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Ask Me Anything #2
Episode 26 • 15th October 2024 • Your Aged Care Compass • Coral Wilkinson & Michelle Brown
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We're asked so many questions in the course of our work. Our first Ask Me Anything podcast was unbelievably popular, so we’re devoting one episode a month to answering your questions.

Send your questions to us and we’ll answer as many as possible during these Ask Me Anything episodes.

In this episode:

  • Home care package funds for commercially prepared meals
  • Basic daily fee vs income tested fee
  • Does home care package funding affect the aged pension?
  • Grandfathering under the new Support at Home program
  • Why can’t I claim the cost of a visit to my GP from my home care package?
  • Do I need a GP letter to get allied health services through my home care package?
  • The dementia and cognition supplement
  • Service agreements for workers with home care providers
  • What are some of the signs my parents might need help?
  • My Aged Care told me someone would contact me. What does that mean?

 

Resources mentioned:


Connect with Coral Wilkinson: 

  

More about Your Aged Care Compass podcast: 

Are you supporting an older loved one at home and ready to give up because it’s just too hard? Your Aged Care Compass is aimed at anyone who is caring for an older loved one who still lives at home and is wondering what support is available to them.


We're Coral and Michelle, the sisters behind our business, See Me Aged Care Navigators.


Coral is a registered nurse with over 30 years’ experience in both health and aged care. A former assessor with the aged care assessment team, an advocate and author, there’s not much Coral doesn’t know about Australia’s aged care system.


Michelle is a former pharmacist with over 30 years in the public health and private sectors of pharmacy. Michelle is now client care manager for our business. 


Our story started as one of supporting our parents to remain in their own home, to be as independent as possible and remain connected to their community. We reached a point however, of needing extra support and we achieved this because we know Australia’s aged care system so well, we knew what programs could assist us and our parents.


This podcast, Your Aged Care Compass, brings together not only our personal experience in supporting our own ageing parents but also our vast professional experience in supporting other families to keep their loved ones at home. 


We will help you makes sense of Australia’s aged care system, from your first contact with My Aged Care through to the different funding streams and assessment workforces, management options for home care packages and extra funding that people might be eligible for.


There's so much more. Topics relating to dementia and legal and financial considerations will be covered, as well as real life stories of where it went wrong for people and how we guided them to get it right.

 

Your Aged Care Compass will guide you clearly and compassionately to the right support at the right time for your ageing parents and loved ones. 


Like what you hear? Please leave us a Rating and Review. We’d love you to share this podcast with any friends or family who have older loved ones.

Transcripts

Michelle:

Hello again, listeners.

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Michelle here.

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We had such amazing feedback after

our last Ask Me Anything episode that

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we decided to devote one podcast a

month to answering your questions.

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Coral: Our first Ask Me Anything

episode is actually our most listened

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to, most downloaded episode shell.

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So let's jump right in and answer

the questions you've asked us today.

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We're covering a few different topics.

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Michelle: Okay, Coral, first question.

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Why doesn't my package provider

cover the full cost of my pre

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prepared meals, like light and easy?

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Coral: Home care package funds

can't be used to purchase food.

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So what the package funds are

covering is the preparation of the

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meal, not the food component as such.

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The government will allow providers

to cover 70 percent of the cost

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of a commercially prepared meal.

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The other 30 percent is regarded as the

actual food component and not covered.

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Michelle: Okay.

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Coral, what's the difference between the

basic daily fee And the income tested fee.

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And why do some providers charge

these fees and others don't?

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Right, right,

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Coral: look, this question

gets asked all the time.

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so the basic daily fee

is not a mandatory fee.

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Unlike the income tested fee.

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So providers can ask someone to pay the

basic daily fee, but it is negotiable.

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It's not mandatory.

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Some years ago, providers who marketed

themselves as charging very low

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fees, and this was before package

management and care management fees.

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So these providers would say,

you know, our, our admin fees

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are only 10 percent and then they

would charge the basic daily fee.

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on top of that.

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But after the government stipulated

the maximum amount of combined package

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management and care management fee

being no greater than 35%, we saw less

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providers charging the basic daily fee.

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So the Basic Daily Fee is charged at

between just over 15 percent to 17.

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5 percent of your aged pension.

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And the Basic Daily Fee is

indexed each March and September

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in line with the aged pension.

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The income tested fee is determined by

Services Australia and not your provider.

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If Services Australia determines you

have the means, that is the income, to

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contribute to your package services,

your subsidy or funding is reduced by

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the amount that you have to contribute.

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So people who will not have to pay

the income tested fee are those on

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a full aged pension and people with

an income of up to 33, 735 a year.

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The My Aged Care website has a

fee calculator so you can work

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out if you would need to pay

the income tested fee or not.

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We've popped the link in the show

notes if you're curious to see if you'd

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have to contribute this fee or not.

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We've been asked about these fees

in the new support at home program.

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Now, there are a lot of questions around

the new fee structure or co contributions

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under the new program, but as the new

act hasn't been passed in parliament yet,

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we're not going to add to the speculation

as, you know, the consultation process may

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change what has been proposed currently.

