Home | Opinion | Why aged care providers should be fired by aged care clients: opinion

Why aged care providers should be fired by aged care clients: opinion

For too long aged care services have focused on balancing budgets while compromising on client care. Unfortunately, the way funding is allocated and providers are evaluated has incentivised a budget-driven mindset, whereas I believe a person-centred model would provide better outcomes overall.

A person-centred approach would facilitate a firing and hiring process of providers based on the care given to clients which leads to each individual client’s outcomes becoming the focal point of the system.

The root cause of many problems

All of you would be familiar with Home Care Packages (HCP) and the Commonwealth Home Support Plan (CHSP). Both funding sources have been designed to include as many clients as possible to maximise the budget, regardless of the outcomes for those clients.

The HCP provider usually brokers services en masse to large allied health providers. The problem is that the therapist who sees the client then becomes accountable to the HCP provider, not the client, because the therapist’s relationship is with the broker.

The care provided needs to only meet the minimum standards for that funding relationship to continue – there is no incentive to provide above average quality of care to the client.

CHSP is a block-funded model where companies will go to tender to receive a certain amount and in return deliver services to a certain number of clients.

Provider XYZ might receive funding for Western Sydney to the tune of $500K a year and, as a condition of that funding, they need to provide 4,000 services to people who are aged. The issue is that the money is provided more or less upfront to the CHSP provider so they are then obliged to seek out clientele to meet the funding conditions.

The client has a limited amount of providers they can receive care from because, due to those tender processes, they can only go to approved providers. But approved providers have a limited budget that may not be related to the total market of what people may need, but instead limited to what they’re able to provide.

As a result, the client is not at the centre of that care model – the budget conditions take priority.

In neither model is the client the centre of attention. Instead, it encourages inadequate or inappropriate care in order to shoehorn client into what’s available according to funding or services.

Client-led care must prevail and it starts with firing providers

The NDIS intends to flip these budget-centred models by giving client control over their care provider. When the client receives the funding and makes decisions, the care provider becomes directly accountable to that client – and I believe this is a much better model that incentivises higher quality care.

Accountability to the client should be a priority, not an afterthought. Therapists need to provide tailored, high quality care without the conditional relationship to funding that has plagued this provision in the past.

By changing the essential foundation and structure of how aged care providers work, I’m confident we can dramatically reverse many of the problems the industry faces with regard to the mismatch between what care the client needs and what care the client is able to access.

It should be expected and normalised that clients have the ability to fire their providers if they are not being given a standard of care which they deserve.

Encouraging our aged care client to demand better services and expect more from their providers will drive the change the industry requires.

We’ve become very selective with our partners. If we are approached by people who are only interested in taking a large part of the funding and providing little to no oversight for quality of care, they’re not the partner for us.

We prefer to be given full control and autonomy, with a direct line to the client, so that we can provide as high quality care as we can. Minimising the middleman in the relationship is the only way to incentivise quality person-centred care.

Jonathan Moody is the founder and CEO of Physio Inq.

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3 comments

  1. Marilyn Lawson-James

    I totally agree. As a community support worker I see this imbalance all the time. We are only allowed to do what us on the car plan, so if a client needs their rubbish bin put out, we are not allowed to, though most of us will, only we don’t put that in our notes. This is only one example of many. Clients want to ” just go out for a drive”, but we’re not allowed. I see this as not caring for the client’s overall health but covering our (the company’s) butts in case anything goes wrong. Many don’t have families to take them out so the only time they get to go out is when they go to a doctor etc. What a boring existence.

  2. Although I agree with the comments in this article, and believe that, as much as possible, the client should be given control over their funds and their care providers, there is another issue which also needs to be considered. When a client needs several providers and if/when their cognitive capacity is diminishing, there is much to be said for having a sensitive and caring case manager who can help to organise care and advocate on behalf of their client. It may be possible for a family member to exercise this role, but if this is not possible, there is a risk that a client may be persuaded by care providers to accept a range of services which serve the interests of the providers more than it does those of the client.

    • Hi Maria, this is a wonderful and valid point. Case managers are vital, and a system of pay for service is definitely needed as part of the oversight of the system. Nothing worse than clients bouncing around in a vertically integrated business with potentially unnecessary supports. Coordinators when necessary can hold a special place in the framework.