ONE of our readers wrote in about his Home Care Package: “They have cut down so many things…”, he wrote. He wasn’t the only one to complain. Recently the Daily Telegraph published a story claiming a range of services, medications and equipment had been cut from the Home Care Packages program list.
Home care package exclusions
Home Care Packages are basically set amounts of money home care recipients can spend on their aged care. The idea is that recipients decide what the money is spent on, because they know best what their aged care needs are. But it’s not without limitations. Some things which seem logical inclusions are, in fact, excluded from package funding.
The Daily Telegraph quotes the example of a man living with advanced Parkinson’s disease who can now not get a special medication. A Home Care Package can’t pay for it, because the PBS (Pharmaceutical Benefits Scheme) subsidises Parkinson’s medications. The problem in this case is that the PBS list does not have this particular medication on it. So, now this man has to pay for this prescription medication out of his own pocket.
The Government’s argument would be that the PBS list has everything on it that people could need, so a Home Care Package can’t fund a medication not on the PBS list.
Similar reasoning means Home Care Package funding can’t pay for taxi fares. If you catch a taxi and you are eligible for a state and territory taxi subsidy program, you need to pay the gap between full fare and subsidy yourself.
Need urgent dental work done? Not on your Home Care Package! There are state and territory programs which are meant to take care of that. Too bad they generally don’t, because they’re under-resourced, but there’s a program, so your Home Care Package can’t pay for your dental work.
The trouble started in January of this year, when the Department of Health published an updated Home Care Packages Program Operational Manual. The January 2023 update was the manual’s third update, while a fourth update was published in August.
The Home Care Packages program started in 2017, but for the first three years no operational manual was available to providers. The January 2023 manual is the first update and represents the first time the Department of Health and Aged Care has attempted to give providers (and consumers) rules about what a Home Care Package does and does not fund.
So, for the first six years of the Home Care Packages program’s operation it was left to providers and consumers to interpret what was intended they could legitimately pay for out of their package.
Given that package recipients could change providers if they were not happy with them, it’s logical that providers would interpret the unwritten rules generously and in their clients’ favour. Otherwise, they might walk.
It should therefore not come as a surprise that interpretations of the unwritten rules about the can-gets and can’t-gets of Home Care Packages were not in lockstep with what the architects of the program had envisaged.
By finally publishing detailed guidelines, the Government did the right thing, but it also lay itself open to the criticism that it had cut services, medications and equipment to package recipients.
From January 2023, providers started applying the rules, and a lot they used to supply to people they then refused to supply.
Department pretends nothing changed
The Government’s response continues to be that the guidelines they published last January are nothing new: “There has been no change in policy, however a number of providers have had to review the services that they are offering as they fall outside the aged care program,” a departmental spokesperson said.
But while there may technically not have been an actual change in policy, effectively there has been. If for six long years your provider allowed you to, say, pay your dentist’s bill from your Homecare Package funds and then in January 2023 told you ‘no’, effectively the policy has changed. A cut has been made, no matter what the departmental spokesperson says.
No wonder, people are angry.
The Government can’t even argue that people could and should have known all along, because there was simply nothing for people to go by. There was nothing where it said: this is what you can have and this is what you can’t have.
Even now, we only have a Home Care Packages Program Operational Manual, which is subtitled A guide for home care providers. There’s no plain English guide for people who are on a Home Care Package.
Department of Health and Aged Care, this is a cue for you to produce one! After all, you as a Department are big on ‘self-managed care’, so how about giving care recipients the tool to help them do so?
On the other hand, some of the things which are now explicitly listed as exclusions for Home Care Package funding are pretty obvious, such as mortgage repayments or TVs.
The Home Care Packages Program Operational Manual gives plenty of examples of inclusions falling under the headings of support services, care services and clinical services.
It does the same for exclusions. Things you pay for throughout your life regardless of age. Anything to do with ordinary accommodation costs. And, as mentioned, any services provided under other state, territory and Commonwealth programs, even if you also have to make a personal contribution or if those government programs are inadequate, even when they’re effectively unavailable, which they often are.