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We'll actually dedicate an ask me

anything episode to the proposed

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changes once the act has been passed.

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Michelle: okay.

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does the home care package

funding affect a person's pension?

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Coral: It doesn't.

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So look, just to clarify that a little

bit more, the package funding is not.

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income.

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it's not your income.

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it's a subsidized government

funding that allows you to

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receive aged care support at home.

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Michelle: Okay.

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Going back to the changes that

are coming, we are hearing that

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people who are currently in the

system will be no worse off, under

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the new support at home program.

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Can you explain what that means?

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Sure.

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Coral: Yeah.

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So look, Shel, I don't want to

elaborate on, all the discussion around

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support at home because, you know,

like I just said, the bill hasn't

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been passed, so things could change.

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But just for the purpose of this

question, Grandfathering or a no worse

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off principle applies to people who on

th of September this year:

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were either receiving a home care package

or they were waiting in the national

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priority system or the queue or assessed

as eligible for a home care package.

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The no worse off principle

ensures that those.

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People who are already in the system

won't be financially disadvantaged

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as we tr as we transition, uh, to

the new support at home program.

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So, I just wanna reiterate again,

there is a lot of discussion.

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Um, there's a lot of concern across social

media and in the community right now

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about the proposed changes under the act.

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You know, what people are

going to have to contribute.

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Will they be able to afford services

within their home care package?

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The new act hasn't been passed.

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So community consultation

has just closed as well.

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So it is my preference to wait until

we're certain about what the new

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program is actually going to look

like before we begin, , explaining and

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commentating on what this is actually

to mean for people come July:

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Michelle: All right.

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coral, why can't I claim the

cost of a visit to my doctor

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from my home care package?

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Coral: So items or services that are

already subsidized by the government,

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being federal or state, cannot be

claimed from home care package funding.

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This applies to GP visits where

there might be an out of pocket cost.

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There is already a Medicare rebate for GP

visits, so although you'd have an out of

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pocket fee for visiting your GP, the rules

are that you cannot pay that out of pocket

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fee from your home care package funding.

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Likewise, if you were to visit an allied

health clinic under a GP care plan, let's

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just say a physiotherapist, you're likely

to have an out of pocket cost as well.

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Now, some allied health clinics will bulk

bill under a GP care plan, but many won't.

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Michelle: Okay.

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Coral: So the out of pocket cost for

visiting a physiotherapist or a dietitian

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or a psychologist, you know, any allied

health clinician, cannot be paid for

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from the package funds as this service is

already being subsidised under Medicare.

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Michelle: Okay.

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Coral: Just following on from that point

about allied health, if you're like

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my mum who has allied health included

in her care plan and has an exercise

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physiologist visit her at home each

week, that service is paid for by mum's

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package provider because the full And

unsubsidised cost is being met by my mum.

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So no, no, the EP that comes to mum

each week, that's not subsidised

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under Medicare, mum is choosing to

pay the full cost and that's why she

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can have that full cost covered by

her home care package because it's not

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already being subsidised by Medicare.

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Michelle: Okay.

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And along those lines, , do I need

a letter of recommendation from

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my GP to get other allied health

services through my home care package?

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So I guess things like physiotherapy, a

dietician, nursing care or podiatrist.

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Coral: No, you don't,

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Michelle: coral, what is the dementia and

cognition supplement and who can get it?

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Coral: The dementia and cognition

supplement is an additional amount

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of government funding that people

can apply for if they are moderately

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to severely cognitively impaired and

they also have a home care package.

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There's a lot of confusion about

the eligibility for this supplement.

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So you do not need to have

a diagnosis of dementia.

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to be eligible for this supplement

or this additional funding.

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Impaired cognition can be caused by

other conditions, not just dementia.

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It can be caused by a stroke, an

acquired brain injury, mental health

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conditions, or even some medication.

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Eligibility for the dementia and

cognition supplement is determined

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solely on the scoring outcome

during the screening process.

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Eligibility for this supplement

is separate from the investigative

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process that you might be going through

with your geriatrician to perhaps

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determine a diagnosis of dementia.

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And it is also separate

from the ACAT assessment.

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So a comment we often see is why didn't

my geriatrician apply for this for me?

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Or why didn't the ACAT complete

the paperwork for this?

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Completely separate process.

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The screening for this supplement is

separate to, you know, investigations

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that a geriatrician might be progressing,

working towards a diagnosis, and it's

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separate again from the ACAT assessment.

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Another comment we see is when

people ask the hospital occupational

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therapist to complete the screening,

and then they're annoyed when Services

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Australia decline that application.

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And unfortunately, What they think is

that they aren't eligible or the older

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person is not eligible, to get the

supplement when in fact what they haven't

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realized is an occupational therapist

or an OT is not one of the approved

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clinicians to complete the screening.

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for this supplement.

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So in hospitals, you know, OTs have

a significant role in screening and

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assessing people for cognitive impairment.

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But for the purpose of this

additional funding, OTs are not

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one of the approved clinicians.

