Pathway to Accessing Home Care
The Australian Government is improving the way home care services are delivered to older Australians. These changes are important for a sustainable and quality aged care system that is more consumer driven, market based and less regulated.
A home care package is assigned to a client, allowing the client to direct funding for their home care package to the provider of their choice. The purpose of this fact sheet is to provide information about a client’s journey to receive home care package services and the steps providers need to undertake when they receive a referral for service.
Home Care Assessment
Aged Care Assessment Teams (ACATs) use the National Screening and Assessment Form (NSAF) to determine client eligibility for home care. ACATs recommend approval for home care at specific home care package:
- Level 1 – supports people with basic care needs
- Level 2 – supports people with low-level care needs
- Level 3 – supports people with intermediate care needs
- Level 4 – supports people with high-level care needs.
During the assessment ACATs also recommend a client’s priority for home care services based on individual needs and circumstances.
Clients are able to indicate the minimum home care package level they are willing to accept as an interim measure. Additionally, the client needs to indicate if they are seeking or not seeking home care services.
A guidance framework and document for ACATs has been developed to support nationally consistent decision making on home care package level and priority.
Client approved prior to 27 February 2017
Clients approved for home care prior to 27 February 2017 have automatically be approved for the higher level of their previous broad-band approval (i.e. clients who were approved for level 1-2 are now approved for level 2 and those approved for level 3-4 will automatically be approved for level 4).
Note: Clients who had their approval updated to a higher level than they are receiving have been added to the national queue. These clients continue to receive services while waiting to receive a package at the higher level For example, if a client was receiving level 3-4 home care package services prior to 27 February 2017, they can continue to receive level 3 services while waiting for a level 4 package to be assigned to them from the national queue.
Client receives the outcome of their assessment
Following the assessment, the ACAT writes to the client to let them know the outcome of their assessment. It is important to note that this is not the package assignment letter. The client, if seeking home care services is automatically placed in the national queue at their approved level, as well as any interim levels they have identified. The national queue takes into account two factors for prioritisation:
1. The clients relative needs and circumstances as determined by the ACAT during their comprehensive assessment; and
2. The time spent waited for care based on the date they were approved for care.
Research home care providers and work out costs
Once a client is approved for a home care package they are advised to start researching providers, they can do this by:
- Using the Home Care Package service finder tool on the My Aged Care website;
- Contacting My Aged Care on 1800 200 422;
- Getting in touch with the ACAT that undertook their assessment; or
- Having a chat to friends or family that are currently receiving home care services.
Clients may be asked to contribute to the cost of their home care package services. The Home Care fee estimator on the My Aged Care website gives clients an indication of the fees and charges they may be asked to pay and can estimate their basic daily fee and income-tested fee. The actual fees that the client may be asked to pay will depend on a formal income assessment undertaken by the Department of Human Services (DHS).
Client is assigned a home care package
When a client has been assigned a home care package they receive a package assignment letter which advises the client:
- Of the date that they need to enter into a Home Care Agreement by;
- Of their referral code; and
- The need to seek a formal income assessment from DHS.
The package assignment may be at a level below the client’s approval. This allows the client to access care and services as an interim measure while waiting for a package at their approved level.
Once assigned a home care package clients have 56 calendar days (with an option for a 28 day extension) to enter into a Home Care Agreement.
Clifford is approved for a level 4 home care package. During his assessment he indicated that he was seeking services and would be willing to take a level 2 or 3 home care package as an interim arrangement. Clifford is assigned a level 2 home care package from the national queue as an interim measure. He contacts his preferred provider to arrange services at his assigned level 2.
Later, Clifford is assigned a level 3 home care package. Clifford receives a letter advising him of his change in package, while his provider receives a notification in the My Aged Care Provider Portal. These notifications should prompt a discussion about additional services he may require and any adjustments to his support plan or Home Care Agreement.
Provider receives and accepts referral for service
Once a client is assigned a home care package from the national queue, a referral for service may be received by providers:
- Directly from client’s registered with My Aged Care. Clients can be issued a referral code by assessors or the My Aged Care contact centre. You need to enter the referral code into the provider portal to accept the client’s referral.
- Electronically through the provider portal issued by assessors or the My Aged Care Contact Centre. Providers can choose to accept, reject or accept the referral to waitlist (if one is available). You are required to action referrals sent through the My Aged Care provider portal within 3 calendar days.
Accepting the client referral in My Aged Care is an important step in committing the client to their home care package. Providers must accept the client’s referral in the provider portal before submitting entry information to the Department of Human Services.
You can view limited information about a potential client in client record area of the provider portal. This information is available to help you determine if you can meet the client’s needs and goals and includes some personal information, the support plan, services in place and assessment information. It is important to note that you will only be able to view a client’s contact details and full address once a referral has been accepted.
Client enters into Home Care Agreement
The new provider should work in partnership with their new client to develop a Home Care Agreement, care plan and individualised budget based on the client’s needs. You should work with the client to develop their care plan and individual budget, which will form the basis of their Home Care Agreement. Clients have 56 calendar days (or 84 calendar days with the 28 day extension) from being assigned a home care package to enter into a Home Care Agreement with their preferred provider. If the client does not enter a Home Care Agreement within this timeframe, their home care package will be withdrawn. Clients will need to contact My Aged Care to re-enter the national queue.
Notify DHS of entry information
You are required to submit entry information to DHS within 28 days of a client commencing their home care package via the:
- Aged Care Online System (ACOS); or
- Submission of an Aged Care Entry Record (ACER)
Entry information must be provided to DHS as early as possible and before the client’s package take-up deadline to ensure their package is not withdrawn.
Key points to remember
- ACATs determine client eligibility and priority for home care services.
- Clients are able to indicate the minimum home care package level they are willing to accept as an interim measure.
- Clients seeking home care services are automatically placed in the national queue at their approved and identified interim levels.
- When a client has been assigned a home care package they receive a package assignment letter.
- Clients have 56 calendar days (with an option for a 28 day extension) from the date they were assigned a home care package to enter into a Home Care Agreement.
- When a client is assigned a home care package a referral for service may be received by providers directly by clients or through a notification in the provider portal.
- Accepting the client referral in My Aged Care is an important step in committing a client to their home care package.
- Entry information must be provided to DHS within 28 days of a client commencing their home care package.
- visit the department’s website
- subscribe to receive electronic updates
- email email@example.com.
- Quick Reference Guide on how to manage referrals for service through the My Aged Care provider portal.
This fact sheet provides general guidance to support the Home Care Packages Program. It does not constitute legal advice, nor is it a substitute for responsibilities under the legislative framework.