3. What can a Government Subsidised Home Care Package pay for?

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What can a Home Care Package pay for? Seeing as Home Care Packages are Consumer Directed you might think it can pay for anything you need or want; however that is NOT the case. Home Care Packages are funded by Tax Payers’ money, so they are “Consumer Directed within the Government’s Home Care Package Guidelines”. It is NOT as simple as, “if the item is on the list below, your Home Care Package can pay for it”. You need to get prior approval from your Care Manager and they will apply these tests:

  1. Does the service / item meet the Home Care Package Program Rule Guidelines? We read Dept of Health information so we have a deeper understanding than simply the list below.
  2. Does the service / item meet an ASSESSED CARE NEED RELATED TO FUNCTIONAL DECLINE, CAUSED BY AGEING & GOAL which are documented in your Care Plan?
  3. Is there sufficient Unspent Funds in your HCP available to pay for the service / item?
  4. When there are insufficient funds to meet all goals / needs / wishes, clinical care trumps all other wishes. When care needs increase your Home Care Package may need to cease paying for services that are non-care services so there is more budget to pay for clinical care and care services.
  5. The cost must represent value because tax payers are paying.
  6. Clinical CARE is always the top priority of your Home Care Package, then CARE, and then non-care services like lawn mowing, cleaning-only services etc.
  7. Is the service being provided by a family member or friend? Your family cannot be paid by taxpayers to pay for your care. Family provides free care because they are family and they love you.

Please: Do not organise any third party services unless your Care Manager has approved these services in advance. If you are unsure talk to your Care Manager.

This following list applies to all 4 levels of Home Care Packages.

 

Specified Inclusions 

The following table provided by the Department specifies the care services that an Approved Provider of a Home Care Package service may provide.

The following services or items are inside the scope of the Home Care Package Programme and may be paid for by your Home Care Package IF approved by your DC Care Manager and the DC Home Care Package Program Manager.

Care Services
Item Service Content
1 Personal services Personal assistance, including individual attention, individual supervision and physical assistance, with:

a)     bathing, showering including providing shower chairs if necessary, personal hygiene and grooming, dressing and undressing, and using dressing aids;

b)     toileting;

c)     mobility;

d)     transfer (including in and out of bed).

2 Activities of daily living Personal assistance, including individual attention, individual supervision and physical assistance, with communication including assistance to address difficulties arising from impaired hearing, sight or speech, or lack of common language, assistance with the fitting of sensory communication aids, checking hearing aid batteries, cleaning spectacles and assistance in using the telephone.
3 Nutrition, hydration, meal preparation and diet Includes:

a)     assistance with preparing meals;

b)     assistance with special diet for health, religious, cultural or other reasons;

c)     assistance with using eating utensils and eating aids and assistance with actual feeding, if necessary; and

d)     providing enteral feeding formula and equipment.

4 Management of skin integrity Includes providing bandages, dressings, and skin emollients and Registered Nurses to dress wounds.
5 Continence management Includes:

a)     assessment for and, if required, providing disposable pads and absorbent aids, commode chairs, bedpans and urinals, catheter and urinary drainage appliances and enemas; and

b)     assistance in using continence aids and appliances and managing continence.

Please note your HCP cannot pay for continence aids if you are a participant of the CAPS Program. See Specified Exclusions List below. 

6 Mobility and dexterity Includes:

a)     providing crutches, quadruped walkers, walking frames, walking sticks and wheelchairs;

b)     providing mechanical devices for lifting, bed rails, slide sheets, sheepskins, tri-pillows, and pressure relieving mattresses;

c)     assistance in using the above aids.

