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A GP's guide to accessing home care

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Appeared on www.medicalobserver.com.au 15 February 2019.
Written by Zilla Efrat

Last December, the Federal Government released 10,000 more high-level home care packages enabling more patients older than 65 — or Aborigines and Torres Strait Islanders older than 50 — to obtain home-based services.

The $287 million expansion in funding came on top of an extra 20,000 home care packages added to the Department of Health’s aged care scheme over the previous 12 months.

The scheme funds much-needed services such as personal care, transport, modifications to the home such as hand rails or ramps, nursing, physiotherapy, meals and help with cooking, household jobs like cleaning or gardening, equipment such as walking frames, and social activities to combat isolation.

Waiting for action

However, the government’s own Home Care Packages Program Data Report for the period 1 July to 30 September 2018, released in November, revealed that 126,732 people were waiting for a package that matched their needs.

This report also showed that the wait times for people receiving the lowest-level package was 3-6 months.

The wait time for all other packages was more than one year, but Therese Adami, general manager for Catholic Healthcare Community Services, says some people have waited for up to two years.

Waiting times depend on the priority to which people are assigned after being assessed by a local Aged Care Assessment Team (ACAT), she says.

Many people self-refer to the scheme, which is part of My Aged Care. However, GPs can also refer and can assist in ensuring patients know how to access the system, Ms Adami says.

First port of call

As a first step, GPs can refer, or direct, patients who would clearly benefit from some assistance in the home, or even a move to an aged care home, to the My Aged Care website and/or hotline.

It can take about 30 minutes to lodge a patient’s details on the website, which can be done by the patient, one of their family members or a member of the practice staff, who can also fax My Aged Care advising them of the patient’s needs.

My Aged Care staff member should make contact with the patient within 48 hours, and if they are not able to reach the person, they will let the practice know.

Looking for service providers

Another route for a patient to take is via a home-care service provider, which can be contacted directly and can go through the My Aged Care process with the patient.

There are many of these service providers. Indeed, their number has nearly doubled to almost 900 since 2016, sparking concerns that it has become too easy to enter this business.

In January, Minister for Aged Care Ken Wyatt told the ABC’s 7.30 Report that the government would review whether it was necessary to tighten registration requirements for these providers after allegations of price-gouging, non-compliance with standards and aggressive sales techniques.

His comments followed reports by the ABC that, since July, 14 home care providers had been served non-compliance notices and three had been sanctioned.

Thus, it’s important for patients to ask people who have used a service for recommendations and to talk to a few providers to compare services, Ms Adami says.

The My Aged Care website’s 'Find a Service' page allows patients to find a list of providers close to where they live.

The home care packages program is means-tested, so depending on a patient’s circumstances, they may have to contribute towards the services. Costs vary for different types of care and different service providers.

However, there may be some patients who have not recognised they require assistance but are struggling at home. GPs only see them as they present in their clinics, so they sometimes don’t get a full picture of how the patients are coping.

“They often fool their children and their doctors until a crisis occurs, at which point everyone looks back to see the tell-tale signs that they missed,” says Warren Hurst, executive officer at home-care service provider Jewish Care.

When to consider aged care services

Signs that a patient may need home care include decreased cognitive function, increased shortness of breath, a recent illness or hospital discharge, marks from recent falls, or looking unkempt or less steady on their feet, Mr Hurst says.

Further red flags include signs that the patient isn’t socialising or is isolated, has reduced mobility or activity levels, and if they need help with managing medication or a chronic disease, Ms Adami says.

Mr Hurst adds: “It can help if GPs can get the patient to contact an organisation like Jewish Care so they can find out what help is available. They are often surprised at how friendly the staff are and can see the benefits of accepting some support.”

Dr John Parikh, head of the RACGP specific interest group on aged care, agrees.

“Doctors are trained to understand a patient’s requirements. All they really need to do is to confirm what they are thinking by asking the patient,” he says.

“They also need to find out what the patient’s relatives and other carers are doing.”

And once receiving home-care assistance, having regular communication with these service providers can really help GPs in co-ordinating their patient’s care, which can often also involve geriatricians, psychiatrists, physiotherapists and podiatrists, Dr Parikh adds.

Asking some open-ended routine questions can provide better insight into a patient’s circumstances, especially if the GP doesn’t know them well or is seeing them for the first time.

These questions could include:

  • How are you coping at home?
  • Have your circumstances changed?
  • Have your carers’ circumstances changed — for example, have they become exhausted or overwhelmed by their responsibilities?
  • Are you still able to manage your own cleaning, cooking or dressing?
  • What are your plans for future living arrangements or care?
  • Do you know that you may qualify for a government-funded home care package?

GPs can claim MBS items 701 (brief), 703 (standard), 705 (long) or 707 (prolonged) for these more in-depth assessments.

 

To find out more about Catholic Healthcare’s Home and Community Services such as personal care, transportation and more, call us on 1800 225 474