Appalled At Aged Care Process – More Bureaucratic Concerns?

The need to better manage Aged Care processes has not lessened – something else for our Indies to address? PWF has addressed this issue before with
Something’s Wrong – Families Struggle To Support Elderly
and
Good News On Direct Family Input Into Aged Care Packages?

The following story about a 92 year old mum written by her daughter, Margaret Gray, recently arrived in my email from www.civilsociety.org.au and appalled me.

The message is about ‘Consumer Directed Care in Aged Care, Disability and Family Services’.

“My mother will be 92 in November. She has no dementia but is ACAS-assessed as High Care as she is wheelchair bound and frail. She lives with my husband and I in outer metropolitan Melbourne in a house we bought to accommodate her care. Mum is a DVA Gold Card War Widow who lived independently until early 2008. In January 2010 we were allocated an EACH package.

The EACH package is worth $43,205. It appears there is no requirement for Approved Providers to allocate the entire package value to my mother’s requirements. Indeed I have been told that if someone else has higher needs, as decided by the “professionals” employed by the Approved Provider, then we should feel it is appropriate that others should receive a “top-up’ from those with “lesser” needs, something called ‘Brokering’ I believe.

This means that only 75% of the package, or $32,409, is available for services for mum, which must be accessed using an agency and the rule of thumb here is that work is charged at a 50% mark-up on the rates actually paid. [When an agency charges a flat hourly rate of $36.50, care workers are paid $19. For a 24 hour shift the agency rate is $350, of which workers are paid $196.]

This means in real terms of worker hourly payments we receive hours amounting to $32,409 / 2, or $16,204 of hours service.

That is, we are only receiving services to the value of 38% of the EACH package.

Irritatingly the Provider never wants to talk about budgets and financial management of our Package but feels it is fine to ask for a co-payment on top of their 25% cut for administration and unwanted case management.

Months of feeling frustrated followed, and I could not put my finger on which bit of this upset us the most and annoyed me as a tertiary qualified retired manager. Was it

§ the lack of understanding that mum living at home is contingent on me being able to sustain this commitment and thus it is the carer who needs support?

§ Or the total lack of information and complete reluctance to discuss this generous Package in terms of effective financial management?

§ Or the enforced case management model that displays a lack respect and understanding of the capabilities and skills of the major stakeholders ie the primary carer and recipient of the package?
Eventually it was the lack of financial transparency that allowed me to see significant parallels with the Financial Services Industry and the current airing of public and government concerns. From this parallel and the proven effectiveness of Self Managed Superannuation Funds (SMSFs), we came up with a model of Real Consumer Directed Care which is applicable in many areas of aged care, disability and family services.

My husband and I have a Self Managed Superannuation Fund (SMSF). We pay a specialised company to provide information and services, including set-up & statutary reporting requirements – much less than 25%. We make our own informed decisions, have flexibility and are in control of all administration costs apart from legislated payments.

When I read the Aged Care Act I could see no reason why this same model will not work for motivated carers to be Self Managed Providers (SMPs). They will need to engage the services of a suitably specialised management company just as we use the suitably specialised company to help with our SMSF but likely only at a single digit % cost of the package.

Of a package of $43,205, our overheads are $4,448, leaving $38,757 for hours of service instead of the $16,204 that the Approved Industry Providers leave us.

This approach increases available funding for real service delivery by a staggering 52%, that is from a current 38% to 90% of the package.

This SMP model allows mum and I to achieve our goal of “no more out-of-home residential respite” and still allows me, the carer, to achieve what the industry sees as the minimum expected accepted standard of

§ 9 weeks of residential respite care equivalent (24 hours care equivalent)

§ 15 hours per week respite for 52-9 = 43 weeks

In fact the SMP model allows more respite time to be taken as the SMP model comes in around $10,000 under the package allocation. What’s more we can take this respite in whatever way we choose as we are no longer locked into the allocated “9 weeks only” of available residential respite bed allocation. The extra money may also be allocated to other needs such as aids or community nurses.

What does this all mean?

The new Department of Health and Ageing Consumer Directed Care models and research projects are well-meaning but suffer from a conflict of interest by association with the current Industry Providers. I am concerned that these models are still full of administration fees for the Industry. My model is not one that I would expect to be put forward by the Industry Providers as they may stand to lose significant funding dollars.

It means we have to put it forward ourselves. Because it is our money. And it is intended for us, not the Industry Providers.

Every political party in the federal election – major and minor – believes throwing money at Industry Providers in health, disability, ageing, education, mental health, family services and indigenous affairs will change things for the better.

None believe that policies and bureaucracies need to be turned around to put the consumer and family first. In every area. Every time.”

The Parents Families and Carers Party was formed to try and make a difference. You can find out more at www.civilsociety.org.au/PFC/Index.htm.