Home' Community Care Review : CCR Nov-Dec 2015 Contents Admin fees, CDC
take-up under scrutiny
Increasing the knowledge of CDC across key agencies and addressing
disincentives to take up Level 1 packages are among the recommendations in
long-awaited home care review, LINDA BELARDI reports.
The Federal Government's national
evaluation of home care packages
and consumer directed care has
recommended trialling new approaches for
some special needs groups and strengthening
a focus on wellness and reablement.
The evaluation, which was completed
by KPMG in April, was released by the
government on 30 September, three months
after the full implementation of CDC.
The report urged the government to
consider developing alternative models
of CDC for indigenous clients, which may
include options for some communal use of
Interviews with stakeholders suggested
the inflexibility of program guidelines was
contributing to the relatively low take-up of
home care packages (HCPs) by indigenous
communities, the report said.
Limited progress has also been made
towards the use of CDC to support
community participation for older people,
and wellness and reablement approaches,
the report found.
The concept of moving consumers to
lower care levels in particular seemed a
foreign concept to many providers, and the
sector could benefit from sharing examples
of best practice, the report said.
To strengthen the implementation and
systemic support of CDC in home care,
KPMG advised increasing the knowledge
and training on CDC available to Aged Care
Assessment Teams, aged care advocacy
services, Aged Care Complaints Scheme
and quality agency staff.
For the first time the evaluation has
made public data on average charges for
administration and case management.
A survey of 77 home care providers
showed that, on average, providers were
taking 27 per cent of a client's subsidy in
administration and case management fees.
Approximately half of the providers
interviewed by KPMG
reported having undertaken
some form of detailed cost
modelling to develop their
cost structures; whilst others
(usually those charging at
the lower end) set the fees
based on what they thought
that they experienced
costs associated with
the implementation of
CDC, such as additional staff time and
brokerage costs, which were being passed
on to consumers (64 per cent of providers
said CDC places had increased the
administrative burden on organisations).
A number of consumers said they were
confused about how their admin and case
management fees were being calculated,
and clients who took on a significant degree
of self-management but saw little reduction
in the fees charged, felt most dissatisfied.
The evaluation said there was still some
work to be done around the transparency of
administration and case management pricing.
A small number of stakeholders told the
review there was a need for an independent
third party to assist new consumers to
understand fees and service pricing.
While the evaluation noted there was a
small number of early adopters of CDC,
as well as a small group of resistant
organisations, most fell somewhere in
between these two extremes.
While steps have been made towards
increasing consumer choice and control,
individualised care and support, and
respectful partnerships, the report said this
varied between providers. Small providers
and those in outer regional areas had been
slower to transition.
The report said some providers were still
focused on services rather
than goals or saw CDC as
usual care with an individual
Providers reported that
there was a tendency for
consumers to choose in-
house services. However
KPMG said the extent
to which providers gave
consumers information about
brokered service options varied. In many
cases, providers explained in a 'general
sense' the option to broker services but
did not always present information on the
services available from other organisations
or the prices of these services. It was noted
that there was an incentive for providers
to encourage consumers to use their own
in-house services to ensure that their
organisations had a steady revenue stream
and remained viable.
Services most likely to be brokered out
were transport, continence management,
clinical care and health services.
KPMG said data it analysed from
providers did not fully support claims that
brokered services were more expensive than
The report concluded that CDC in
Australia was still evolving: "The overall
message is that it takes time for staff to
change their practice, just as it takes time
for many consumers to be comfortable in
asserting and exercising some control."
The evaluation also recommended
that the interface between HCPs and the
Commonwealth Home Support Program
should be resolved as soon as possible,
including addressing the perceived financial
disincentive for consumers to take up a
lower level home care package.
The evaluation was conducted between
April 2014 and February 2015. n
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