The Definitive Guide to Government Funded Consumer Directed In Home Aged Care Packages

1. What is a Consumer Directed Care (CDC) in Home Care Package?

2. How many hours of support or care can I receive for my Home Care Package?

3. What can a Government Subsidised Home Care Package pay for? Current Page

4. What are the costs of a Consumer Directed Care (CDC) Home Care Package?

5. What does Consumer Directed Care (CDC) Home Care Package mean?

6. Consumers’ 9 New Rights under Consumer Directed Care (CDC)

7. How do you apply for a Government Subsidised Home Care Package?

8. Are you approved or assigned a Government Funded Home Care Package?

9. Should Self-Funded Seniors accept a Level 2 Home Care Package?

10. Should Self-Funded Seniors accept a Level 3 or 4 Home Care Package?

11. Should a Pensioner accept a Level 1 or 2 Home Care Package?

12. How do I start my Home Care Package?

13. How do I transfer my Home Care Package to Daughterly Care Community Services?

14. How do I know if the Home Care Package fees I’m being charged are fair?

15. How will Consumer Directed Care (CDC) benefit my loved one?

16. Is Consumer Directed Care (CDC) working?

17. Will Consumer Directed Care (CDC) make it easier for my loved one to stay at home?

18. What happens to the Unspent Funds in my Government Funded / Subsidised Home Care Package?

19. If I hold a DVA Card can I have an In Home Care Package too?

20. Can I take leave from my Home Care Package?

21. Frequently asked questions about Consumer Directed Care (CDC) Home Care Packages

Discover the secret to getting more out of your Consumer Directed Care (CDC) Home Care Package!

Do you have a question that isn’t answered here or just looking for more information? Browse our FAQs.

Support services

The following table provided by the health Department specifies the support services that an Approved Provider of a Home Care Package service may provide.

Support services
Item Service Content
1 Support services Includes:

a)     cleaning;

b)     personal laundry services, including laundering of care recipient’s clothing and bedding that can be machine-washed, and ironing;

c)     arranging for dry-cleaning of care recipient’s clothing and bedding that cannot be machine-washed;

d)     light gardening for safe access to the home;

e)     medication management;

f)      rehabilitative support, or helping to access rehabilitative support, to meet a professionally determined therapeutic need;

g)     emotional support including ongoing support in adjusting to a lifestyle involving increased dependency and assistance for the care recipient and carer, if appropriate;

h)     support for care recipients with cognitive impairment, including individual therapy, activities and access to specific programs designed to prevent or manage a particular condition or behaviour, enhance quality of life and provide ongoing support;

i)       providing 24-hour on-call access to emergency assistance including access to an emergency call system if the care recipient is assessed as requiring it;

j)      transport and personal assistance to help the care recipient shop, visit health practitioners or attend social activities;

k)     respite care;

l)       home maintenance, reasonably required to maintain the home and garden in a condition of functional safety and provide an adequate level of security such as cleaning gutters; See Specified Exclusion list to get an idea of modifications that cannot be paid by your HCP;

m)    modifications to the home, such as easy access taps, shower hose or bath rails i.e. small modifications; See Specified Exclusion list below to get an idea of modifications that cannot be paid by your HCP.

n)     assisting the care recipient, and the homeowner if the home owner is not the care recipient, to access technical advice on major home modifications;

o)     advising the care recipient on areas of concern in their home that pose safety risks and ways to mitigate the risks;

p)     arranging social activities and providing or coordinating transport to social functions, entertainment activities and other out-of-home services;

q)     assistance to access support services to maintain personal affairs.

2 Leisure, interests and activities Includes encouragement to take part in social and community activities that promote and protect the care recipient’s lifestyle, interests and wellbeing.

Clinical Services

The following table provided by the Department specifies the care services that an Approved Provider of a Home Care Package service may provide.

 

Clinical services
Item Service Content
1 Clinical Care Includes:

a)     nursing, allied health and therapy services such as speech therapy, podiatry, occupational or physiotherapy services;

b)     other clinical services such as hearing and vision services.
Note: Your Home Care Package cannot pay for hearing aids or glasses.

2 Access to other health and related services Includes referral to health practitioners or other related service providers.

 

If you need clinical care such as services provided by Registered Nurses or Allied Health staff (such as a Physio, Occupational Therapist, Dietician, Podiatrist) the Government Guidelines are very clear that clinical care must be prioritised over less essential services such as gardening or cleaning.

