What you should know before opting to self-manage your home care

You, or perhaps your lovely partner or parent, are active and in touch with the world but maybe you have a health issue that means you could do with a bit of regular assistance at home or just need some help while recuperating. If you’re comfortable with technology and used to managing your own activities – from home maintenance to healthcare appointments – you might be considering self-managed home care as a solution.

After all, the government’s system of subsidised home care, through Home Care Packages (HCPs), is all about the consumer driving the allocation of those subsidies, so why not take total control of your HCP by self-managing it rather than choosing an approved home care provider to manage your funding and services?

In the simplest terms, self-managed home care allows a HCP recipient (i.e. you or your loved one) to manage all of the practical tasks of administering the subsidy package. You do still have to find a government-approved home care provider or platform to ‘host’ your HCP funding, because the government doesn’t permit it to be paid straight to your bank account, but many providers will allow you to then entirely determine how that funding is allocated to services and will leave you to organise those services.

(Some providers allow you to mix some self-management with some provider-management, so it’s important to speak to multiple providers to find your best fit and ensure you understand the terms of your personal arrangement.)

The upsides of self-managed home care

Top of the list of self-managed home care advantages is that you won’t have to pay administrative or case management fees to a home care provider for its management of your HCP, which means you have more funds to spend on actual care. These fees can account for as much as 35 per cent of your HCP funding, so the fees a provider charges for provider-managed home care is an important consideration.

Another benefit of self-management is the level of control you have over your own care – you decide exactly who cares for you, how much you pay for that care and how you receive it. You can negotiate fees with care providers and set a care timetable that suits your lifestyle.

Despite this, Jasmine Pyyvaara, the senior program manager for aged care and disability at Prestige Inhome Care, says she’s seen more older Australians than ever switching from self-managed home care to provider-managed home care.

“I absolutely advocate for individuals managing their own home care packages but it feels like, from my personal view, that everything was magnified during Covid-19, including what care people had in place and what was or wasn’t working for them, and the challenges in arranging care,” Pyyvaara says.

“We heard people saying ‘self-management is getting too much for me, I can’t keep doing it on my own’, and that’s why they came to Prestige Inhome Care  – because we can offer the best of both worlds.”

What it really takes to self-manage your own care

The cost reductions and personal control offered by self-managed home care are countered by some serious considerations that shouldn’t deter you if you’re confident you can cope with them, but don’t suit all home care users. These considerations include:

It helps to be tech-savvy if you want to self-manage care. Most self-management host platforms require you to set up and manage your care through an online account, and many care workers will expect you to communicate with them online, either via the platform or one-to-one.

“Scheduling your own care can be quite difficult if you’re using multiple platforms and agencies,” Pyyvaara says. “It might suit someone who’s very confident with online systems and scheduling tools or people with family who can help them do that – but that’s not the case for everyone.”

You must stick to strict requirements on how you self-manage care. How HCPs are administered is subject to legislation, so you must ensure that you complete the required paperwork, which can range from documenting your own care needs and updating your care plan if your circumstances change to checking care workers’ timesheets and approving their invoices.

You must also be careful to spend your HCP funding only on services and purchases that are permitted by the legislation and are in line with your care plan.

If you choose to use more than one host platform to access the full range of services you need, this can mean your administrative requirements become more complex, especially if you have a Level 3 or 4 HCP that gives you access to a wider range of allied health professionals, each operating on different terms.

“Different platforms and care providers will each use their own system, which means the admin work differs slightly with each,” Pyyvaara explains. “And with so many options within the guidelines for how you get your clinical needs met, particularly at Levels 3 and 4, it can be really confusing to know that you’re spending your funds on approved services.”

You should be comfortable with numbers if self-managing care. Pyyvaara notes that self-managing care requires you to “monitor your expenses and track your HCP budget, including how much funding you have each day, how much you’ve spent and how much is left”.

“You also have to advise your host platform or provider of any changes in your circumstance that could affect your home care package funding or the nature of your care management requirements and let them know if you can’t complete the expected self-management tasks,” she adds.

If this sounds like more work than you want to take on, she suggests considering whether a home care provider such as Prestige Inhome Care, which gives its clients control over their own care, while making sure clients’ paperwork and legal requirements are covered, might be a viable alternative to self-managed care.

“Our clients are still in total control of how their funds are spent and how they’re delivered, we just take the admin away so they can concentrate on their health and wellbeing and, really, living how they want to live,” Pyyvaara says.

Being self-aware is key when self-managing care. Assessing your own needs, managing your services in line with your own care plan and updating that plan if your needs change requires keen self-awareness. Prestige Inhome Care knows how hard it can be to make objective judgements about your own abilities, which is why Pyyvaara says the company’s free, biannual home care review is so important.

