A $53,000 home-care package gets just nine hours of support yet the government has slung suppliers an extra $6.5 billion. Dr Sarah Russell reports on aged care profiteers and finds self-management is the answer.
The only aspect of in-home care for older people that makes the news is the ridiculously long queue for home care packages. Flying under the radar is the chronic rorting, with corporate providers skimming off vast profits.
The Aged Care Royal Commissioners noted that a recipient of a Level 4 home care package worth $53,000 received on average just 8 hours and 45 minutes of support. Surely this was a big red flag.
Yet the federal government has given the home care sector an extra $6.5 billion over next four years without putting in place any accountability measures to stop the rorting of the system.
My recent research reveals how shocked older people were when they realised just how much of their home care package went into providers’ pockets. As one study participant noted: home care packages are “a cash cow for providers”.
Said another: “I honestly think these providers see the aged care sector as a money ticket for their own selfish needs.”
And another: “I strongly object to billions of dollars of taxpayers’ money going to for-profit companies or admin-heavy non-profits rather than being spent on actual care.”
As the study participants repeatedly pointed out, case management fees were extremely high and when additional charges were deducted for administration expenses, travel and high rates charged for support workers (although workers themselves were paid a pittance), most of the home care package was soaked up.
This was especially galling when many participants said they were effectively doing the work of a case manager but were still being charged case management fees by their corporate provider.
“I also found that I was doing most of the work. In fact, I only heard from them once for the entire six or so months. When they did call, it was obvious that [the call] was part of their job task. They said they would visit and touch base monthly but never did.”
Best kept secret
One of the best-kept secrets in home care is that older people and their families don’t have to pay high case management and administration fees to corporate providers. They can self-manage the home care package.
By cutting out corporate providers and their exorbitant fees, these people have far more money available to spend on buying the essential support services they need to remain living in their own home.
Why doesn’t the federal government promote self-management? Are they protecting a lucrative stream of revenue for big companies?
Study participants repeatedly expressed disappointment about their lack of awareness about self-management. Most said they found out about self-management via the internet and social media.
“When you get a home care package, you are not made aware of self-management unless you are Facebook savvy. I literally heard nothing about self-managing and it’s definitely a better way to go.”
Participants noted it was simply not in the interest of their providers to offer self-management because it would decrease their profits.
The ability to self-manage home care packages had a number of benefits for older people and their families – with families being able to choose the best support services and have control over how the home care package was spent.
“I like almost everything about self-managing. We have much freedom and choice to do the very best we can for Mum … We are not constantly hindered, belittled, patronised and having to beg the provider for the basics. We get to make our own decisions about who to employ as a care worker, allied health workers etc.”
“We had been with a traditional provider for a couple of years and were finding it very difficult to get the help and resources Mum required. We felt that we were being very restricted and ‘controlled’ by the provider.”
A focus on corporate profits over people
A number of the participants also spoke of “disrespectful and undignified” treatment when corporate providers dictated the care and support that would be given. With self-management, they were in control.
“Carers always kept checking with head office about everything. They didn’t work for me. They worked for the provider. Now they’re working for me.”
Another criticism was that corporate providers repeatedly sent different support workers into the homes of elderly people. This made some older people feel unsafe in their own home. Self-management allowed older people genuine choice as to who worked in their home, when they worked, and what tasks they did.
However, it was also noted that self-management did require considerable acumen and work from older people and their families. But the benefits of self-managing their home care package were considerable.
“Self-management has enhanced my life immeasurably. I was slipping into accepting that my life was being taken over by opportunistic providers who, due to their greedy money-grubbing focus on building a business, rather than enhancing seniors’ quality of life, were diminishing my independence and self-esteem.”
Society too often stereotypes/dismisses older people as incapacitated. Yet they have raised children, run businesses, bought houses and possibly self-managed their super funds. Their desire to continue to make decisions about their lives remains integral to their dignity and quality of life. Self-management allows this. It is an indictment that the federal government does not promote this widely.
Dr Sarah Russell is a public health researcher who specialises in qualitative research. She has been the Principal Researcher at Research Matters since 1999. She is also the Director, Aged Care Matters. She believes the aged care system requires greater scrutiny, accountability and transparency.