Aged Care Insite Issue 112 | Apr-May 2019 | Page 14

industry & reform Unpacking packages Making sense of the mindboggling world of home care packages. Braam Lowies and Rob Whait interviewed by Conor Burke R evelations from a leaked report commissioned by Aged Care Minister Ken Wyatt show that providers are charging “obscene” fees for home care packages. The Nine Publishing newspapers revealed that in some instances, providers are charging half of their fees in admin costs or case management. The research, conducted by Dr Sarah Russell, found that in one example a provider charged over $600 in case management and admin fees for one service valued at $130.22. The study also found large differentials in the hourly rates for support workers – between $39 and $61 – and that when a provider took a bigger chunk of the home care package funds, “some participants received less than 10 hours of personal/ domestic support on a Level 4 home care package”. The minister responded to the claims that the home care system lacked transparency. He told the newspapers that nearly a third of providers do not publish their pricing online, as is the legal requirement. Russell’s report also highlighted the problem people have in understanding the current system. One research participant told her that: “We didn’t understand the statement. Nobody explained. We asked the case manager to explain. She couldn’t understand it either. Our granddaughters who are studying at university couldn’t even understand. It was very confusing.” Researchers at the University of South Australia, Dr Braam Lowies and Dr Rob Whait, found similar problems in their study 12 agedcareinsite.com.au of the ability of over-65s to navigate the financials of the home care system. “Our research found that older people felt insecure about their capacity to manage home care packages to their best advantage and we wanted to understand why,” Lowies said. “We found a host of problems, from a general lack of confidence and knowledge of the system among older people, to overly complicated communications, high staff turnover and inadequately trained staff providing in-home care, inconsistencies in package administration, confusing fee structures and even inaccurate billing processes.” Aged Care Insite spoke with Lowies and Whait to find out why home care is so complicated. ACI: A recent government-sponsored report found that home care packages have many problems, such as over-charging, mismanagement of funds and high management fees. Did your research find similar things? RW: Yes. Our research focused on the financial capability of older people in selecting and managing their home care packages. This was also through the older person’s perspective, so we’re talking to them about their perceptions and experiences. Along the way, we came across perceived inconsistencies in billing, over- charging, unfair charges, double-charging and unclear invoices. It must be also stressed that older people aren’t a homogenous group: they’re quite varied in their outlooks in life. So, some people want to have significant ownership over their home care package. They want to have much greater control over where the money’s spent, what it’s spent on and who provides the services. But they’re stifled in that, in general terms, by the administrative arrangements from the provider. Sometimes the provider is probably hindered in the way they can administer the package as well. This system, whether that be through government or providers, stifles those who want to manage their package. At the same time, those older people who are happy to have the provider look after their package for them aren’t really encouraged to have any greater input. BL: Also, it was clear from the people that we spoke to that the high staff turnover in the aged care services industry is really an issue. A lot of them were exposed to 1–4 case managers at a time. That in itself presents a problem, because you can’t really establish