What is a Government Home Care Package?

The Australian Government wants to support older Australians to stay in their home by paying for in home care services. Anyone can apply for these funds. This is great news for ageing Australians! It is widely recognised that people are happier, healthier and more likely to thrive in their own environment.

The Home Care Package Programme allows eligible Australians to access funds to assist them to remain living in their home whilst maintaining their health, wellbeing and social connections. Home Care Packages can make a difference in improving the quality of life of people needing support to live at home.

What Services can be Purchased using a Home Care Package?

Care and Services supported by the HCP Programme may include:

• Care services: Personal care services, activities of daily living, nutrition, hydration, meal preparation and diet, management of skin integrity, continence, mobility and dexterity
• Support services: Cleaning, personal laundry services, gardening, home modifications, leisure interests and activities
• Clinical services: Nursing, allied health (podiatry, physiotherapy services; and other clinical services such as hearing and vision services) and access to other health and related services

What are the Different Home Care Package Levels?

The Home Care Package Programme provides 4 levels of support and each individual is assessed to determine what level of support they require. Each package level has a different amount of funding (subsidy) that is paid to your provider by the Australian Government to deliver your care and services. The higher the level, the more funding the government pays on your behalf, allowing you to buy more services.

A Level 1 package has the lowest subsidy and a Level 4 package allows you to buy the most services. A client who starts with a lower Home Care Package can be reassessed and upgraded to a higher package level if their care needs change.

The Four Package Levels:

• Level 1 supports people with basic care needs. People on a level 1 package mainly use this for things they are struggling to do themselves, such as domestic assistance.
• Level 2 supports people with low-level care needs. Level 2 package recipients may use this level of support for domestic assistance, shopping and social support, possibly home podiatry or some gardening assistance.
• Level 3 supports people with intermediate care needs. Recipients will have support in personal care, some meal preparation and medication support. Other funds may be spent on social support, transport, nursing, allied health, gardening and minor home modifications like ramps and rails.
• Level 4 supports people with high-level care needs. Recipients will have support in personal care from five to seven times per week, once to twice daily. Other funds may be spent on social support, transport, nursing, allied health, gardening and minor home modifications.

Who is Eligible to Apply for a Home Care Package?

Anyone who feels that they need assistance to remain living in their home can apply for a Home Care Package. Home Care Packages are meant for older people aged 65 years and above, but there is no minimum age requirement. There are no citizenship or residency restrictions on Home Care Packages. However, Home Care Packages are not meant for visitors to Australia or people who need only temporary or short-term care.

If you would like to apply for a Home Care Package you will first need to contact My Aged Care by calling 1800 200 422 or visit www.myagedcare.gov.au. A My Aged Care consultant will then assist you through the assessment process. In many cases a health professional already involved in your care will refer you for an assessment. This might be your GP or nurse. If you are in hospital, it might be a social worker. This process is aimed at determining your eligibility and the package level you are approved for.

How Does the Assessment Work?

In the first instance anyone interested in applying for a Home Care Package needs to contact My Aged Care. The contact centre staff will register you on their system and ask you a series of questions in order to understand your needs. They will ask you questions about any support you are currently receiving, if you have any health concerns, how you manage with everyday living tasks and activities around the home and some questions relating to your safety in your home. This assessment is also needed to receive aged care services through a Home Care Package.

If your care needs indicate you may benefit from a Home Care Package, My Aged Care will refer you to an Aged Care Assessment Team (ACAT) to complete an in home assessment. This assessment will identify your care needs. These assessments are free. It is important to know that your preferences will always be considered, and you do not need to make any decisions about your future during your assessment. You are welcome to have someone else—perhaps a friend, family member or your carer—attend your assessment for extra support. All information provided will be treated confidentially.

What Happens After the Assessment?

Following an in home assessment from a member of the ACAT team you may be approved as eligible for either a level 1, 2, 3 or 4 Home Care Package. You will receive a letter to let you know the outcome of your assessment, the level of care you are eligible for and approved to receive, as well as an overview of that care.

Keep a copy of these documents to show that you are eligible to receive Australian Government-subsidised aged care services. It will include your AC number and “Referral Code”. If you don’t receive a letter explaining your assessment outcome, contact the ACAT and request a copy.

Your approval does not expire unless there is a specific time limitation placed on the approval. Unless your care needs have changed significantly, you will not need another assessment to be eligible for a Home Care Package. If your care needs change significantly while you are waiting for a Home Care Package, you can request a new ACAT assessment by contacting My Aged Care.

Waiting List and Package Approval

After you have been assessed as eligible for a Home Care Package, you will be placed on a national waiting list. Your position on the wait list is determined by the date of your assessment and the priority of your request which is determined by your ACAT assessor. When you get to the top of the waiting list you will receive another letter from My Aged Care advising that your status is approved. It is now that you need to locate an Approved Provider to manage your Home Care Package and start receiving services.

