For elderly Victorians who need assistance with their daily living needs but who wish to remain In their homes, an alternative to moving into an aged care facility is available: home care. Under this scheme, carers can come to you and help with a range of needs, both personal and medical, at varying levels, from basic care to high-level care.
Since 1 July 2013, “community care” has been called “home care”.
Home care consists of individually tailored packages of personal care services and other personal assistance provided to frail older people with complex care needs, who wish to continue living in their own homes. The packages are called “home care packages”. They consist of low-care services (e.g. assistance with showering and personal hygiene, assistance with mobility and dressing, preparation of meals, administration of medication, laundry, gardening, emotional support and supervision, and transport to medical appointments, shopping or social activities) (s 45.3 Aged Care Act; Subsidy Principles 2014).
Home care packages are targeted packages that are part of the Commonwealth-funded aged-care system.
Home support services provided by local councils in Victoria – known as Home and Community Care services – are targeted to both elderly and younger people who need home-based assistance (e.g. cleaning and home maintenance, and transport).
Home care packages are specifically targeted packages that tend to be directed to elderly people in the home who require a higher level of care that might include, for example, nursing care.
An important change came into effect on 1 July 2015 at a national level for people who receive home care packages. From 1 July 2015, everyone who receives a home care package will now receive that care in a way that is more focussed on individual choice – on a “consumer directed care” (CDC) basis.
This means that all home care packages will be delivered in a way that allows the choice to:
•have more say in the care and services accessed, how it is delivered, and by whom;
•develop their own care plan with their service provider;
•determine how much involvement they want in managing their home care package;
•have more understanding about how the home care package is funded, and how these funds are spent;
•monitor the home care package to determine whether it still meets their care needs.
Subsidised aged care for people who received care at home – such as Extended Aged Care at Home (“EACH”) and EACH Dementia (“EACHD”)before 1 July 2014 – continues on the same arrangements.
There are no changes to the level of care that they currently receive or to the fee arrangements for that care. Access to a home care package still requires an ACAS assessment.
Aged persons who started to receive home care packages at home after 1 July 2014 receive the same level of appropriate care but the fee arrangements are different.
There are four levels of home care packages that are designed to give the necessary care:
•Level 1 supports people with basic care needs;
•Level 2 supports people with low-level care needs (equivalent to the former Community Aged Care Packages);
•Level 3 supports people with intermediate care needs; and
•Level 4 supports people with high-level care needs (equivalent to the former EACH and EACHD packages).
In addition, a recipient may, depending on their needs, receive supplements to the package. The supplements include:
•dementia and cognition supplement;
•veterans’ supplement for veterans with service-related mental health conditions; accepted by the Department of Veterans’ Affairs;
•oxygen supplement for people with an ongoing medical need for oxygen;
•enteral feeding supplement for people who need enteral feeding on an ongoing basis.
An ACAS or a RAS must assess and approve a person for a home care package. To be approved, a person must have physical, social or psychological needs requiring the provision of care that can be met appropriately through non-residential care services.
Standards of care for pre-1 July 2014 recipients
The Department of Health’s Community Packaged Care Guidelines 2011 set out the responsibilities of providers under the Aged Care Act and the Principles not only in relation to CACPs, but also in relation to EACH and EACHD packages. The Guidelines are available on the Department of Health’s website.
Standards of care for post-1 July 2014 recipients
Standards are set out in the home care package guidelines, available on the Department of Health website.
Costs of post-1 July 2014 home care packages
A home care service provider may ask a post 1 July 2014 recipient to pay:
•a basic fee of up to 17.5% of the single basic Age Pension;
•an income-tested care fee if the recipient’s income is over a certain amount.
The basic fee for a home care package, including consumer directed care, that the service provider may charge is up to $133.98 per person per fortnight (from 20 March 2014 to 19 September 2014). This rate increases on 20 March and 20 September each year in line with changes to the Age Pension. This applies to each person receiving a home care package, even if the person is a member of a couple.
Depending on the person’s income, the person may be asked by the service provider to contribute more to the cost of the care. This extra amount is known as an “income-tested care fee”.
A person can only be asked to pay an income-tested care fee if the person has a yearly income above the following thresholds:
•individual person – $24,835.20;
•member of a couple but now separated due to illness (individual income) – $24,367.20; and
•member of a couple living together (combined income) – $38,552.80.
The Department of Human Services works out the income-tested care fee based on an assessment of the person’s financial information. The assessment does not include the value of the person’s home or any other assets.
There are annual and lifetime caps that apply to the income-tested care fee. Once these caps are reached, the person cannot be asked to pay any more income-tested care fees. More information on the income-tested care fee is available on the My Aged Care website.
Responsibility of home care providers
Providers of home care must meet obligations such as providing:
•security of place for the care recipient;
•protection of personal information;
•access to advocates for care recipients; and
•a complaints resolution mechanism.
There are specific requirements in relation to fees. For example, the provider cannot charge a single person any more than:
•if the care recipient’s income does not exceed the maximum basic rate of pension – 17.5% of the amount of the pension; or
•if the care recipient’s income does exceed the maximum basic rate of pension – 17.5% of the amount of the pension plus 50% of the amount by which the care recipient’s income exceeds the amount of the pension.
A home care agreement must be offered to a prospective care recipient before a date for commencing services is agreed. The provider must assist the care recipient to understand the terms and effect of the agreement, which must set out or provide for matters such as:
•the home care that the care recipient has been assessed as requiring;
•charges payable and method of calculation;
•rights of the care recipient;
•giving of financial information to the care recipient;
•that the care recipient is entitled to make, without fear of reprisal, any complaint about the care and the mechanisms for doing this; and
•conditions under which the care may be suspended or the agreement may be terminated.
Level 4 home care packages (formerly EACH and EACH D packages)
Prior to 1 July 2014, two kinds of care were provided to people in their homes: EACH and EACHD. They are now equivalent to Level 4 home care packages. They comprise individually tailored and managed packages of care for people who have high level care needs who are able to be cared for in their homes.
These packages are specifically designed for people assessed as having complex care needs because of behavioural and psychological symptoms associated with their dementia. Both packages are flexible and coordinated to suit a recipient’s particular needs. The packages include the provision of technical and complex nursing services, personal assistance and social support. Appropriately trained professionals, usually registered nurses, undertake care planning and review.
Providers of home care must comply with the Home Care Common Standards that comprise three Standards: effective management; appropriate access and service delivery; and service user rights and responsibilities – and 18 expected outcomes relating to those Standards (sch 5 Quality of Care Principles).
The rights and responsibilities of community care recipients include those in the Charter of Rights and Responsibilities for Community Care set out in schedule 2 of the User Rights Principles. These rights and responsibilities refer to:
•participation in decision making;
•comments and complaints; and