Navigating the My Aged Care system

Navigating the My Aged Care system
John Keighran is an active Peer Support Volunteer based in South Australia. In this article John shares his insights into navigating the My Aged Care system and tips about ways of making this funding stream work for you.

I am now 79 years of age and as I was over the age of 65 when my medical problems occurred, I was not eligible for the National Disability Insurance Scheme (NDIS). Instead, I am covered by the My Aged Care scheme which, while it has greatly assisted me, certainly has tested my patience! The main thing to accept and understand is that nothing happens overnight with My Aged Care. The Federal Government’s My Aged Care scheme only commenced in July 2013 and it’s definitely still experiencing teething problems, which I believe is due to the large and unexpected number of people seeking support packages. There are two packages available – the Commonwealth Home Support Programme and the Home Care Package.

After my first surgery in July 2017, where part of my left foot was amputated, I was ACAT (Aged Care Assessment Team) assessed. A Home Support Assessor from My Aged Care visited me at my home and completed the necessary documentation. I was recommended for a Level 2 Home Care Package. There is a ‘waiting list’ for approval of packages and in the meantime on the 15th of August 2017 I was approved for the Commonwealth Home Support Programme (which is support that is less than offered in a Home Care Package). ‘Referral Codes’ were provided so that I could access services such as ‘goods and equipment’ and ‘home maintenance’ supports pending approval of my Home Care Package.

On the 18th of September 2017, I received advice from the Aged Care Assessment Team that I could access Residential Respite Care at a ‘High Level’ and was also placed on the national queue for access to a Level 2 ‘Medium Priority’ Home Care Package. Fortunately, I have not required any Residential Respite Care but it was available should I have needed it.

Subsequently in November 2017 I underwent a second amputation, this time my left leg below the knee. I was informed that this type of amputation would probably place me at a Level 3 Home Care Package (at this stage I had not even received advice that the Level 2 package was available.) The social worker at the rehabilitation centre that I was attending completed the request for re-assessment at Level 3. I received advice on the 7th of May 2018 that I was eligible to receive a Level 3 ‘Medium Priority’ Home Care Package and again placed in the national queue.

On the 4th of December 2018, I received a letter advising that I had been assigned a Level 2 Home Care Package. The package was lower than the level approved but would enable me to receive some home care services and, meanwhile, I would stay in the queue for a Level 3 package. I was also made aware that depending on my income and assets assessment I would potentially need to co-contribute to the cost of services.

To access My Aged Care funded supports I had to select a provider and enter in to a ‘Home Care Agreement’ with a service provider. My social worker suggested some providers that had vacancies on their books for cleaning staff and gardeners. I knew nothing about providers and was willing to have discussions with one that I knew had vacancies.

When choosing a provider it is essential that you take into account your needs, especially if you have special requirements (such as dementia, lack of mobility, speak another language etc). The types of aged care services that you require can be negotiated and you can ask for a quote on what each service will cost. You should also ask about exit fees should you later wish to change providers and request information about complaint procedures – and it’s good to do this before you enter into a Home Care Agreement.

I was able to find out through an income assessment, which you can get from Centrelink, what level of co-contribution I would need to pay for services. I was informed that the two basic fees that I might be required to pay were a basic daily fee and a care fee. The daily fees could change over time, such as when increases are made to the Age Pension or if my circumstances change. The basic daily fee and the income-tested care fee are paid for every day that a Home Care Package support service is assigned, irrespective of whether any service is, or is not, received on a particular day. These fees are paid by you to your provider on a fortnightly or monthly basis, depending on what your provider requires.

The provider will also deduct an administration fee from your funding package. These services may be identified as ‘Care Management’ or ‘Advisory Services’ and you are entitled to ask for details of what the administration fee covers. Providers supply a monthly statement to each client so that it is easy to see where your funds have been spent and how much remains in your package.

My Level 2 package was in place by early 2019, and my selected provider then allocated a case manager to assist me.

On the 17th of December 2019, I received advice that I had been assigned the higher-level package (Level 3). This would enable me to receive some additional home care services. As you can see, it’s clear that receiving a My Aged Care package is not immediate and that there is a waiting time depending on the priority allocated to each case (i.e. medium, urgent etc). The priority for each case is rightly determined by the treating medical experts. And your provider may arrange for an occupational therapist to visit, to evaluate your needs and ensure your safety.

The information on the website for My Aged Care is very comprehensive - The staff are also responsive should you need to call - 1800 200 422. And, while it seems complicated the system does get easier to navigate over time.

So the system is fair, the Commonwealth Government determines the services and supports that can be covered (e.g. assistive technology, home modifications, shopping, gardening) and what is not covered (e.g buying food, payment for permanent accommodation, entertainment activities). I am still learning about assistance that is available to me in my package. Basically, the idea of My Aged Care is to support people to stay in their own homes for longer and the packages provide assistance to ensure that goal is met. Always discuss any concerns with your case manager and obtain prior approval for any purchases of aids or equipment that you might require.

Some examples of supports and services I have received funding for include:

  • rails on the walls where there are steps
  • rails to assist me to access my backyard
  • ramps
  • anti-slip mats for the shower
  • gardening and lawn mowing
  • house cleaning, and occasional window cleaning and spring cleaning.

If you are a wheelchair-user, modifications to the house might be required to enable access to toilets, showers etc. Some clients may require personal care, assistance with shopping, transport to attend appointments, nursing services etc. An occupational therapist has recently assessed me for a number of aids including a new wheelchair (I had been using a borrowed chair) and an electronic lift-up chair.

As at May 2021 the annual amounts that apply to each package levels are:

  • Level 1 (basic care needs): approximately $9,000
  • Level 2 (low level care needs): approximately $15,750
  • Level 3 (intermediate care needs): approximately $34,250
  • Level 4 (high care needs): approximately $52,000

These amounts are paid to your provider. It is then their task to then provide care so you can remain independent, safe and living in your own home.

It’s important to note that a Home Care Package terminates should you enter into a nursing home, as it’s deemed you do not require support in your home anymore.

I hope my experience helps to explain some of the basic My Aged Care processes, and how it’s helped me. But always remember to contact the My Aged Care team to discuss your individual needs and situation.