Country to Coast Home Care Services says its quarterly Support at Home care management funding runs out after approximately six weeks. The calls, reviews, risk assessments and coordination its clients need continue for the remaining six.
“Providers can then choose either to absorb the costs or reduce the level of coordination available to participants. Neither option is sustainable,” Managing Director and Founder Lucy Lincoln said in a statement.
Lincoln will raise the issue at Ageing Australia’s inaugural Parliamentary Engagement Program in Canberra on 14-15 October, calling for funding that reflects the work required to coordinate care safely.
How Support at Home care management funding works
Under Support at Home, 10% of each participant’s quarterly budget is allocated to a pooled care management account at the provider’s service delivery branch.
The pool lets providers direct more resources to participants with complex or changing needs. But the allocation remains fixed, even when workloads increase.
Care management includes:
- Assessments
- Care planning
- Reviews
- Service coordination, monitoring, and communication with families and health professionals.
Lincoln stressed that these activities shouldn’t be confused with general business overheads.
“Our business operating costs are not funded through care management and are built into service pricing.”
Providers report care management shortfalls
Country to Coast is not alone in reporting a shortfall.
UnitingCare Australia told the Support at Home Senate inquiry that providers in its network were delivering unfunded care management while labour, travel and administrative costs continued to rise.
Ageing Australia estimates that care management costs average approximately 17% across the sector. It recommended increasing the allocation to 15% immediately, followed by a review.
The funding pressures extend beyond care management. Uniting NSW.ACT previously told Hello Leaders that gaps between assessed needs and funded support were placing additional pressure on providers, staff and service capacity.
They also warned that inadequate funding could limit providers’ capacity to accept participants with complex needs and contribute to workforce reductions, including registered nurses.
The pressure on care managers and support workers
With funding falling short, providers are finding ways to manage the workload.
Country to Coast has responded to broader Support at Home cost pressures by hiring offshore staff to assist with administration and governance. Lincoln said the arrangement lets its local team stay focused on frontline service delivery and client support.
But reducing administrative pressure doesn’t resolve the gap between care management funding and the work required.
Other potential responses include increasing care manager caseloads, changing workforce skill mix or reducing proactive coordination. Larger caseloads and fewer proactive reviews could leave less time to identify and respond to changes in participants’ needs.
Support workers may also feel the pressure. Often the first to notice changes in a participant’s condition or circumstances, they rely on effective care management to escalate concerns and coordinate an appropriate response.
UnitingCare Australia reported that workers were increasingly undertaking social work-type responsibilities without corresponding funding, while constrained care management was contributing to burnout.
What participants could experience
For participants and families, the funding shortfall may be less visible.
Instead, they could experience delayed reviews, less proactive monitoring, fragmented communication or more responsibility for coordinating services themselves.
The consequences are particularly relevant for participants with dementia, complex health needs or limited informal support.
Lincoln warned that reducing care management expenditure could shift costs into other parts of the health and aged care system.
“Reducing expenditure on care management and early support in the home may appear to generate short-term savings, but it increases the likelihood of preventable deterioration, carer breakdown, hospital admission and premature entry into residential aged care.”
Don’t keep your Board in the dark
When care management costs exceed the available funding, boards need visibility of how the shortfall is being covered and what that means for staffing and service delivery.
That includes tracking unrecovered staff time, care manager caseloads, workforce pressures and any changes to the organisation’s capacity to support participants with complex needs.
For providers already absorbing these costs, the longer-term concern is whether they can maintain current levels of care coordination without putting further pressure on their workforce or finances.
