Many people – including providers – think care management is just administration. Not so, write Troy Speirs and Tim Hicks.
Care management is a big part of home care, accounting for about 17 per cent of fees. It is also the key distinction between home care packages anexd commonwealth home support – which is about getting specific services rather than a comprehensive care plan.
Lots of people (including some providers) think care management is just administrative activities like booking appointments and arranging subcontractors.
In fact, care management should be delivering the sort of advice, assessment, monitoring and planning for home care needs that doctors offer in relation to health care.
What good care management looks like
Good care management should include:
- Coordination and scheduling of services
- Ensuring care is aligned with complimentary supports
- Making adjustment to care delivery in response to changes in care recipient preferences and circumstances
- Providing a point-of-contact for care recipients or their support network
- Identifying and addressing risks to a care recipient’s safety as they arise
- Family conferences and liaison with assessors, GPs and other health professionals
- Reviewing a care recipient’s home care agreement and care plan with variation on reassessment
- Coordinating delivering of equipment, consumables, and medications where needed
So, is all this worth 17 per cent of package costs? Couldn’t the funding instead be used to buy more cleaning, personal care or shopping?
The short answer is that a good care manager – like a good GP – is worth their weight in gold.
Benefits of care management
There’s no shortage of research demonstrating the benefits of care management and coordination. For example, one large European study found that over a one-year period, home care recipients without a care manager were 56 per cent more likely to be admitted to residential care.
Why does care management matter? Well by the time a person needs a home care package they usually have a number of chronic conditions and areas of need, requiring different types of care from a range of health and care professionals. Sometimes there are hospital admissions and respite care.
To deliver the right care and support, all these different people need to be communicating openly. Carers need to identify the risks they observe and escalate these for response. Potential supports and interventions need to be identified and planned for proactively.
The absence of good care management may mean missed services, declining care quality, delayed care transitions or even worse – a preventable hospital admission. Anecdotally, lack of care management also means higher unspent funds, because people don’t know what support they need.
What about self-management?
So, what about the self-management option that many providers offer? Consumers can choose to go down this path, but they still need to ensure they have access to experts to regularly assess needs and help navigate support options. Consumers also need to understand the effort that will be required to make sure information flows between different in-home, community and health care service providers.
Sometimes people choose to self-manage because they want to save money. However, LASA’s Home Care Price Regulation and Market Stewardship report estimates average care management hourly prices for a level four Home Care Package as being near $75.
This seems fairly cheap given quality care management may include access to a nurse or allied health professional that is both clinician and care manager with experience in age-related decline of both health and function. Average nursing care hourly prices is more near $95.
The other reason people often choose self-management is because they experience (directly or through someone they know) care management that is done poorly.
Lifting the quality of care management is a priority issue for industry – and LASA runs two courses a month focused on upskilling the care management workforce.
Troy Speirs is a senior policy adviser at LASA and Tim Hicks is LASA general manager policy