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Home care fee arrangements under the spotlight

More than half of home care providers are charging consumers less than the maximum basic daily fee amount and 22 per cent are waiving the fee altogether, a new survey finds.

The Aged Care Financing Authority survey of 370 providers also found 17 per cent of providers were not collecting the income-tested care fee from home care package clients.

Small providers and those serving remote communities were less likely to charge the consumer fees, while for-profit services had higher than average rates of charging.

The client co-contributions were introduced in 2014 as part of the Gillard government’s Living Longer Living Better aged care reforms. Under the fee arrangements, the government’s home care package subsidy is reduced by the amount of the client’s assessed income-tested care fee.

The survey results show that many providers chose not to collect the consumer fees because they believed clients could not afford them.

However, ACFA said inconsistency in the fee charging practices of providers created inequity in consumer contributions and the government could consider making it compulsory for providers to collect the assessed income-tested care fee.

“Different consumers with the same income are paying different fees in some cases,” said the ACFA report provided to the Aged Care Legislated Review.

It was unclear if providers were absorbing the cost of the subsidy reduction, and therefore potentially impacting their viability, or waiving the fee and reducing the value of a person’s package, which was not permitted by legislation, the report said.

ACFA conducted the provider survey on home care fees for its report to the Aged Care Legislated Review, which was handed to government on Tuesday.

The financing authority said the relatively high level of consumer contribution for Level 1 packages was also likely to be contributing to the limited uptake of packages by part-pensioners and self-funded retirees.

It said the government could consider linking consumer fees to the level of package.

In 2015-16, the government reduced its package subsidies from income-tested care fees by only $13.1 million.

The data showed that the majority of home care consumers (82 per cent) were pensioners and therefore were not assessed as being able to pay an income-tested care fee.

The Federal Government is required to table the recommendations of the Aged Care Legislated Review by 14 September.

Read the ACFA report here.

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5 Responses to Home care fee arrangements under the spotlight

  1. Paul August 3, 2017 at 4:00 pm #

    To be honest, this should be of no surprise to anyone. I support people contributing to their cost of care according to their means and I support the collection of the ITCF given it is independently means tested and is mandatory. That means that consumers can’t provider shop until they find one that isn’t charging it.

    The BDF is another story. Consumers find it confusing and it is so small that invoicing it separately can prove extremely costly. Also, in a competitive market, consumers have quickly worked out they can shop around until they find a provider that doesn’t levy the fee. In a market of 700+ approved providers, all competing for just 80,000 consumers, why would a provider create one more objection in a consumer’s mind by charging this fee?

    I strongly support people being asked to contribute to their cost of care according to their means. The ITCF is the right approach, albeit it clunky at the moment. Hopefully this will improve with time. Unless the BDF is means tested and mandatory it is destined to dwindle in this highly competitive market.

  2. Leeanne August 4, 2017 at 10:46 am #

    Why is there such inequity in the community care systems? There is no mention of NDIS here but it needs to be raised – the NDIS ( a community support program for people under 65) has no means test ( for clients or supporting parents), a short and often over the phone assessment, no fees to be paid by the client and very liberal funding. Yet once you turn 65 you are subject to a means test, have a top to toe assessment, have complicated centerlink processes ( attached to the means testing) and then fees for care – What is the difference? Why are the aged devalued in the care process? There is no interest by Peak Bodies to take this up , many of the carers of the aged cohort are aged themselves and/ or exhausted trying to cope with families, work, aged and at times demented parents and possibly the tyranny of distance due to circumstances beyond their needs. Can someone with influence please take on this inequity and bring it into the spot light – after all what is good for one should be good for all in a country who has a catch cry of equity and access

  3. Ekram August 4, 2017 at 2:21 pm #

    I totally agree with Leanne, the system requires serious review. In the current competitive market, it makes no sense to insist on the BDF if based on the care plan the client will receive the services needed within the package funding. If BDF becomes compulsory, unfortunately we will see many seniors going without services and carers continuing to provide unsustainable care. Policy makers need to understand the variation in clients circumstances, not everyone who can’t contribute is eligible for financial hardship. It is already a huge administrative burden for service providers to assist clients when ITF are incorrectly determined (often) and then clients withdrawing from the package once excessive ITF is determined. Hospitals will be inundated with seniors and carers presenting with symptoms and issues that could have been detected earlier and dealt with if they had adequate services at home.
    Our seniors worked all their lives, contributed to the economy and they serviced their communities. It is time to provide them with the support they need to continue living the way they choose.

  4. Debra Ward August 6, 2017 at 5:07 pm #

    I agree with all the comments mentioned. It’s hard to ask a consumer to pay a Basic Daily Fee (BDF) if their package covers their needs as the cost to the provider to bill this out would be higher than what they actually make out of it considering it just adds to the consumers Unspent Funds.
    Totally agree with the charging of an Income Tested Fee (ITF) if the consumer earns over the allowable limit however it would be better if the government just reduced the funding allocation for that consumer rather than the provider having to explain it, bill it and collect it.
    As we all know, there are many improvements that can be made to the system so would recommend that providers feed into the “Future reform – an integrated care at home program to support older Australians” paper due by 21 August 2017.

    Link: https://consultations.health.gov.au/aged-care-policy-and-regulation/discussion-paper-future-care-at-home-reform

  5. alice August 8, 2017 at 3:27 pm #

    The ICTF is determined by Centrelink so consumers aren’t able to provider shop, as they will receive the same result regardless of where they go. It is triggered as soon as they accept a package and their details are sent to Medicare to commence the package. Whatever information Centrelink has on hand, they will use to determine what the ICTF will be.

    The NDIS is completely separate and much more individualised, and it intended for a much smaller segment of the population (4mil reported having a disability in Australia in 2009, and a large proportion of those would not be eligible for long term disability supports). The NDIS was designed to take a more early intervention approach, especially for younger people so they can increase their chances of participating in society and in the workforce.

    The reason seniors cannot expect to receive services for free is because we are looking at a huge ageing, baby boomer population who should contribute to the cost of their care if they wish to be more actively involved in the direction it takes. The government is already spending approx $5b every year and has clawed back some of that money in recent years.

    There is simply not the population or tax revenue available to fully subsidise this population who is the wealthiest in recent history. The ICTF was introduced to stop subsidising people who have large investments, multiple income streams and yet still eligible for part pension or health care card benefits. I am tired of the ‘paying taxes your whole working life’ – yes, and so will everyone else, but this support will likely not be available in the future.

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