A new report indicates a high level of consumer dissatisfaction with home care providers for overcharging, sending out inadequately trained workers and failing to communicate.
“The data from this research indicates that the government is giving home care package licences to companies with no expertise in delivering aged care services,” the Aged Care Matters report, based on the experiences of 40 home care recipients and their carers, said.
“Participants described these providers as delivering poor quality services, primarily due to a high turnover of inexperienced and poorly trained staff.”
Names have been passed on to the aged care minister Ken Wyatt – who commissioned the study – the health department and the aged care royal commission, the report says.
Only providers which could demonstrate expertise in aged care, employ qualified staff and provide ongoing training should be given licenses, respondents said.
Lead researcher Sarah Russell said self-management, or the use of a “broker”, may be the best option for those who are capable of managing their own HCP or who have strong family support.
“If you’re a frail older person on your own I certainly don’t recommend it … but some of the relatives are saying ‘I’m basically the case manager anyway’,” she told Community Care Review.
“Some of them have moved into self-managed packages and they’re so much much happier.”
Respondents objected to “obscene profits” and said it was unreasonable for a large percentage of a HCP to end up in “providers’ pockets”. The report found charges ranged from nine to 53 per cent.
In one case study a provider charged $607, or 51.56 per cent of a level 2 package, in case management and administration fees for a service valued at $130. 51.56 per cent.
The report also found consumers are unhappy with fixed rates for case management, with one client charged more than $600 a month despite not having a case manager.
Some clients chose to privately fund care rather than get a level 2 package, and some paid so much in administration costs that they ended up with less than 10 hours of a level 4.
“This may indicate differences in the health needs of the older person and the complexity of providing case management. Alternatively, it may suggest overcharging,” Russell writes.
Consumers also want it to be mandatory to be given a schedule of fees before signing a Home Care Agreement. Although this is expected, not all providers currently do it, the report says.
The report also echoed concerns, recently expressed by commissioners at the Royal Commission into Aged Care Quality and Safety, that some providers are failing to publish pricing information, despite being directed to do so by the government.
Among recalcitrant providers “some “with the highest case management and administration fees”, the report says.
Respondents identified case managers as integral in the quality of services and said they should be specifically trained in person-centered and consumer-directed care.
“A case manager who explained entitlements, was easy to contact and met regularly with recipients to ensure the services were meeting their needs was described as ‘a good case manager’,” the report said.
“Participants appreciated case managers who listened to the older person and their families, understood their needs and matched them with compatible support workers.”
The report also identified concern that support workers hadn’t been trained to care for people with dementia and that some training had only been done online.
However, despite the criticism of providers, described home care was described as “a godsend” which made it possible to avoid moving into residential care.
“Without the government subsidy, many older people would be unable to remain in their own homes,” Russell said.
Contributing to unspent funds
Russell says one woman with early onset dementia ended up in residential care at the age of 61 after a bad experience with a provider, which had no experience in aged care and sent out different staff every day.
“In the end her partner was so beside herself that they ended up not using her package,” she said.
“They had $30,000 left in their account because the provider couldn’t offer them what they needed, which was people with dementia training, someone older or in the LBGTQI community.
The government and providers need to consider whether experiences like this are contributing to the problem of unspent funds, Russell says.
“Are they saving it for maintenance of their house down the track, or are they not using it because the service is so bad?”
Working towards improvement
Industry peaks said the home care sector is working towards improvement with the government and consumer groups.
However LASA CEO Sean Rooney said the small, qualitative study couldn’t be applied to everyone getting home care.
“A more robust picture of home care performance is provided by looking at a range of other satisfaction surveys which find around 80 to 90 per cent of people are satisfied, including a 2017 qualitative study commissioned by the Department of Health and an earlier Australian Bureau of Statistics survey,” he said.
He added while administration and case management fees were an issue for consumers, there reflected the costs of managing complex client needs.
ACSA CEO Pat Sparrow said pricing transparency was a major area of concern.
“ACSA has been very involved in working with all stakeholders to develop pricing transparency information which will be available to support consumers make informed decisions about their package,” she said.
Problems identified in the report
- Unable to access reliable information
- High fees
- Unclear financial statements
- No benchmark for costs (e.g. hourly rates)
- Lack of audits
- Poor quality of some services
- Poor communication
- Staffing issues
- Inadequate training
- Insufficient numbers of staff
- High turnover of case managers and support workers
- Ineffective complaints system
- Policy of full cost recovery