 

Service inclusions Content
Care management Includes:

ongoing assessment and planning undertaken on at least a monthly basis to ensure that the care recipient receives the care and services they need. This includes:

·       regularly assessing the care recipient’s needs, goals and preferences

·       reviewing the care recipient’s Home Care Agreement and Care Plan

·       ensuring the care recipient’s care and services are aligned with other supports

·       partnering with the care recipient and the care recipient’s representatives about the care recipient’s care and services

·       ensuring that the care recipient’s care and services are culturally safe

·      identifying and addressing risks to the care recipient’s safety, health and wellbeing.

 


Excluded items that your Government Subsidised Home Care Package cannot pay for

 

Section 2 – Specified Exclusions

The Quality of Care Principles 2014 lists those care & services that must not be included in the package.  These are always excluded; even if they may advance the care recipient’s assessed ageing related care needs and goals, as they are not aligned to the intent and scope of the Home Care Package program.

The following items must not be included in a package of Care and Services under the HCP Program.

Exclusions Examples
Services, goods or supports that people are expected to cover out of their general income throughout their life regardless of age

Another way to think of this is that your HCP cannot pay for general living expenses that are unrelated to your assessed needs and goals in your Care Plan.

·       General home services that were never, or are generally not completed independently prior to age-related functional decline, including home repairs/maintenance/specialist cleaning performed by a tradesperson or other licensed professional

·       Food (except as part of enteral feeding requirements or items listed under food for special medical purposes as per the Australia New Zealand Food Standards Code – Standard 2.9.5). Further information on food is below under Meal services

·       Home insurance

·       Rates

·       Water, sewage, gas and electricity costs

·       Private transport related costs including vehicle registration, vehicle repairs, vehicle insurance and petrol

·       Local transit costs of public bus, ferry or train fares

·       Funeral plans / insurance costs

·       Pet care and associated costs such as pet food; registration; taxidermy, cremation

·       Internet and telephone costs, exceptions include:

o   Care recipients who are homeless or at risk of homelessness (as identified in a care recipient’s ACAT assessment) can use HCP funds for the ongoing monthly charges to ensure connection with service providers

o   Care recipients who require the internet or landline to support delivery of medication management, remote monitoring service or delivery of an included service on the phone can use HCP funds to set-up telecommunications connections (e.g., to get internet connected)

·       Beauty therapy (e.g., manicures) and hairdressing

·       Cost of entertainment activities, such as club memberships and tickets to sporting events

·       Travel and accommodation for holidays

·       Supplies to participate in any activity, e.g. gardening or craft

·       Using HCP funds to pay for solicitors or accountants for maintaining care recipients’ personal affairs

·       Gym or pool memberships/access costs when not prescribed for aged-related functional decline and monitored by health professional operating within their scope of practice

Accommodation costs ·       Assistance with home purchase

·       Mortgage payments

·       Rent

·       Permanent residential care (subsidised or private) and residential respite (subsidised)

·       Heating and cooling costs (installation and repairs)

·       Whitegoods and electrical appliances (except items designed specifically for frailty such as a tipping kettle)

·       Household furniture and furnishings:

o   lounge suites and recliners which do not support a care recipient’s mobility, dexterity and functional care needs and goals

o   Other general household furniture such as coffee tables, wardrobes, and bookshelves.

o   Massage chairs when not prescribed by treating medical practitioner and/or allied health professional

o   General mattress and frame for bed (exceptions for pressure relieving mattress or mattress/frame for an electrical adjustable bed or hospital bed)