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So If you've had an OT, you know,

complete the screening and then complete

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the application form, send it into

Services Australia, it will be denied or

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declined because the OT is not one of the

authorized clinicians for this process.

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Michelle: Right.

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So not because the person's not eligible.

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Coral: Correct.

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So the person might be eligible, but

the OT is not allowed to sign off on

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the application form in this instance.

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Who can complete the screening?

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Um, well, GPs and other medical

practitioners can, registered nurses

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can, and clinical psychologists can.

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Michelle: Okay.

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Why are home care providers making it

harder for me to choose my own workers

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and then submit the invoice for payment?

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They say my workers need a

service agreement with them.

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Coral: Yeah, so this question

would, I think, mainly relate to

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people who are with a self managed

provider for their home care package.

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So, the aged care system is heavily

regulated and the government

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wants to ensure that their funding

is being used appropriately.

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So providers must ensure that workers

have ticked all the regulatory boxes

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to be paid for from the government

funding or package funding.

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So there are requirements such as

a police check, there might be stat

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decks, uh, the insurance policy and

the ABN of let's just say the worker.

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And that could be a non

clinician or a clinician.

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The government wants to make sure

that family members aren't being

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paid for from package funds.

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And that your cleaner or your law knowing

contractor is a legitimate business.

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So, you know, if you come to your

provider, particularly if you are with

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a self managed provider and you want

to bring your cleaner with you, uh,

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when you sign up with one of the self

managed providers, then your cleaner

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will have to produce you know, certain

documents like I've just described to be

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able to enter into a service agreement

with the provider and your lawn mowing

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contractor will have to do that and your

registered nurse will have to do that.

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Um, anyone that's involved in

your care must have a service

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agreement with the provider.

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Michelle: Uh, another question, Coral.

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I've been a bit worried

about my parents for a while.

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I'm not sure that

they're managing at home.

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What are some of the signs I

should be looking for to know

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if I need to get help for them?

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Coral: So I would say if you've been

a bit worried about your parents for

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a while and concerned that they're not

managing at home, you're probably right.

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Some of the early signs that people might

notice are the older person not keeping

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the house as clean as they used to.

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Michelle: Mm hmm.

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Coral: They might not be

managing to mow their yard.

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they might be losing weight.

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They might be leaving food

out on the kitchen benchtop.

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There might be some body odour.

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You know, meaning that the older person

is forgetting to have a shower each

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day or they're wearing the same clothes

day after day without washing them.

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The older person might not

want to go out like they used

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to and prefer to stay at home.

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They might be calling you on

the phone multiple times a day,

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asking you about appointments.

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They might be coming up with stories

that might seem odd, such as accusing a

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neighbor of stealing their belongings.

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Um, now these signs mostly relate

to cognitive impairment where, the

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person may have thought that they've

had breakfast, lunch or dinner, but

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in fact, they haven't, um, you know,

forgetting to put food back in the

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fridge, when they finished, eating

it or, you know, leaving it out on

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the bench and the food is going off.

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these are early sort of signs

that you would start to wonder,

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um, that the person's cognition

might be impaired, that there's

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something going on with their memory.

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There are also signs that, um, relate

to more sort of functional indicators

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like becoming more unsteady on their

feet and perhaps experiencing falls.

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They might be having pain that prevents

them from being able to complete their

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activities of daily living independently.

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Not wanting to go out could also be

an indicator of a mood disorder, or

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it might even relate to incontinence.

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You know, that the older person might be

afraid that they might have an accident

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because they can't get to the toilet on

time when they're out in the community.

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So there are a lot of different signs,

but one way of looking at it is if your

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older loved one is struggling to manage

by themselves, uh, and you find yourself

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providing more and more support, then

this would be the time to contact My Aged

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Care and begin to seek for more support.

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Michelle: Right.

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And our final question, Coral,

actually relates to that.

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, so we were asked, I rang My Aged

Care and I'm not sure what happened.

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They said someone would contact me,

but I don't know what that all means.

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Can you explain?

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Coral: When you contact My Aged Care

and they've completed their screening

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to establish what kind of support

you need, they will then refer you on

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to one of the two assessment teams.

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So this could be either the Entry Level

Assessment Team, which is the Regional

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Assessment Service or RAS, or the Aged

Care Assessment Team, which is the ACAT.

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For both teams, there is an expectation

that they will contact you to arrange an

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assessment within a specified time frame.

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So this is what My Aged Care is advising

you when they say someone will call you.

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Michelle: we get lots of questions and

we try to answer as many as possible.

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As Coral mentioned earlier, because

the changes that are coming with

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support at home are not yet finalised,

we don't want to add to the confusion

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by answering questions that we don't

have definite information for yet.

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There is a lot of speculation and,

understandably, a lot of concern.

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As things become more definite,

we'll be sure to let you know.

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Next week, we'll pick up our

conversation about Dad's diagnosis of

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dementia and our experience of caring

for him as the disease progressed.

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Thanks for joining us today.

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Until next week, take care.

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