Home Care Package Costs

The devil is in the ‘detail' or so the saying goes. And this could certainly be the case for consumers who are not aware of some providers’ Home Care Package costs. The less you pay in fees more of your Home Care Package funds are spent on actual services and care hours.
From 1 January 2023;
• care management prices will be capped at 20% of the package level
• package management prices will be capped at 15% of the package level
• providers cannot charge for package management in a calendar month where no services (other than care management) are delivered, except for the first month of care
• providers cannot charge separately for third-party services
• providers cannot charge exit amounts.

There are 4 different types of fees (or costs) to consider when choosing an Approved Provider to manage your Home Care Package.

1. The Basic Daily Fee

If you take up a Home Care Package you can be asked to pay the basic daily fee irrespective of your income. If you are unable to pay all or part of the basic daily fee, you can discuss reducing this fee with your Provider. Some Providers require you to pay the full 17.5% of the pension and there are others who decide not to charge this fee at all.

The maximum basic daily fee is 17.5% of the single person rate of the basic Age Pension. Each year the basic daily fee rate increases on 20 March, and again on 20 September, in line with changes to the Age Pension. This applies to each person receiving a Home Care Package, even if you are a couple.

2. The Income Tested Fee

Depending on your income, you may be asked to contribute more to the cost of your care. This is known as the ‘income-tested fee’ and is in addition to the basic daily fee. The Department of Human Services works out the maximum fees payable based on an assessment of your financial information and notifies you and your Home Care Package Provider.

When calculating the fees, assessable income includes payments received from Centrelink or Veterans’ Affairs as well as assessable income from assets and investments using Centrelink income test rules. For example, cash, term deposits and shares will be assessed under deeming rules.

If you are able to structure your investments in a way that reduces assessable income this may reduce the fees you will be asked to pay. But it is always important to review your full situation to ensure that sufficient cash flow can be generated and to determine the impact on your net wealth.

There are daily, annual and lifetime limits on the amount of income-tested care fee that you can be asked to pay. This fee is determined by the government making an assessment of your income and Providers do not have any influence over the amount being set. Your home is not included in the assessment of your income for Home Care Package purposes.

Full pensioners cannot be asked to pay an income-tested care fee and you will not be asked to pay an income-tested care fee if you have a yearly income below the maximum income amount a person can have to be classified as a full pensioner. If you are a part of a couple, fees payable will be determined by halving your combined income, regardless of who earned the income.

My Aged Care can provide you with an estimate of your likely Income Tested Fee. Call the My Aged Care contact centre (1800 200 422) or go to www.myagedcare.gov.au and use the Home Care Fee Estimator.

3. The Provider Fees

Another cost to your Home Care Package is the fee that is charged by the Approved Provider that manages your package on your behalf. They are often stated by the Provider as an Administration Fee and a Case Management Fee. They are usually expressed as a percentage amount that is taken from the total subsidy amount of your package (including the Daily Contribution Fee and the Income Tested Fee).

The Administration Fee typically pays for operating costs, such as buildings, telephones, staff and administration. These are costs that are not provided to Approved Providers from any other source; they are therefore taken from the Home Care Package.

The Case Management Fee pays for the set-up of your package, including the development of your care plan, home visits and phone consultations with your case manager and the co-ordination of your care and services.

These costs can vary between different Providers and should be clearly stated by the Providers that you are comparing. Providers are expected to keep these costs to a minimum so that most of the subsidy is spent on you and your home care needs. It is well worth comparing these fees when choosing the best Approved Provider to manage your package.

4. The Exit Fee

Since 27th February 2017, Home Care Packages are allocated to you not your Home Care Provider. This means that if you wish to change Providers, you can. Some people want to change Providers through a move to a new location. You can ask your current Provider to assist you with the transition to a new Provider should you move to a location that your existing Provider does not support. You will not need to be reassessed by an ACAT unless your care needs have changed significantly. But you will need to enter into a new Home Care Agreement and develop a new care plan with your new Provider.

Another reason to change Providers is because you are unsatisfied with the service you are receiving from your current Provider. A Provider is allowed to charge you an Exit Fee to help cover their administration costs in the event that you leave the Provider due to switching or you do not require the package anymore. Some Providers charge this fee and some opt not to. This should be clarified at the outset when entering into a contract with a new Home Care Provider. It is now obligatory for providers to publish their maximum exit fees on the My Aged Care website. These are coming in at around $500 – $700. Providers must also publish the average percentage of Home Care Package funds that are available for services after their fees have been deducted.

If you are moving providers the unspent funds will be transferred to your new provider less any Exit fee which your current Provider charges. The amount of Exit fees (if any) will be included in your Home Care Package Agreement. If you are permanently leaving Home Care Packages the unspent funds less any Exit fee will be refunded in proportion to the funds contributed by the Government and yourself.

Selecting an Approved Provider to Manage Your Package

To begin receiving care and services from your Home Care Package you must engage an Approved Service Provider to help manage your package. Once you have chosen an Approved Provider to manage your package you will enter into a Home Care Agreement with this provider. The Home Care Agreement is an agreement between you and the Approved Provider that sets out how your package will be provided to you. All Home Care Packages are required by law to have an Agreement between the Provider and the consumer. You should not be rushed into signing an agreement before having the opportunity to read it through and seek Financial and Legal advice (if you wish). If you are unable to sign a Home Care Agreement because of any physical incapacity or mental impairment, another person representing you may enter the Agreement on your behalf.