“We understand that people’s health or mobility may change, which is why we prioritise open communication with our clients, so we can support them through any changes, as well as doing a thorough, in-home check every six months to ensure everything is going as it should and they’re getting the assistance they need,” she says. “But clients can request additional reviews at any time, to ensure their services always match their requirements.”

Prestige Inhome Care can also combine the services you fund with your HCP with self-funded services, such as 24-hour care, to make sure you’re well cared for no matter what your circumstances and how they might change.

You must vet your own carers when self-managing care. When deciding who comes into your home, of course it pays to be careful. Some self-managed HCP host platforms will do some care worker checks on your behalf, while others will expect you to do those checks, which can be onerous if you want to carefully vet your carers.

Prestige Inhome Care, for example, conducts reference checks, police checks and background checks on all of its care staff, as well as requiring them to have at least a Certificate 3 in Home and Community care (which isn’t a requirement all home care providers have). Prestige also employs registered and enrolled nurses to ensure clients with higher healthcare needs have access to the expert care required.

“We have a very refined matching process that puts clients and carers who’ll be comfortable with each other together,” Pyyvaara says. “We know all our carers well and we know our clients well and take the time and care to make sure they’re well-matched.”

Each Prestige Inhome Care client is matched with a case manager who assesses their needs and develops a tailored care plan in collaboration with the client, then manages their services according to the plan, adjusting it whenever required – all while ensuring that the administration required by legislation is done and that the client’s HCP funding is being used most effectively. Prestige Inhome Care’s case managers can also help clients seek additional subsidies, if their needs change and more services are needed.

Self-managed care requires having an emergency plan. While provider-managed care means your care provider will be able to provide alternative care if your usual care worker is unavailable, and arrange services at short notice if your needs suddenly change, self-managed care requires a back-up plan in case unexpected changes occur. You may need to ask a family member or friend if they’re happy to step in to manage your services if you’re not able to, or have care alternatives organised in case the services you arranged are unavailable.

Are you really saving on fees with self-managed care?

In addition to thinking about whether you feel up to self-managing your HCP, it’s important to know exactly what funding benefit you’ll gain from doing so.

Fees range across the home care sector, with some provider companies charging daily care fees, case management fees and exit fees. As mentioned above, in extreme cases these charges can eat up as much as 35 per cent of your HCP funding.

But that’s not always the case. Prestige Inhome Care, for example, doesn’t charge daily care fees.

Prestige Inhome Care doesn’t charge a minimum case management fee either; you pay only for the case management assistance you need. Care plan reviews, held every six months, are free and Prestige Inhome Care doesn’t charge exit fees.

“We believe you should spend your home care package on services, not fees,” Pyyvaara says. “We see the opportunity to help support our clients’ physical and emotional wellbeing as a privilege. Seeing someone maintaining their independence in the way they want is one of the most rewarding things about the job we do.”

“It’s a full-time job staying alive!”

When the time came that Wendy Carmichael needed help at home, she looked into self-managing her care.

Diagnosed with multiple myeloma at just 59, Wendy went on to develop a crippling range of related conditions in her 60s, including full renal failure that requires dialysis three times a week, chronic exhaustion, severe arthritis, fractures of the spine and heart issues.

So, while Wendy is a computer whiz who does her shopping and banking online – as well as conducting a lively online social life – housework, gardening and driving are out of the question.

“It’s dreadful the number of changes multiple myeloma has made to my health over the years,” the now-71-year-old, says. “It’s really wrecked me physically; my head works but it’s dragging my body behind it!”

Wendy is divorced and her adult children both live too far from her home in Mentone, Victoria, to help her regularly – and nor does Wendy want them to.

“My daughter’s in Brisbane so we talk on Facebook and the phone. My son’s one-and-a-half hours from me; he rings me twice a day and would be here if I ever asked, but he’s got his own life to lead, not being tied down to looking after his old mum,” she explains.

Having been approved for a HCP at a Level 3, Wendy considered self-managing her funding package.

“I was worried about not having enough say on the services,” she says. “When you’ve been living by yourself for a long time, you become very independent and get used to doing things the way you want them done!

“But it’s a full-time job staying alive for me. I have enough on my plate just with my medical appointments, so I decided I didn’t want to manage even more paperwork and appointments.”

Instead, Wendy chose Prestige Inhome Care to manage her HCP, in part because of Prestige Inhome Care’s reasonable fees, but she has found other advantages to working with the company, including the fact she’s very much in control of her own care.

“I don’t feel like I’m being dominated by my case manager or my carers; I have input and they listen to me!” Wendy explains. “I was recently upgraded to a level four home care package and my case manager came around to my house to discuss what would be the most useful ways for me to use the money. If I need something or there’s a change in my schedule, I ring her and she gets it for me or re-organises any people I’ve got coming to my house.

“I get a very straightforward statement once a month where I can see my funding coming in, what it has been spent on and the balance left over – and I don’t want for anything.”