When things change there is always confusion. Actually before you get to confusion there is usually a big dose of denial where people often cling to the hope that change won’t happen and they’ll be able to keep doing what they’ve always done. But as we all know…things do change. Once you ditch the denial you move into confusion. Confusion is about uncertainty and being unsure, but it is also where you find ways forward.
A recent ABC News on-line article (www.abc.net.au/news/2015-08-08/sweeping-changes-to-in-home-care-brings-confusion-surprise-fees/6681914?WT.mc_id=newsmail Norman Hermant, Sat 8 Aug 2015 ) reports that the ‘sweeping changes’ from the introduction of Consumer Directed Care has delivered confusion.
In confusion, the best thing leaders and managers can do, is present the facts and point to possible ways forward. Here are five facts that might help you navigate any CDC confusion.
Fact 1: CDC has been coming for quite a while.
CDC brings about change in the way consumers are treated which is mandated through the User Rights Principles 2015. The roll out has been slowly introduced over the past 3 years when all new Home Care Packages (HCPs) were allocated on the provision they be delivered under a CDC approach. Providers were also encouraged to transition existing HCPs to CDC in readiness for the July 1, 2015 deadline.
The evolution of CDC though, goes back even further to the 1990’s, where social gerontologists advocated for individuals to be actively involved in managing their own health. CDC has been around for quite a while (over 25 years) and the steps towards its introduction as the new consumer approach has not only been promoted but mandated.
Fact 2: CDC is an approach, not a program
If you say the words out loud – Consumer and Directed and Care – you get a strong sense of the approach. It’s about the consumer directing the care they need and want so they can, as much as is possible, continue to live an independent life in their own home, in their own community.
What underlies the approach are attitudes towards the degree of control and choice you think consumers should have. If your attitudes include working with consumers; understanding consumers; taking time with consumers; being mindful of boundaries, roles, responsibilities and responding to what consumers want, then the CDC approach will come naturally…to whatever program you’re running.
Fact No 3: CDC did not change the way Home Care Packages are funded
The changes that have recently occurred in Home Care Package funding, fees and potential consumer contributions are the result of the Productivity Commission and National Aged Care Reform Agenda not CDC.
This agenda began with the Federal Labor Government in 2013 and has been continued by the present Federal Liberal/National Party Government. The reforms enjoy bi-partisan support and therefore acknowledge the need to do things differently. They are here to stay!
The fees are also the result of each aged care provider’s response to the reforms and also their individual businesses; what they are able to offer consumers.
The funding and fees changes came into effect in 2014. There are two aspects to these changes, one of which is simply about putting limits on what already existed.
The Basic Daily Care Fee
17.5% of the aged care pension has now been set as the maximum amount aged care providers can charge as a fee for home care services. Consumers have always been charged a fee for home care services. Now however, there is a legislated upper limit.
Also new, is that providers are required to negotiate how much (if anything) their consumers will pay for what is now called the Basic Daily Care Fee (as opposed to the fee for home care services consumers have always paid).
If providers say ‘no daily care fee’ then their consumers will not pay anything from their pension. If they set their limit at say 10% then that will be the charge. It’s part of the ‘offer’ (and explanation) providers now need to make to their consumers to on the one hand develop consumer loyalty and on the other, ensure business viability.
Although it is not mandatory to charge the full 17.5% or to charge anything at all, it can under many circumstances, be sensible, prudent and wise..and here’s why. The Basic Daily Care Fee goes into the consumer’s budget. It’s there for services the consumer needs. So it becomes a mechanism for ensuring there are enough funds to provide consumers with the opportunity to pay for and therefore achieve the consumer’s goals.
There’s a bit of history here too. Remember the ‘denial’ that follows the announcement of change and is the warm up to full confusion. In the past, cross-subsidisation was the norm and fees were minimal. Providers are now required to have very difficult conversations with consumers about the financial aspects of their package, and very little has been done to help prepare consumers for the change waiting in the wings. So when the changes did inevitably arrive, there were big shocks for some.
Means Testing
We’ve lived with means testing in our country for a long time. It’s part of our national psyche to strive to be fair and equitable. Under this banner, consumers are now required to be means tested to determine if they are able to contribute more to their care. If they can, then the government says they have to and reduces their funding accordingly. There is of course a safety net. If consumers claim hardship and are successful then the means tested fees can be reduced or waived. And there is an annual and lifetime cap to means tested care fees.
There is also something quite fundamental to understand here….both the Basic Daily Care Fee and the means tested fees are added to the government funding that forms the consumer’s individual budget. The monies are for the consumers …not the providers.
So where does the confusion over charges, contributions and consumer directed care come from? Easy. They were basically introduced at the same time so of course there will be confusion. They are not, however, the same thing.
Fact No 4: CDC involves transparency
Part of the requirements of CDC is financial transparency. After all, how can you successfully manage the services you need if you don’t know how much money you have. Financial transparency requires the provider to clearly state what the consumer’s individual budget includes in government funding, basic daily care fees and means tested fees; the costs of services and how much is left in the budget at any given time….all the information you need to make informed decisions.
Providers also need to make sure that the consumer actually understands the budget information presented to them. Budget details must be clearly documented in the HCP Agreement that the consumer signs and in a monthly statement outlining all income and expenditure with balances remaining.
In the past, consumers were not informed about how the funds were spent but with the CDC approach, it’s a case of mandatory transparency.
Fact No 5: If you don’t get involved you’ll continue to be confused.
If you don’t get involved with what is happening with changes in aged care you run the risk of being relegated to confusion or worse still, irrelevancy.
CDC has been coming for a while; it’s evolution for an even longer time.
CDC is an approach not a program; it’s about attitude to the consumer, their choice and their control.
CDC did not change the way Home Care Packages are funded; the Aged Care Reform Agenda dictated the changes to fees and contributions.
CDC is about financial transparency: consumers should know and understand how much they’re paying, what they’re getting and what remaining monies they have.
Change can make you confused; but stick with it because within confusion lies the pathways to understanding and therefore the potential for improved outcomes for everyone.
August 2015
Sandra Bygrave and Lynda Jones
Who have both learnt to love confusion!