“Self-management a best kept secret”. Dr Sarah Russell investigates the government’s new Support at Home program, finds ‘ka-ching’ for private providers.
The Aged Care Royal Commission was blunt about some aged care providers rorting home care packages.
In their final report, the royal commissioners noted that a Level 4 home care package – then worth around $52,000 a year – offered on average less than nine hours a week support for older people.
Meanwhile, older people who managed their own home care package could buy more than double the support – around 20 hours a week.
And now we find out that the Albanese Labor government is enabling aged care providers to take an even bigger cut of the aged care budget, this time via those who self-manage Support at Home.
Self-management has always been a well-kept secret.
Most older people opt for an aged care provider to manage their support workers and suppliers. They simply don’t know there is an option to manage their home care themselves.
Pay per shower: fully-funded aged care turns market-driven aged support
Although the new Support at Home program allows older people to self-manage, the rules have changed significantly. So too have payment processes.
In the past, invoices from support workers and suppliers were submitted to the self-managed provider. The provider paid these invoices from the client’s home care package.
The new Support at Home – Self Management Fact Sheet explains that self-management can involve “paying invoices for services and being reimbursed”. As a result, some providers require older people to pay their support workers and suppliers from their own pocket. They are later reimbursed.
This policy assumes people have the cash available to pay for their home care services.
Provider-managed and self-managed care are two fundamentally different approaches to home care. Provider-managed puts the aged care provider in the drivers’ seat. In contrast, self-management is based on shared decision making between the older person their support workers and the self-managed provider.
In my 2021 research Consumer views of self-managed home care packages older people described “choice, control and costs” as their main reasons for switching from provider-managed to self-management. They also appreciated being treated as adults.
With self-management, older people were not only able to choose who worked in their home, when they came and what they did but also able to negotiate directly with their support workers about how much they were paid.
Support at Home package expensive
The financial benefits of self-management will be much less with the Support at Home program. From 1 July 2026, older people will no longer be able to negotiate lower rates with support workers or services outside the government approved pricing schedule.
In addition, those who self-manage will be charged an overhead for the third-party service.
This overhead fee has been capped at 10 per cent – with clients encouraged to “negotiate” this fee based on how much work the provider is required to do before paying an invoice (e.g. ensuring the third party supplier meets workforce requirements). Not surprisingly, some providers simply charge their clients a 10 per cent “processing” or “loading” fee on each invoice, irrespective of how much work they did.
Another significant change is the requirement of a co-contribution. With the new system, providers resemble debt collectors – responsible for collecting the government’s co-contribution.
Complex fee-fest
To ensure providers are not out of pocket for this co-contribution, some require their self-managed clients to pay for their support services out of their own pocket and then submit proof of amount they have paid. They are then reimbursed the full amount they have paid less the amount of the co-contribution.
Some providers have changed the payment process for all clients, both those who have been grandfathered (on home care packages) and new clients (on Support at Home).
Take for example an 88 year old pensioner who has a Level 4 home care package. He lives in a remote location with no local aged care provider. His only option is to self-manage. He employs local support workers and suppliers who are all registered with a provider.
Previously, invoices from the registered nurse, support workers and suppliers were submitted to the provider. These invoices were then paid in full from his home care package. The provider charged a monthly administration fee.
Since the recent introduction of Support at Home program on 1 November, his provider has changed the payment process – to ensure the provider collects the co-contribution.
Although this man’s home care package has been grandfathered (i.e. he does not pay a co-contribution), his provider recently asked him to pay his monthly support services from his own pocket. The provider would then reimburse these costs.
Just to be clear, a pensioner is asked to pay around $5,000 per month for his support services, money he does not have. As a result, he has a home care package he can no longer afford to access.
Fortunately, his registered nurse acted as an advocate. The provider agreed to continue to pay the monthly invoices. However, there will undoubtedly be other older people living in remote areas who have an assessed need for support but will be unable to afford to access it.
The Support at Home program has made self-management a much less attractive option.
As a result, providers, not older people, are back in control. Ka-ching.
Dr Sarah Russell is a public health researcher. She is the Principal Researcher at Research Matters and Chair of Progressives of the Peninsula. She was formerly the Director, Aged Care Matters.