to think about it. One clients said they might be dead by
then...very sad’
Case studies - Level 2 packages
The following is a sample of case studies provided by respondents to help exemplify the
impact the required changes will have on consumers:
One client who is marginally over budget may have to choose between gardening
services or a social outing as he chooses to have showers three times a week and
he requires an hour for this as is frail and slow and cannot be rushed. His new
budget will not extend to all he desires.
Consumer receives 6.25 hours service over 7 day period. Consumer has impaired
vision, poor mobility, super pubic catheter and arthritis. Services includes Medication
assistance twice daily, Personal Care 3 times a week and daily meal preparation.
Transport is required visit local doctor. All the above services are essential however
consumer will not be financially able to top up service to the above level.
Mrs D lives on an isolated farm alone with no close neighbours she has a carer visit
x5 times per week for domestic support and take her into town once a week she is
currently well over budget especially when we factor in travel costs .She currently
uses 5 hrs per week plus travel costs after July 2015 we would have to either reduce
her times or get her to contribute more $ to her package .
A client who is significantly over her budget receives the following Visits 5 days a
week totalling 8 hours plus case management. These visits include travel to her
preferred shopping centre 8 kms away. At $1 km cost for travel this will have to be
reviewed as will her social outing where she stops for a light lunch when out
shopping with the staff member. This is her only outing for the whole week. If she
chooses to keep this as part of her package she will have to consider reductions in
domestic assistance or personal care both of which are essential. Her house is old
and cluttered and she has occasional incontinent episodes which require extra
domestic tasks Her medication prompts must remain as she forgets to take meds
and even phone calls as reminders have not worked. She must be supervised (family
do this at weekend) with meds.
Client currently receives 8.5 hrs per week of support. Dementia sufferer who needs
visits 5 days per week (family cover week-ends) to prompt with medications and
nutrition (MOW's delivered) as well as other duties. personal care 3 times per week 2
hrs social support 2 hours domestic assistance (includes all aspects of house
cleaning, laundry, bed changes, maintaining kitchen etc) 1 hour gardening. After July
2015 client package will not be able to provide the support required and client will
probably have to go into residential care. Personal care would need to continue to
Home Care Packages - Consumers receiving services that exceed package budget
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ensure hygiene to prevent UTI's etc and client is passionate about her garden so
would choose to keep the gardener, therefore DA and SS would not be addressed.
Transport to Dialysis 3 times a week totalling 3 hours, personal care 5 days totalling
2.5 hours and housework 1 day a week totalling 1.5 hours. Dialysis is essential,
consumer cannot attend her personal care independently however 5 day service
would need to be reduced to 2 times a week and housework hours reduced to 1
hour.
93 Years old. Approved for level 4 in Nov 2013 but to date no provider has offered to
pick up services. Client requires twice daily med prompt and P/C (dress in am and
undress in pm), assistance to heat meal, shopping, and domestic. Very supportive
family provide all services on W/end and arrange all appointments. Client receives 21
visits per fortnight; totalling 18 hours. Support worker travel time for fortnight 1 hour
22m and 139 kilometres @ .76 per km equates to $105.64 in travel cost.. Even on a
conservative pricing model services would need to be cut by half. Likely result is
client would no longer remain at home and would need to move some distance from
her family.
Current services: Permanent 8 hours per week over 5 days. Assistance provided with
transport to all apts, shopping, bill paying. Personal care as requested. Domestic
assistance. Meal Preparation. Social support. Garden service. Significant time spent
by CWs making telephone enquires and arranging apts. Allocated time is often
exceeded due to nature of appointments, distance travelled. Client does not have
any family support, CALD background. Post July 2015 : On waiting list for Level 3/4.
Uncertain as to how this clients best interests will be managed with reduced services
if higher level package is not available.
Case studies – Level 4 Packages
The following is a sample of case studies provided by respondents to help exemplify the
impact the required changes will have on consumers:
Clients choosing less visits of more time to save time. Clients choosing to have
unaccompanied transport where this is safe for them to do so. Addition of respite
service to support the carer. Family have opted pay for services over and above
subsidy
Receives 14 hours of service each week for meal preparation, mobilisation,
medication (morning and night) and personal care which includes second daily
showering. Each personal care service requires 2 staff members so in effect actual
hours of service are 17. Post-July 2015 services will be cut to possibly the following
Medication morning and night - 7 hours 2 x personal care services with 2 staff
members -4 hours Meal preparation x 2 - 2 hours but this does not address is the
high level case management needed
Current: Personal Hygiene Assistance x6 weekly, 45min each visit Domestic
Assistance x1 weekly, 45 min each visit Social Support x2 weekly, 4.25 Hours in total
Shopping x1 weekly, 4.5 Hours Total Hours: 11.75 Hours Total Hours monthly: 61
Home Care Packages - Consumers receiving services that exceed package budget
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Hours Post July 2015: Reduction in of Service Hours either for Social Support or
Shopping.
Current: Personal Hygiene Assistance: x3 weekly, 1 hour each visit Domestic
Assistance x1 weekly, 2 hours each visit Social Support x2 weekly, 2 hours each visit
In-Home Respite x1 weekly 4.5 hours Total Hours: 13.5 hours Total Hours monthly:
51 Hours - Post July 2015: Changes in Services will potentially reduction in Social
Support and In-Home Respite.
Client currently receives 26.25 hours/ fortnight. This includes 7 day/ week AM and
PM 15 min visits for medication administration, personal care 5 days week for 30
mins, 7 days week 30min evening visits for meal preparation, shopping 1 hour
weekly and Nurses visits monthly. Reduction – From July 1st she would need to go
without a Sunday night evening visit (medication administration and meal
preparation) total 45 mins / week (family would need to assist).
Client is currently receiving 19 to 20 hours per week of care. The client's daughter is
the full time live in carer for her mother, however requires a 2 person assist lifting
spending the majority of her time in bed. The client also has limited speech and
incontinence. Services include personal care in the morning and evenings and two
respite shifts to enable the daughter to attend to activities such as shopping. A
reduction in services would significantly increase the risk of carer burnout and impact
upon the ability to safely provide services
This client receives 18 hours per week but this will decrease dramatically in 2015 (to
less than 15) - dramatically due to high medical need and specific care needs. There
will be no other options but for this person to consider residential care as there is
limited family support and high medical need.
This client receives 22 hrs per week and will receive less than 15 post July 2015. The
only option for this person will be residential care as they are at the absolute
threshold of what a package can provide currently so any reduction will mean the
care plan is totally unsustainable.
Lisa Ralphs
Community Policy Adviser
Aged and Community Services NSW & ACT
[email protected]
(02) 8754 0400
17 April 2014
1.
Comments on survey structure
Respondents were only given 9 business days to complete to the survey. Feedback from some larger organisations
was that this timeframe made it difficult for them to collect the information from all of their sites, so some responses
did not cover their total packages.
A number of respondents answered ‘unsure’ to questions related to number of packages where services exceed
budget. These responses were counted as zero. Therefore the actual number of consumers in receipt of packages
that exceed budget may be higher than indicated.
Home Care Packages - Consumers receiving services that exceed package budget
7.