·       Replacement/maintenance/servicing/cleaning of:

o   Water tanks

o   Solar panels

o   Fencing

o   Roofs

o   Heating and cooling or hot water systems

o   Swimming pools

·       Home modifications or capital items that are not related to the care recipient’s ageing-related care needs, for example:

o   Windows, roofs, pergolas, sunrooms, decking

o   Home modifications that don’t support ageing safely e.g., non-accessible bathroom and kitchen modifications; non-standard fittings in accessible bathroom modifications (e.g., mosaic tiles)

o   Home modifications requiring development applications

o   Aesthetic modifications of any kind

o   Repainting the home

o   Major plumbing

o   Emptying of septic tank; remedying sewage surcharge (matter for water company/insurer)

o   Major electrical work, e.g., rewiring house

o   Replacement of entire floor and floor coverings throughout the home unless safe passage for mobility equipment required or slip hazard reduction required, as recommended by a health professional for care recipients at risk of falls

o   Replacement of foundation e.g., concrete/cement slab

o   Significant changes to the floorplan of the home, such as adding a new bathroom or extension

·       Extensive gardening services such as:

o   Planting and maintaining crops, natives and ornamental plants

o   The installation and/or maintenance of raised garden beds

o   Compost heaps

o   Watering systems

o   Water features and rock gardens

o   Landscaping

o   Tree removal

o   Removal of garden beds

o   Removal of shrubbery (unless preventing safe access and egress)

Payment of home care fees ·       Defined at section 52D of the Aged Care Act 1997

·       Includes income tested care fees, basic daily fees and additional fees

Payment of fees or charges for care or services funded or jointly funded by the Australian Government ·       Co-payments for state/territory government funded programs, such as subsidised taxi vouchers and/or aids and equipment schemes

·       Dentures, dentistry and dental surgery

·       Prescription glasses or contact lenses

·       Prostheses (e.g., artificial limb)

·       Spectacles

·       Hearing aids available under the Hearing Services Program (HSP). Contact the Hearing Service Program (HSP) for guidance on hearing aid replacement and delegate approval for non-standard hearing aids. Exception if care recipient is not a pension concession card holder as HCP may cover like for like of typical hearing aid covered by HSP in this case only.

·       Continence aids if a participant in the Continence Aids Payment Scheme (CAPS) program

·       Diagnostic imaging

·       Natural therapies, including:

o   Alexander technique

o   Aromatherapy

o   Bowen therapy

o   Buteyko

o   Feldenkrais

o   Homeopathy

o   Iridology

o   Kinesiology

o   Naturopathy

o   Pilates (except sessions supervised by an exercise physiologist or physiotherapist)

o   Reflexology

o   Rolfing

o   Shiatsu

o   Tai chi (except sessions supervised by a Chinese Medicine Practitioner, exercise physiologist or physiotherapist)

o   Western herbalism

o   Yoga (except sessions supervised by an exercise physiologist or physiotherapist)

·       Payment for informal care, eg family, friends – a Carer’s Payments is available to fund the support of family and friends.

·       Section 16.1 of the HCP Program Manual specifies more information about what ageing related programs can and cannot be accessed while receiving a HCP.

Payment for services and items covered by the Medicare Benefits Schedule (MBS) or the Pharmaceutical Benefits Scheme (PBS) (or items that should be considered for funding through these schemes) ·       Co-payments or gap fees, including for services covered by private health insurance.

·       Medications, vitamins and supplements (as well as items not covered by the PBS such as off-indication prescriptions, medicines not endorsed for listing by the Pharmaceutical Benefits Advisory Committee (PBAC) or medicines where the manufacturer has chosen not to list the product on the PBS

·       Consultation/tests/surgery with medical practitioner (GPs and specialists) – The only exception to this is a private appointment (i.e. not covered by MBS) with a GP to meet evidence requirements for the dementia and cognition supplement and oxygen and enteral feeding supplements. Please note Daughterly Care provides free assessment a your home for he cognition supplement.

·       Hospital costs

·       Ambulance cover

·       Private health insurance premiums

Provision of cash debit cards or like payments to care recipients for any purpose ·       Debit cards (unless the provider has rigorous systems in place to vet every payment and keep on file all receipts in accordance with the Records Principles 2014. Debit cards may pose issues for GST credits. Consult with the ATO for more information).

·       Cash payments or gift vouchers/cards, including online vouchers and coupons