Home' Community Care Review : CCR Jan-Feb 2015 Contents With the looming deadline of 1 July 2015
for full transformation of all home care
packages to consumer directed care (CDC),
organisations are facing major challenges.
Financial management is one of these,
requiring re-configurations of administrative
support and systems to cope with providing
individual monthly income and expenditure
statements to homecare customers.
There has been a lot of commentary and
debate in the industry regarding the system
needs of this transition.
Accounting systems might have initially
appeared to offer a natural solution, given their
abilities around financial reporting. On closer
review, however, frontline care management
staff struggle using accounting systems.
There is also a massive effort required for an
organisation to go from several cost centres to
hundreds (one cost centre per package) and
then manage these cost centres on behalf of
the care recipients.
Next in line have been the care management
systems that have many advantages over the
accounting system, such as care management
staff familiarity and the ability to capture a
significant amount of relevant care recipient
information. Care management companies
have been spending the year building CDC
financial reports, many of which are working
to different degrees, albeit still with challenges
for getting information in and out from other
areas, including payroll and accounting.
Many larger organisations have had some
success having spent the best part of the past
year integrated various systems. The ongoing
cost of staffing these integrations and new
processes is not yet entirely clear. Time will
tell, as these costs need to be passed on in a
transparent manner to care recipients as an
administration charge. CDC is empowering
home care recipients to select their providers
of care management services, and cost of
administration will play a role.
While processes and systems are being
re-engineered, other options with negligible
costs are appearing, such as cloud services
provider Capital Guardians, a product that
combined a bank platform and invoicing
system. Designed to eliminate the traditionally
high sector costs of administration,
governance and software, it automates
all invoicing with all suppliers through
smartphone applications, and interfaces that
work with all accounting systems.
Ross McDonald, CEO of Capital Guardians,
said: "While our headline value comprises
a system with no initial costs and low
ongoing $3 monthly fee, the real value is
the systems elimination of all administration,
limiting care coordinators management to
uploading individual budgets and the online
authorisation of invoices for payment against
these budgets. The system is being used
by dozens of operators alongside their care
management systems, without the need
for finance staff, allowing CDC providers to
maximise their care packages with the lowest
CDC financial management:
are we ready?
For more information visit capitalguardians.com
making in their state. This education should
ensure staff are aware of the requirements
to make a valid decision about end-of-life
care in circumstances where the client has
capacity and when decisions need to be
made by substitute decision-makers.
It is important to make sure your staff
also understands the difference between
an ACP and AHD i.e. if there is an advance
care plan but no directive who will make
decisions for the client in the event they
Staff should also understand that the
basic premise that a substitute decision-
maker must always make decisions which
are in the best interests of the adult and,
in turn, understand that if they become
concerned that a substitute decision-maker
is making decisions in a way that is not
consistent with the interests of the adult
that there is a process for staff to follow to
report the inappropriate behaviour, and that
appropriate action is taken in response.
Providers should adopt a clear plan in
consultation with the family and the
client's GP that includes palliative care
options tailored to each person's needs
and circumstances. It is important to
make sure that any discussions with the
patient and their family focuses on realistic
options and the difference between active
treatment and palliative care.
The client and their plan needs to
contemplate who will make decisions in
the event that the client loses capacity. This
is, of course, on the presumption that you
have provided training to your staff and
have included in your policy information
about who can be appointed as a substitute
decision-maker and their powers.
In the end-of-life care context, the planning
process should consider questions such as:
• When do you want to be transferred to
• When do you want to receive antibiotics?
i.e. chronic conditions versus acute illness
• When, if at all, do you want to be actively
• Are there any treatments you definitely do
Timing and implementation:
The final thing that may seem obvious
but needs to be said is that adopting
a plan is only the first step; it is vitally
important then to ensure that the plan is
There is no point having an ACP or AHD
if there is little chance it will be followed.
It is critical to ensure that once the plan
is adopted, a provider has processes in
place to ensure the plan is implemented in
accordance with the client's wishes.
It is also important to ensure you embed
in your processes a mechanism to re--visit
and review the end-of-life care decision-
making process. This review process could
include care planning at regular intervals to
ensure that the client still wishes their care to
be managed in the same way. This becomes
more important as health starts to decline.
There is no doubt there will be an increase
in supply and demand for end-of-life care
services at home in coming years.
To ensure palliative care is delivered at
home in a way that meets the client's needs
but mitigates a provider's compliance risk, you
should make sure you have an appropriate
process in place which is consistent with the
laws in the states in which you operate and
that your staff, clients and their families know
about the process and how it will work. n
Julie McStay is head of Hynes Legal's
aged care and retirement living team.
She is contactable on Julie.mcstay@
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