The continued rollout of consumer-directed approaches in aged and disability services should strengthen rather than diminish the importance of case managers.
There is a major redefining of the case manager role as Australia’s approach to home care in the aged and disability service sectors shifts to customer choice and control, with individualised funding to address the care recipient’s needs and goals. Despite the similarity in the goals of these two programs and the skill sets required by services, the implementation of these reforms is being approached very differently.
HOME CARE: A MANAGEMENT-HEAVY APPROACH
Home care packages, operated by the Department of Health, are a highly controlled program whereby providers licenced to deliver government-subsidised aged care create and manage budgets based on an independent assessment of an individual’s required level of support.
The approved provider remains the fund holder of those government subsidies and administers them in line with customer goals and preferences. The provider is responsible for meeting quality and accountability requirements set by the government.
Providers have traditionally used case managers to manage care planning, negotiate with service providers manage services and secure funding. Case managers have been supported by head office in relation to finance, quality and systems.
As accountability sits with the provider, governance and quality processes have been effective in ensuring the safety of care recipients. This has, however come at a cost, with between 30 and 50 per cent of all packaged funding going towards overheads covering case management and head office costs.
NDIS: A MANAGEMENT-LIGHT APPROACH
In parallel, the NDIS, reporting through the Department of Social Services, is rolling out a model whereby NDIS planners establish an individual’s budget with information collected from phone and face-to-face visits with the client.
By default, clients’ budgets are managed by the National Disability Insurance Agency and limited to goods and services from registered NDIS providers and NDIS pricing.
An individual is required to make a request to self-manage their funds or appoint a plan manager to fully exercise choice in providers of goods and services without NDIS price restrictions. Plan managers are the NDIS equivalent of a case manager in aged care.
The price paid for plan management is tightly controlled, with the financial management component limited to approximately $100 per month.
Despite the attractiveness of self-management for individuals to choose their own providers, take-up is low due to the administrative requirements on individuals and plan managers for limited funding support.
The home care packages program has a mature case management model that can oversee quality care and financial management and is moving towards increasing customer choice and control. However, high fees and charges cannot be justified, and have negatively impacted the reputation of case management in the home care program.
Costs are being questioned by clients and their families, aided by greater transparency and increased competition.
From 27 February 2017, home care package recipients were able to leave a provider if they feel an organisation is not demonstrating value for money
What the NDIS is gaining on low management costs, it is losing in expert oversight and clear accountability. Financial and quality governance between NDIS participants will be highly variable and will rely solely on the NDIA’s controls and audits at the individual level.
The demand is there for coordination and case management among NDIS participants as they look to exercise choice in providers. However. what’s missing is the scheme’s appreciation of the value added by case managers to safety, risk management and financial governance. What’s needed is better priced case management or support coordination funding.
The NDIS and home care packages program are moving in parallel and will eventually collide. Home care operators are improving their cost effectiveness and the NDIS is increasing its understanding of the value of independent third parties in the support of care recipients. This is a big opportunity for the case management industry.
Published in the Community Care Review, Autumn 2017