Developing Your Care Plan

The information contained in you ACAT assessment will guide the discussion about your goals, preferences and care needs. When talking about your needs with your Provider, you need to think about what is most important to you. You might consider:

• What sorts of things might help to improve your day to day life?
• What do you enjoy doing most?
• What support do you need to stay safe?
• What makes your life enjoyable and meaningful?
• Where and when do you want that support?
• How much could you be asked to contribute to your care costs?

Identifying your personal goals will help guide your choice of care and services to best support your needs. A goal might be maintaining a healthy lifestyle, or achieving independence in mobility. The goals will be also shaped by your own circumstances, including your health and wellbeing, cultural and personal values, and the amount of support available from family, friends and carers.

Your Provider will need to take into account any supports you already have in place, such as carers, family members, local community and other services. The responsibilities of the home care provider/care worker and you/your carer should be included in your Home Care Agreement and care plan.

Once you have entered a Home Care Agreement with your chosen Provider, this Provider will then work in partnership with you to develop a Care Plan and purchase services that will assist you to remain at home using your individualised budget that is based on your package level and contributions.

A copy of your care plan must be given to you before, or within 14 days of, your care and services starting. It is important to remember that your care needs can change over time and that your care plan can be amended to meet those changing needs. Your Provider cannot change your care plan without your agreement.

Your care plan should include:

1. Your goals – what it is you would like to achieve through your package
2. Your identified care needs
3. The level of involvement and control you will have in managing and coordinating your home care package
4. The exact care and services to be provided to support your assessed care needs and any identified goals
5. Who will provide those services
6. When the services are to be delivered, including the frequency of services and days/times when regular services are expected to be provided
7. Case management arrangements, including how ongoing monitoring and informal reviews will be managed
8. The frequency of formal reassessments
9. An individualised budget
10. Security of tenure
11. Leave provisions

Individualised Budget

Your individualised budget will be developed when you design your care plan with your Provider and should be amended whenever your care plan or costs change. An individualised budget provides you with greater transparency so you are able to see what funds are available in your package, and how those funds are being spent. All care and services provided to you through a Home Care Package must be able to be paid for within your package budget.

If you want additional services you can speak to your Home Care Provider and arrange to pay for these separately. Your package budget income is made up of: the subsidy amount, the basic daily fee (if payable), the income tested fee (if payable) plus any additional supplements e.g. Oxygen Supplement. Additional supplements are discussed later in this guide under ‘Additional Needs’.

Additional Needs

Home Care Providers may be able to access further funding (supplements) to ensure you receive the care you need. These include:

• Dementia and Cognition Supplement
• Veterans’ Supplement for veterans with service-related mental health conditions accepted by the Department of Veterans’ Affairs
• Oxygen Supplement for people with an ongoing medical need for oxygen
• Enteral Feeding Supplement for people who need enteral feeding on an ongoing basis
• Viability Supplement for people living in rural and remote areas

If you are eligible, your Home Care Provider will receive this extra funding to make sure you receive the care you need. You do not need to apply for these supplements. Your Provider will apply on your behalf, and in most cases, the supplement will be paid automatically to your Home Care Provider. These supplements will be recorded in your monthly statement.

Monthly Statement

All Home Care Package recipients are required by law to receive regular monthly statements that show how your budget is being spent. The statement will show you the income and expenditure under the package, as well as any unspent funds. Any unspent package funds must carry over from month to month, and from year to year, for as long as you continue to receive care under the package.

Commence Your Services

Once you have a Home Care Agreement, a care plan and an individualised budget, your care and services can begin. Your package starts on the day your Home Care Agreement is signed, not from the day you receive care and services. You can continue using your Home Care Package for as long as you need it. This is called ‘security of tenure’ and this should be included in the Home Care Agreement. This means your package cannot be allocated to another person unless you notify your Provider in writing that you no longer wish to receive services in your Home Care Package. There are some situations in which you may need to consider leaving your package. This includes moving to another location where your existing Provider does not service or if your care needs increase beyond what the package funds can provide. You are free to leave your package at any time.

Change in Care Needs

If your care needs change and you need different care and services, you can arrange with your Provider to review your care plan and budget. Your care plan and your individualised budget cannot be changed without your agreement. If you were assessed as having low-level care needs, but your needs have increased since then, you can request a reassessment by your local ACAT/ACAS to determine if you are eligible for high-level care. Consumers will need to be reassessed if they wish to move to a higher level package.

The information provided on and made available through this website does not constitute financial product advice. The information is of a general nature only and does not take into account your individual objectives, financial situation or needs. It should not be used, relied upon, or treated as a substitute for specific professional advice. I recommend that you obtain your own independent professional advice before making any decision in relation to your particular requirements or circumstances.