The proposed 10% cap on care management fees under the Support at Home model has emerged as one of the most contentious issues of the new Aged Care Bill, released on 12 September.

Sarah Newman, General Manager BaptistCare At Home, which has 15,000 home care clients in NSW, ACT, and WA, told The Weekly SOURCE, said she is concerned the reforms will "threaten" its "high quality" care management model.

The "decrease in funding" will "either lessen the quality of care that can be provided or threaten the financial viability of high-quality providers", she said.

Bronwyn Perry, Executive Director, Silverchain, which services more than 11,500 Home Care Package (HCP) or Commonwealth Home Support Programme (CHSP) clients, told The Weekly SOURCE, applying a cap on care management, even if pooled, doesn't "provide scope to properly address the diversity in the needs of clients".

The issue was also one of the most supported questions during two Support at Home webinars, and was highlighted in many submissions to the Senate Inquiry on the Bill.

Bolton Clarke, in its submission, said price controls and care management caps could cause "major service disruption" and needed to be "deferred, pending a review".

"Caps on care management are particularly perplexing as a large share of non-compliance in home care is related to low care management spending and poor care management practices," Bolton Clarke noted.

The proposed changes

The Support at Home reforms contained in the Aged Care Bill 2024 are aimed at allowing older people to remain living at home for longer. The Government has pledged consumers will have to wait no longer than three months to receive services by July 2027, and has a target of supporting 300,000 more participants within a decade. Under the reforms, aged care spending as a share of GDP is projected to decline from 1.5% of GDP to 1.4%. 76,000 people are currently waiting for a Home Care Package. 

As part of the reforms, home care recipients will have 10% of their quarterly budget set aside for care management. Those funds will go into a Care Management Fund. Providers will be required to invoice for care management services after they have been delivered. The idea of the pooled fund is that spending on care management can be lumpy, with higher costs early on that smooth out as time goes on and the care is established. The proposed new arrangements cater for those uneven spending patterns.

Administration expenses, on the other hand, will be built into service prices, which are based on prices recommended by the Independent Health and Aged Care Pricing Authority (IHACPA).

Insufficient time

Sarah and Bronwyn said more information is needed on the reforms before they can begin to be implemented.

Sarah is also concerned about the "timelines proposed to implement such significant changes".