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Some thoughts on aged care packages

I wish people in government would stop pretending to be surprised that Australia’s aged care system is a mess. It’s not surprising at all. Encourage private investors to take over any “caring” sector, let them shift profits offshore to avoid taxes, let them cut staff to the bone and employ the least qualified workers they can find, let them hide the truth about what they spend on food and care and avoid regulating or scrutinising them and what do you think you will get?

The bottom line seems to be that governments don’t care about powerless groups of people, and they hope that enough voters share their disregard to avoid having to do anything meaningful about the mess they have consciously created in aged care.

And from what I have seen, it isn’t just residential aged care that’s messy. The system of home care packages can be pretty dicey too, if our family’s experiences are any guide. I’m not saying they can’t work to the benefit of their recipients, but the recent Royal Commission recommendations in favour of independent advocates to help old folk navigate the jungle of hard-to-compare providers ought be taken up urgently, in my opinion, for home care packages as well as residential care. That’s because the fees and charges levied by different providers can vary so much, and this can have a considerable effect on the actual services the “client” receives from their package.

Once an elderly person decides to be assessed for an aged care package, it is up to assessment teams to determine what level of package they need to support them in their home. Level 1 is about$9,000 a year, level 2 is a bit under $16,000, level 3 is a bit over $34,000 and level 4 is $52,000. You might think that sounds like a lot of money, and it is. Which is why the various organisations that administer these packages are so keen to sign up clients who have been approved. These organisations stand to make a decent whack from their role as gatekeepers for care services, and they can get that money in a variety of ways.

Co-payment isn’t compulsory

When we first began exploring these packages for elderly relatives one thing we noticed was that representatives of some providers told us – or at least strongly implied to us – that the government required the client to pay at least $10 a day from their own pocket on top of the money provided by the package. In the course of shopping around we discovered that this contribution was actually at the discretion of the provider, and some routinely waive it, or will do so if a little light pressure is applied. In some cases the services actually required by a client mean this co-payment is unnecessary and apparently achieves little other than helping the provider’s cash-flow. In our experience some providers – especially the big church-based ones it seems – flatly refuse to waive the co-payment, no matter what.

It is possible to make some basic comparisons on the myagedcare website, and this is very handy although still sometimes a bit ambiguous. You can see, by comparing the various charges levied by providers, how many hours of care you might expect to receive after their fees have been extracted. Leaving aside the personal co-payment which – if paid – is on top of the package payment from the government, the providers will charge you a figure for managing the services you request. This can vary a lot, and might be up to 30% of the package or even more. Naturally, the higher this charge, the less money left to spend on the services you need.

I assume the providers also clip the ticket on the hourly rate they charge you for the labour of the various people they send to provide your direct services. And again, these hourly rates vary quite a bit across the whole spectrum of services. Cleaning, for example, might be charged between $48 and $65 a hour, and nursing typically between $90 and $110 an hour, but if you ask the workers who attend your home they won’t be receiving this amount. But the more you pay per hour for any service, the fewer hours you will receive under your package.

Watch out for exit fees

Then there might be “package management fees” (also highly variable), charges for staff to visit you, extra costs if you ask the package administrators to help you access a service they don’t directly provide and possibly even exit fees (up to as much as $500) if you decide to switch to a different provider. You can see that, depending on all these variables, you might find that the choice you make means another hour or three of care provided by your package.

Of course there is more to consider than the number of hours, although it’s hard to gauge things like quality of care and responsiveness of the provider unless you actually try them out. Our experience has been varied. It appears to be very difficult, for example, to get good quality cleaning provided. We have been obliged to repeatedly request different cleaners for the two “clients” in our family, with quite extraordinary quality issues to raise, including total failure to clean toilets and showers, and also a marked tendency to leave well before the paid-for hours have expired. (Not surprisingly, these hefty “early marks” are never reflected when it comes time to bill the package.) It’s possibly also worth noting that the cleaners retained by the package administrators are not allowed to do certain jobs: they can’t stand on anything to reach high places, for example, and they can’t use certain types of cleaning products.

What stands out to me is that the process of comparing service providers is reasonably challenging, and could be quite difficult for many elderly people. And yet, it’s a very important exercise, since the various fees and charges can quickly have a noticeable impact on the actual hours of care provided. Not every client has friends and family to help navigate the system, so I believe some government-funded independent advocates would be an excellent idea.

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