As argued in our previous post, the Aged Care Royal Commission came close to proposing an effective ban on self-managed care by stipulating that the legislation replacing the Aged Care Act 1992 “should include a general, positive and non-delegable statutory duty on any approved provider to ensure that the personal care or nursing care they provide is of high quality and safe so far as is reasonable …”
However, they didn’t shut the door on self-managed care completely. This post looks at self-managed care as it is delivered currently under a better model than the one where the duty of care is effectively delegated to the care recipient.
Self-managed care, pure but not quite
One step down from its purest form, self-managed care still has the care recipient doing the hiring and firing and procuring of any services required.
However, the involvement of the approved provider is extended to making available to the care recipient an online database (platform) of care workers and services controlled by the approved provider. The care recipient can advertise on this platform for staff, or they can contact care workers or services listed.
It very much resembles platforms such as described in the previous post, but the difference is that such platforms are not dependent on an approved ‘mailbox’ provider. This may (and certainly should) mean that the approved provider operating the platform takes care management seriously, because they cannot blame any of the things that go wrong on the care recipient and the worker(s) recruited through the online platform.
They have, not as a fly-by-night operator but as an approved provider, vetted and listed care staff for hire on their platform and not only do they vouch for the suitability of staff, they are also responsible for them as they perform their duties.
Currently for example, an online platform owned and operated by approved provider the Care Side advertises that it charges a 12 per cent care management fee and a 3 per cent administration fee, 15 per cent all up. This is far below the industry average of about 30 per cent per cent and the regulated maximum of 35 per cent.
As mentioned, a further recommendation (31) of the Aged Care Royal Commission is that “a person’s approved provider must assign a care manager to the person unless an assessment team has assessed the person as eligible … without the need for any care management”.
The opportunity for self-managed care in its second-purest form also becomes very small that way. In practical and effective terms, it will be limited to meal services, domestic assistance, social support and community transport. This type of self-managed care is likely to be confined to entry-level care, at a point where care recipients are capable of managing their package. Moving beyond this to personal care and certainly clinical care, the Aged Care Royal Commission clearly envisaged that care management involve a care manager other than the care recipient.
Clearly, the Aged Care Royal Commission did not feel the distinction between ‘pure’ and ‘not so pure’ self-managed care should result in the aged care regulatory system treating one differently from the other.
The October 2022 discussion paper and its focus on how to best implement the desired clinical oversight and practical assistance through care partners for older Australians receiving care at home should be viewed in that light. Also, how to ensure the flexibility to respond to the changing needs of older Australians should be viewed, in part, and how the home care system should be responding to people who start out self-managing their entry-level care but won’t accept that their needs have developed beyond entry-level care.
The next post will deal with care badged as self-managed but which in fact is non-self-managed.