What you should know about at-home care

Trials and triumphs of at-home care: what you should know

Former banker turned aged care system disruptor Peter Scutt never expected to be an expert advocate on ageing. He shares the lessons he has learnt about home-based care.

Mere mention of the words ‘aged’ and ‘care’ in the one sentence is often enough to strike fear into the heart of the hardiest This is how we need to think about ourselves as we get older. If we have a health problem preventing or limiting our enjoyment of souls and leave a nasty aftertaste of dread – especially as the years roll by and many of us come to deal with it – for our parents and ourselves. I’ve come a long way in my understanding of homebased care in the past eight years, since my first exposure with my parents in 2013. However, I know that most people don’t want to acknowledge the subject, let alone Being approved as discuss it. But we need to change that. eligible for a Home In large part, the reason for this ‘ostrich attitude’ to accessing Care Package only support is because we live in an means you’re now on ageist society that says youth is good, age is bad, and you should that waiting list to have fear it, deny it and ignore it at all one ‘assigned’ to you. costs – even if that means making poor choices that can make your life a whole lot worse than it needs to be. Within this mindset, the prospect of admitting to a health-related change or acknowledging any reduction in capacity that might be helped by getting support services at home, is like accepting defeat. You won’t do it unless you absolutely have no choice. I have learnt to have a different – and more appreciative – attitude to getting older, and in particular to accepting support or care at home, as well as a more simplified understanding of how it all works. This is my personal, potted guide. A stitch in time If you value your car, you wouldn’t persistently ignore an unusual noise in the engine on the basis that you’ll deal with it if and when the engine explodes. And you know that getting your favourite shoes repaired before they’re totally ruined will give you a few more good years from them. You take the initiative, you address the problem, you save yourself money, time and inconvenience. of life or stopping us from doing everyday things or remaining connected with friends, we should act on it. The right kind of assistance at the right time, whether temporary – while you regain skills or adapt to new approaches – or long term, can keep you going safely and well at home. The system of home-based care in Australia is designed to perform precisely this function, by subsidising services that can be delivered to people in their homes, tailored to their individual needs and situation. Two support programs There are two government programs that provide in-home support for people over the age of 65. The Commonwealth Home Support Program (CHSP) provides more ‘entry-level’ support. If you’re managing fairly well at home but just need one or two services to make life easier and safer – maybe house cleaning, transport or some home-delivered meals, for example – that might be enough. The other program is the Home Care Package (HCP) program. These are designed for people who need more complex care and ongoing support. There are four levels of HCPs that provide funding based on the support you need. A basic Level 1 HCP offers about $9000 a year and they scale up to Level 4, offering around $52,000 a year. Most of the services you can get with CHSP, you can also get with a HCP. But a HCP can provide a lot more – such as nursing and allied healthcare, personal care with showering and dressing, modifications to your home and help with staying connected with the community and friends. HCP funding is also consumer-directed, meaning you can tailor the support to address your needs and preferences, including who provides the support.

Get assessed – don’t delay

If any of this sounds like a good idea for you or someone close to you, my strong advice is to drop everything and get an assessment as soon as possible. With people waiting for up to a year to receive their funding – that is, after being assessed as eligible – this urgency can’t be overstated. There are two steps involved in assessment. The first involves providing some top-line information to My Aged Care about the reasons you, or the person in question, want an assessment. You can do this online or by calling 1800 200 422 and speaking with someone directly. It’s really important to be clear and honest with the information you provide in this first step because it could determine the type of face-toface assessment you will have in the second step and the level of support you’re likely to be offered. This is not the time to downplay or gloss over your real situation and needs.

The second step is a face-to-face assessment in your home. There are two types of face-to-face assessments and the one you have will be decided based on the information you gave in that initial assessment. If the information you gave suggests you need only minimal support, you will be referred for assessment with a Regional Assessment Service (RAS) assessor, connected with the Commonwealth Home Support Program. If it sounds like you need more complex support, your face-to-face assessment will be with an Aged Care Assessment Team (ACAT). The ACAT assessment will determine which of the four levels of Home Care Packages for which you are eligible.

Do your research

If approved, you’ll receive a letter from My Aged Care telling you what type and level of support you have been ‘approved’ to receive. That sounds terrific but, unfortunately, being approved as eligible for a HCP only means you’re now on that waiting list to have one ‘assigned’ to you. As the government releases more packages in line with budget promises, waiting times might improve but, in the meantime, you can start researching HCP providers. The HCP funding, while allocated to you, must be ‘hosted’ and administered by a governmentapproved HCP provider of your choice. The My Aged Care website enables you to search different providers by criteria including location, the services they provide and a range of specialised categories. The other big areas to compare are quality and costs and both can vary enormously. Unfortunately, it is not uncommon for people to lose between 25 and 45 per cent of the value of their HCP in administration fees, which means there’s less money to spend on actual support. Fortunately, all home care providers must publish online a full price list of their service costs as well as the fees they charge to manage your services and administer the HCP.

Choose your management approach

Another consideration is the amount of involvement you want to have in managing your consumerdirected HCP. You can save on administration fees and get more support hours if you decide to selfmanage your package. Provided you stick to the guidelines, you can choose the services you need, engage the workers you want and manage the schedule according to your needs and preferences. Getting more care time out of package funds is one reason people choose to self-manage; but for many people it is just as much about feeling they have choices and can remain in control of their lives. Selfmanagement isn’t difficult but you – or someone close to you – do need to have the time and desire to do it.

You also need to make sure the package provider you are choosing will allow you to self-manage. Not all providers truly offer this but that number is increasing. Our website has some excellent information and resources to help people who are interested in self-management. You can also easily switch your HCP at any time to a provider that supports self-management, if your provider doesn’t. Investing some time, learning how everything works, and choosing the package provider that is right for you, will mean you’re absolutely ready to go when you get that golden ticket – the news that you have been ‘assigned’ your Home Care Package!

Peter Scutt is the founder and chief executive at Mable, which helps you find trusted care and support workers in your community.