Home Care an option for few

Advisers who are considering aged care options for their clients will need to consider whether Home Care can be accessed.

The latest statistics from the Government show demand continues to outstrip supply, so Home Care will not be an option for everyone. Even though the Government has released more Home Care packages, there are still over 50,000 people waiting for a package, and another 50,000 waiting to get on the right package. 

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For those who are unfamiliar with the Home Care it is a Government-funded program that assists eligible individuals to receive care in their home. 

Before a person can access Home Care, they require an assessment by an Aged Care Assessment Team (ACAT) to determine if they are eligible to receive care. Those who are eligible are also assigned a level of care, based upon their needs. Level one is the lowest and level four is the highest. 

What does Home Care provide?

The breadth of services provided by Home Care is determined by the level (one – four) assigned to an individual. 

Provided below is a summary of the services that each package may provide. Note that the service provided is dependant upon the individual’s needs, therefore this list is not exhaustive.

Level 1 for basic needs

Provides regular support, such as personal care, domestic assistance, social support and assistance with meals. 

Level 2 for low level needs

Provides a similar level of care as level one, but also includes some access to clinical services. Those who are assessed under this level may also consider entry into a residential care, such as a hostel. 

Level 3 for intermediate needs

Provides access to a higher level of needs, such as personal care, domestic assistance, transportation, household assistance, and clinical services. Additional support is provided with medication and nursing support.

Access to a greater amount of assistance aids are provided as part of the package. Those who are assessed at level three (or level four) may consider entry into a residential care facility, such as a nursing home. 

Level 4 for highest care needs

Provides a similar level of care as level three, but also includes additional support with medication management and changes in memory or behaviour. 

The problem is that not everyone can get access to the level of care that they require. 

The Home Care Packages Program data report Third Quarter 2017-18 indicated that there are 54,821 Australians who are assigned a lower level Home Care package compared to the level they require. This means that a person may require access to a level four package, but is only able to access a lower level package. 

Table one indicates the number of people queued at 31 March 2018 to receive a package.

Table one: People queued as at 31 March, 2018 to receive a home care package

Source: Home Care Packages Program data report 3^rd Quarter 2017-18

Fees and charges 

Home Care recipients are liable to pay a basic daily fee and may be asked to pay an income-tested fee. However, unlike residential care, there are no accommodation deposits to pay. 

The basic daily fee is currently $10.32 per day. The income-tested fee is based upon a person’s income and subject to a formula. However, the maximum income tested fee is currently $10,785. The income-tested fee is a contribution towards the cost of care.

Accessing a Home Care package

As detailed earlier, over 53,600 people have not been assigned a Home Care package. Availability of a Home Care package is generally based upon an individual’s geographic location. 

Therefore, it is interesting to consider the availability of packages per state, based upon the various levels. This data is shown in table two.

Table two: Availability of home care packages per state

Source: Home Care Packages Program data report 3^rd Quarter 2017-18 report

Waiting time

With so many people waiting for Home Care packages, it may be no surprise that there is often a waiting list to access a Home Care package. Table three provides the estimated maximum wait time for those entering the queue.

Table three: Estimated maximum weight time for those entering the queue

Source: Home Care Packages Program data report

How much can clients receive?

The Government subsidises Home Care packages, however the amount of subsidy that a person receives is based upon their level of care and their income-tested fee amount. 

A level one Home Care package costs the Australian Government up to $8,000 per year, whilst a level four package can cost is up to $49,500 per year. Provided in table four is a summary of the yearly amounts paid by the Government.

Table four: Yearly amounts paid by the Government to home care packages

Source: Home Care Packages Program data report

Since 2015, all Home Care packages have been delivered on a Consumer Directed Care basis. This means that consumers can decide the types of services that they receive, and how they are delivered. 

In February 2017, the sector underwent further reform where packages are provided directly to consumers. This means that people can decide who will provide their Home Care services, based upon their needs and circumstances.  

Case study: Meet Margaret

Margaret recently celebrated her 80th birthday. She has been widowed for four years, but continues to live in her home. Last week she had a fall, and was admitted to hospital. 

Whilst she was in hospital, she was assessed by an ACAT, who determined that she required care. It was determined that she would be eligible for Home Care (level two) or residential care. Margaret must decide whether she will receive care, and whether she will opt for Home Care or residential care. 

In Margaret’s case, she is eligible to receive Home Care (level two), which means that she receives access to services such as assistance with bathing, showering, dressing, and toileting (note that this list is not exhaustive). Margaret will choose which services she requires based upon what the package can provide and her needs.

However, Margaret cannot use her package to pay day-to-day bills, rent, mortgage payments, or to pay for food. These packages are not to be used as an additional source of income. 

Margaret is subject to a basic daily fee of $10.32 which equates to $3,766.80 per year. Based upon her income she is liable for an income-tested fee (annualised) of $5,000. This means that her total annual cost is $8,766.80 per year, although her basic daily fee is subject to indexation and her income-tested fee will be reviewed on a regular basis. 

Based upon her income-tested amount, she contributes $5,000 to the cost of her Home Care. The Government will contribute $9,500, which totals to $14,500. This is the amount that Margaret has available to spend on Home Care, where she would select a combination of services based upon her needs. 

If we assume that Margaret lives in NSW and requires access to a level two package, then based upon the Home Care Packages Program data report there are over 6,000 other people waiting for a similar package. She is likely to have to wait for between three to six months to receive a level one package. And then she will need to wait even longer until she can receive the level two package that she requires. 

Conclusion

The Home Care Packages Program data report shows we need more Home Care places to be released in order to meet demand. When a person is assessed as requiring care, they need it now, not in three or six or 12 months. Perhaps the waiting time to access Home Care is one of the driving reasons for people moving into residential care.

Whilst the Government is providing more money to release additional packages, it appears that many people are failing to receive the care they need. And with an ageing population, it will only get harder to access a Home Care package as demand continues to increase. 

Those who are interested in locating Home Care services in their local area should access the “Find a service tool” on the www.myagedcare.gov.au website. 

Troy Smith is technical services manager at ANZ Wealth.