With increasing competition in the home care market and the emphasis on consumer directed care, some providers are struggling with the question of whether or not they should accept some of the more “out of the box” consumer expenditure requests under the Home Care Packages Program (HCPP).
Some consumers have requested their funds be used to pay for pet grooming, interior furnishings, tennis lessons and landscaping works. Others have used their funds to purchase iPads which have promptly been given to family members.
The Aged Care Act largely leaves the decision of how to use the consumer’s package funds to be negotiated between the provider and the consumer. The specified care and services in the Quality of Care Principles (Principles) provide a list of items which a provider is permitted to use the consumer’s package for. It also provides a list of banned or “excluded" items which includes things like travel expenses, rent, capital works and other items.
But what about those items that are not listed in the Principles as clearly included or excluded? How are providers to determine whether including such items will not be a breach of the Act?
It is generally understood that, provided the expenditure is supported by the client’s care plan, it is permitted. However, it is not quite as simple as mentioning an item in a consumer’s care plan.
The User Rights Principles make it clear that expenditure is only permitted if the item is “required to support the consumer to live at home”. This places an additional threshold on what is permitted by the Act and is consistent with the fact that package funds are not permitted to be used as a “source of general income”.
Providers keen to offer their consumers choice in the design and delivery of services need to ensure that these are offered for genuine purposes and can be reasonably linked to the consumer’s needs and goals. Requests that are not consistent with or seek additional personal benefit above the program’s objectives are likely to be considered outside the scope of the legislation.
Providers are ultimately accountable for determining whether such items are appropriate. Providers should therefore be in a position to discuss the aims of the HCPP with the consumer to help them make reasonable decisions about the services they access. This may not be easy in an environment of increased competition. We have already seen some shrewd consumers threatening to change providers when their requests are refused.
Despite this, providers should carefully consider requests from consumers of this nature and remember that ultimately, the test is whether the item or service is “required to support the consumer to live at home”. With all the focus on consumer choice, it is important to remember that one of the key words in the phrase consumer directed care, is still care. Approved providers are responsible for delivering aged care services, they are not a concierge service responsive only to the requests of their customers.
Providers who allow consumers to spend their money other than in accordance with the HCPP objectives and the Act may be found to have breached the Act. From a broader perspective, there is a risk the industry will face a crackdown if the public perceives that providers are complicit in consumers using their taxpayer funded packages for services which are clearly outside the ambit of the HCPP and the legislation. Providers may also be criticised if they are unable to provide the clinical services their consumers need because the funds have been spent on non-essential, lifestyle services.