1. Redesigning and Expanding Provision
under the
Commonwealth Home Care Packages Program
in a
Small Rural Health Service
Josie Gebert, Community Services Manager
Fiona Vizard, Home Care Coordinator
Andrea Dunlop, Manager Workforce & Service Development
Hesse Rural Health

2. Session Overview Meet Charlie Consumer Directed Care
Service opportunities for a smaller rural health service
Achievements
Unanticipated outcomes
New challenges
Lessons learned

3. But Charlie was not having a bar of it!
Meet Charlie
Charlie is 80 and lives at home alone in his rural farming property near Winchelsea. It’s 45 minutes into Geelong where his adult children live and work.
He enjoys the farm wants to remain living there as long as possible but he no longer drives.
He is isolated from social supports aside from a few neighbours who pop in from time to time.
A recent health crisis meant additional demands on his children. They were considering Dad for residential aged care.
But Charlie was not having a bar of it!

4. Home Care Packages – a service solution
Increasing Choice in Home Care
Consumer Directed Care - First Introduced in 2015
Greater Choice and Control
Respectful Balanced Partnerships
Participation in plan of care
Independence
Transparency

5. LIMITED HOME BASED OPTIONS
Pre 2017 Service Solution
Community Aged Care Packages (CACPS)
Hesse Rural Health
BUT
All 4 existing packages utilised
LIMITED HOME BASED OPTIONS

6. 2017 ‘Increasing Choice in Home Care’
Package allocation to consumers not providers
Consumers can: choose their provider
choose level of control of funds and services
(self manage their packaged funds or purchase provider assistance)
change providers readily
National allocation process based on assessed needs and wait list
Level 1 package = basic level ($ 8,000)
Level 2 package = low level ($14,500)
Level 3 package = intermediate ($32,500)
Level 4 package = high level ($49,500)

7. Good News ! Charlie Hesse Rural Health
Could remain living at home with services he needed
Choose Hesse as his preferred provider
Hesse Rural Health
No more unsuccessful ACAR applications

8. A Service Development Opportunity
Integrated service with existing service profile
Nursing, personal care and allied health workforce
Well established reputation for quality care
Established business mechanisms
Providing local jobs to local people

9. Service Development Challenges
Small start up base (the 4 allocated packages)
Competition from new start up from corporate providers
No funds for service growth
Infrastructure needs – office space, vehicles, coordination
Industrial climate – generous provisions within public sector EBA’s compared with private sector
Unpredictable service levels, low volume, over resourcing
Workforce retention due to non guaranteed work levels
Program specific business viability

10. Expanding Services
Board strategic target set – from 4 packages to 30 by June 2019
Incremental service growth
Recruitment for Coordination – Registered Nurse
Mixed brokerage and internal resourced model of care delivery
Recruitment of Personal Care Workers – internally & externally
Dual roles - Social support activities and Home Care
Occupational Therapy support
Expanded vehicle fleet – new investment & existing
Leased a portable site office as a temporary base
E Tools – aged care business systems software

11. Results to Date Five fold growth in 18 months. 15 clients. On target
Waiting list (23), pending Commonwealth allocation
Supporting clients with:
personal care, domestic support, community access, respite, home maintenance, gardening, purchase of assisted living equipment and supplies
Public sector recruitment advantage
Provision of vehicle fleet also is attractive
Satisfied staff
Benefits to registered nursing supervision structure
High levels of consumer satisfaction
Good service continuity within an integrated service

12. Challenges Timely release of further Commonwealth packages
‘Time is money’ – a public health dichotomy
My Aged Care – rural IT connectivity and computer literacy
Inadequacy of existing Cert III and IV training
Recruitment challenge – Home Care is not for all
Working autonomously
Independent problem solving/good observation skills
Flexibility
Professional boundaries (no direct supervision)
Infrastructure investment without dedicated funding
The unanticipated impact on residential aged care occupancy

13. Service Impact in 12 months
Increase in Home Care Services (fivefold)
Decrease in Residential Aged Occupancy
from 98% - 88%
( -$ 600,000 )

14. Lessons Learned The impact of new services on existing ones
Home Care Worker are not synonymous with Personal Care Worker
A tailored education program is necessary
Get ready for Consumer Directed Care into residential aged care
Improve care planning and link it to resourcing
New Aged Care Quality Standards increasing the focus on dignity and choice
This is simply a training ground
Change can happen very quickly

15. Charlie is happier, healthier and living better at home

16. Josie Gebert, Community Services Manager
Good reference
The impact of the home care reforms on the older person, the aged care workforce and the wider Health System
Deeble Institute Issues Brief No. 27. Jorgensen M, Haddock R Canberra: Australian Healthcare and Hospitals Association; p
Josie Gebert, Community Services Manager
Hesse Rural Health Tel