Home care recipients have told researchers they sometimes have to fight to get their provider to deliver services they are due, describing it as “a battle” and “like pulling teeth”.
The government-commissioned study published in the Australasian Journal on Ageing interviewed 37 Home Care Package (HCP) recipients between September and November 2018.
Participants were asked a series of questions relating to their degree of satisfaction with their HCP, including how they went about getting their services, how they identified providers, whether services were meeting their needs and about the staff who came to their home.
It builds on an earlier study released last year.
The current research, Consumer experiences of home care packages, says tighter regulation of providers, attention to fees and minimal standards of training would result in more positive consumer experiences.
Lead researcher Sarah Russell, Principal Researcher at Melbourne-based Research Matters, says the interviews highlight many of the problems plaguing home care, including price gauging and poor quality and continuity of care.
“The major problems in home care in my opinion at the moment are that providers taking a very large slice for administration and case management but they’re not providing good case management,” she told Community Care Review.
“Many of the people I interviewed had not even met their case manager. They are sending inexperienced untrained people into homes, some people tell me they see someone different nearly every day.
“I think home care needs to be much better regulated and there needs to be more rules around what providers can and should do.”
Participants who had satisfactory experiences reported common themes, the study found.
- Providers charged reasonable fees
- Case managers delivered person-centred care
- Consistently assigned support workers
- Support and advocacy from family
- Community engagement.
But there were also common threads among the complaints.
Respondents said it was difficult to get information from My Aged Care and described their home care agreements as “long and complicated”, with some admitting to signing without understanding what they were agreeing to, and choosing providers purely on the basis of cost.
One participant said she was offered a new vacuum cleaner as an incentive for signing up, others complained about misleading advertisements, and some providers were unable to provide services promised because of staff shortages.
Another older person was advised by hospital staff to go to a larger provider because small ones were likely to “go broke”. However respondents also said they found smaller organisations provided better and more person-centered care.
The study found fees ranged from nine per cent to 53 per cent of the government subsidy, with some clients being charged up to $500 a month for case management and administration. Hourly fees for support workers ranged from $39 to $65 per hour.
One participant on a level 4 package received only 14 hours of personal support a week, leading to the perception that the money was going straight to the provider’s pocket.
“Findings indicated large differences among providers in both case management and administration fees and also hourly rates for support workers. This may indicate differences in the health needs of the older person and the complexity of providing case management and support.
“Alternatively, it may suggest overcharging,” the report says.
Dr Russell said there was “no question” that “financial gouging” was occurring in the sector.
Full cost recovery
The research also suggests that the policy of full cost recovery under the HCP program is preventing older people from being involved in as many social activities as they would have wanted, as they tended to prioritise funds for more immediate needs.
“This policy may result in older people on higher-level packages having limited access to social and community activities that were delivered by CHSP which in turn can increase social isolation,” the researchers write.
The research says rather than HCPs being capped, packages should be funded to reflect individual needs.
This would eliminate having to choose between allied health, personal care, home care, home modifications and social support, the study says.