THE FUNDAMENTALS

Jonathan Pietsch Service Provider Consultant

May 2016

1

Topics

Providers and consumers- the markets

Legal framework and the Program Guidelines

Legal issues project

Client agreement

Current providers adaptations

2

Provider growth

deregulation and

competition

504 providers

New providers

From

• CHSP/ HACC services

Residential aged

• Disability

• For profits

3

Growth

4

Ageing population

100,000 packages by 2018

Tripling demand over 40

years

504 providers- some stats80% have 10%(from 10 to 100

packages)

Only 49 providers have

5

Resi

Home support +

HCP

New openings

= Franchises

Mostly not for profits

5% have 50%

Length of StayAverage LOS

is 94 weeks.

Turnover 30% to 40%

per year

30%

for 6

months

22.8% for

2 to 5 years90%

turnover

in 3 years

6

Consumer views:KPMG Report

3 broad markets

Full pensioner (70% of packages)

Part pensioners- 30% shrinking

Self funded

retirees

8

Further market segmentation

Level 1

Level 2 or

levels 3 and 4

most isolated elderly in rural

areas

Chronic illness

LGBTI

multicultural communities

Aboriginal and Torres Strait

Islanders

9

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Copyright Iconic Consulting Pty Ltd. All Rights Reserved.

Self funded retirees

security healthtransport safety

property

maintenancedomestic

duties

lawn &

garden

• help me feel

more secure

opening the door

to strangers

• help me feel

more confident

out in the

community

• facilitate

independence

• help me get to

medical & social

appointments

• help me get

home smoothly

& safely

• help me increase

mobility around

the home

• help me access

specialist & allied

health

• assist me to

coordinate & attend

appointments

• help me with

nursing in the home

• assist me to

choose

reputable,

trustworthy

contractors

• assist me with

domestic duties,

to my standard

• help me maintain

my standard of

garden and lawn

care

Across Australia or niche?

• Australia

• Region

• Niche

• Care coordination/brokerage

11

Winners and losers

More packages

Less packages

Consumer portability from 2017

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Legalities - Operational Guidelines

Legislation

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Changes

Operational manual

Rights

Legislation -The Age Care Act

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Principles:

• Accountability

• Access

• Quality

• User rights

• Affordable – fees and charges

• Other relevant legislation – Consumer Law

Rights - The Charter

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• Rights and responsibilities

• Amended 1 July 2015

Charter of Care Recipients’ rights andresponsibilities- Home Care

• CDC principles

• Individualised budgets

• Personal information

• Comments and complaints

• Updated frequently (Next – before Feb 2017?)

• Defines program

• Legal Framework

• History of changes

• Access and eligibility and fees

• Care Planning

• Agreement

• Individualised budgets

• Excluded items

• Duty of Care and dignity of risk -The Ten D’s

Operational Manual

Changes over time

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• The guidelines are becoming greyer

• Encouraging innovation

• CDC included in Charter of Rights

• Less focus on reablement

Fees and charges

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1. Basic Daily Care Fee 17.5% of full pension rate

$9.93 per day = $139.02 (Negotiable and added to package value) (Hardship application)

2. Income tested Care fee (Threshold)Individual Pension $20,664 (threshold begins at $25,659)

($30,000 pay ITCF of $2158 pa.)

($36,000 pay ITCF of $5174 pa.) (Annual cap)(50 cents in the dollar)

Couple pension $31,148 at ($42,000 pay $520 pa)

(61,000 pay $5174 pa.)

4 Levels

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Level 1 supports people with basic care needs $21.71 DR

Plus Daily Care Fee = $3,615

= $7924

= $11,556

Level 2 supports people with low-level care needs $39.50 DR = $14,378

Level 3 supports people with intermediate care needs $86.84 DR = $31,609

Level 4 supports people with high-level care needs $132.01 =$48,052

Home Care Subsidy rates

Home Care Viability Supplement

ARIA Score

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Amount of Supplement

ARIA Score 0 to 3.51 inclusive $0.00

ARIA Score 3.52 to 4.66 inclusive $5.22

ARIA Score 4.67 to 5.80 inclusive $6.27

ARIA Score 5.81 to 7.44 inclusive $8.77

ARIA Score 7.45 to 9.08 inclusive $10.53

ARIA Score 9.09 to 10.54 inclusive $14.73

ARIA Score 10.55 to 12.00 inclusive $17.68

Consumer agreement

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• See operational manual

• HCT guide

• Consumer guide- prepared by a consumerhttp://homecaretoday.org.au/consumer/your-guide-to-new-choices-in-home-care/home-care-agreements

• Consumer law

• Keep it simple

– Folder of information

– Agreement has the basics

Legal Issues Project

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Context

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• 18 months ago

• Anxiety from providers re CDC

• Actual and potential issues being raised

– WorkCover and employee status

– Home Care Agreements

– Providers seeking indemnity from consumer choices

• Legal Issues Project commissioned Sept 2014

Legal issues research

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Literature review and 51 in-depthinterviews:

• Issues facing consumers

• Issues for providers

• Alternative approaches to risk andother legal issues

• Potential ways forward

Summary of interviews

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1. Choice

2. Provider responsible

3. Home Care agreement

4. The guidelines

5. Workforce

6. Resources - no capacity to crosssubsidise

1. Independent advice for consumers

2. Confusion with fees

3. Independent advice

4. What ifs? Consumerholds funds.

Poll

26

What issues are you most concerned about?

1. Increased consumer choice

2. Grey areas of guidelines

3. Workforce not ready

4. Unable to cross subsidise

5. Plain language agreement

Duty Of Care

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Four elements to the law of negligence

• A duty of care was owed

• There was a breach of that duty of care

• There was damage suffered as a result of the breach, and

• That the damage was reasonably foreseeable

Project findings

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• Potential issues

• Aged Care Law and the guidelines are adequate (Operational manual)

• Communication is the key

• Good examples of positive risk and risk enablement (Other countries)

• The need to create provider and consumer resources

Risk defined

CDC requires risk to be considered as the probability of an event that will

occur with beneficial or harmful outcomes for a particular person or

others with whom they comeinto contact.

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Consumer risk - disclaimer

• If you wish to partake in activities that place you at risk and are not agreed to in your support plan you will indemnify …………… and its staff against any liability for injury or harm that may incur to your person.

• Noted and communicated

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Ten D’s for decision making

• Discover

• Discern and dream

• Duty of care

• Dignity of risk

• Discuss

• Do

• Decline

• Document

• Disclaimer

• Disagreement31

Good communication

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• Don't be defensive, be curious

• Don’t make excuses, take responsibility

• Don’t waffle, use fewer words

Consumer Complaints and Issues

• Cost of Home Care Packages

• Lack of information

• Poor communication

• Lack of choice and flexibility

• Questionable value for money

• Change in relationship

“From case

managers to

advisors”

Case studies - current providers

Understanding

diversity in the

community

Workforce changes

Customer focus

Changing policies to reflect

new environment

Consumer focused

34

Models of partnering

create

35

Understand the context

Understand the law and the guidelines

Understand consumer need

Build systems and processes

Don’t forget its about the relationship

Take-home messages

36

• ???

• !!!!!!!

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What light bulbs have been turning

on for you?

Questions?

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