n 2018, Russell Kennedy published an article about the challenges for aged care providers when offering self-management models to home care clients. Since then self-management models have continued to become increasingly common and the new standardised Pricing Schedule has an option for self-management.
Consumer groups have welcomed the shift towards self-management. In 2019, COTA Australia, in conjunction with RMIT University, completed their ‘Increasing Self-management in Home Care’ project. This project, which looked at the experiences of 7 home care providers has resulted in COTA developing a suite of resources to inform providers and consumers what “self-management” means and how it can operate in practice.
What does self-management mean? Does it mean there is no care management component?
While there are a number of core attributes to the self-management model, there is no “one size fits all” model. Models differ based on the degree of consumer (or representative) control and the particular role of the provider and the consumer. Providers may offer consumers the opportunity to manage parts of their package (as a co-managed style) or a fully self-managed model where the case management by a provider is very limited.
There are also differences in terms of the way the package is managed at the consumer’s end. In some cases, it is the consumer who manages their package, in others it is a family member or friend. This will differ on a case by case basis.
What are providers responsible for?
Regardless of the model, it is important for providers to understand that from the regulatory perspective, their responsibilities under the Aged Care Act are the same. The approved provider is fundamentally responsible for the quality of care delivered to the consumer, even in cases where the consumer is directing who provides the care and how that care is provided. For example:
- Standard 3 requires that consumers get “safe and effective personal and clinical care that is best practice, tailored to their needs, and which optimises their health and well-being”. This Standard applies regardless of whether that care is being provided by the provider, their contractor or by an organisation selected by the consumer.
- Likewise, providers are responsible for ensuring those providing care to their consumers are suitably qualified and skilled. The Guidance expressly states “the organisation that receives funding from the Australian Government is expected to make sure its workforce (including contractors) meets the relevant Quality Standards.”
What does this mean for providers?
This means it is not possible for an aged care provider to “outsource” their responsibilities for the quality of care to the consumer just because that consumer is self-managing their package. The provider must maintain oversight of the workforce used by the consumer and take steps to ensure the care they deliver is adequate. Meeting these responsibilities require the aged care provider to provide some care (case) management.
Providers also need to implement systems to ensure that they are aware of any issues that arise in relation to service quality. For example, providers should require both the consumer and the service provider to report any issues, incidents or complaints to the provider, otherwise the provider may find themselves answering to the Quality and Safety Commission in an audit or complaint for issues they weren’t aware of.
Minimum requirements for providers introducing self-management options
Providers considering offering self-management need to ensure their model is consistent with the obligations and responsibilities of approved providers under the Aged Care Act and the Quality Standards. At minimum, providers must:
- Ensure that the model of self-management they are utilising is tailored to, and appropriate for, the needs and capabilities of the individual consumers.
- When dealing with representatives in situations where the consumer does not have capacity, ensure they are the appropriate person (eg a power of attorney); don’t assume a next-of-kin has the authority to make decisions.
- Ensure that their client agreements clearly outline the roles and responsibilities of the consumer and their representatives, the provider and any service providers so that it is clear who is responsible for what. The agreement should also have provisions to prevent the consumer from over-spending.
- Be clear and transparent around what happens if the consumer becomes incapable of managing their package.
- Have adequate service agreements in place with those delivering services to clients. As set out in the Commission’s Guidelines “contracts requiring compliance with the Standards and effective contractor management are essential”.
- Ensure the fees they charge consumers for self-managing, cover the costs and risks to the provider in this model.
Finally, providers should be aware that if the services provided to consumers (including those who self-manage) are not adequate, it is the approved provider who will be answering to the Quality and Safety Commission.