Home Care Package provider webinar – program inclusions and exclusions

This webinar is for Home Care Packages providers and peak bodies.

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Recording and Transcript

52:49

Julia Atkinson:

Thank you for joining us today for the Home Care Packages Program Inclusions and Exclusions Provider Webinar.

I would like to acknowledge the traditional owners and custodians of the vast lands on which we meet today and pay my respects to Elders past, present and emerging. I am presenting to you today from Ngunnawal country. I would like to extend that acknowledgement and respect to any Aboriginal and Torres Strait Islander peoples joining us today.

My name is Julia Atkinson and I’m the Acting Assistant Secretary of the Home Care and Assessment Branch in the Department of Health and Aged Care. My branch manages the day to day running of the Home Care Packages Program including the National Priority System and program policy such as improved payment arrangements and price capping. I’m also responsible for the Aged Care Assessment Program and Regional Assessment Services.

I’ll be your main presenter today but I’ll also be joined a little later on by Stephanie O’Halloran who is the Director of the Home Care Operations section and she’ll co-present with me and she’ll be on board to answer some questions that you have submitted to us ahead of the webinar.

Many thanks to all of you who have submitted questions in advance. It’s put us in a great position to be able to identify the most frequently asked questions and make sure we cover them today.

Before we get into it I just want to say that today’s webinar is intended for providers, their employees and provider peaks and we’ve tailored it as such for that audience. Obviously if you’ve joined us in this webinar and you’re not a provider you are most welcome to stay but just please note the content is geared toward a provider audience.

If you are an older person in home care or have a family member in a Home Care Package I would also encourage you to register for the Older Persons Advocacy Network’s webinar on the 18th of April which will cover a similar topic but looking at it from the perspective of a care recipient. You can register for that webinar on the OPAN.org.au website under the ‘Events’ tab. I will be a part of the panel for OPAN’s webinar and I will discuss inclusions and exclusions and what price caps mean to home care fees.

So in terms of our agenda for today firstly I will cover the purpose of the webinar and give you a brief program overview, then I’ll talk about the Program Manuals and the consultation that was undertaken by my branch over several months leading up to the updates.

This will be followed by us talking about the program’s legislation and the legislation underpins how program funds can be spent so it’s very important that we understand that context. We’ll then cover some general information on inclusions and some general information on exclusions before moving on to frequently asked questions. We’ll also talk about our upcoming communications and next steps.

[Visual of slide with text saying ‘Program overview’, ‘The policy intent of the HCP Program’]

So the Home Care Packages Program provides coordinated care and services that help older Australians with complex ageing related care needs to live safely and independently in their own home for as long as it is safe and appropriate to do so. The Home Care Packages Program is not an income support program. It is not a medical or dental program and it does not take the place of other Government programs such as the aged pension, the Medical Benefits Scheme, Pharmaceutical Benefits Scheme or the Federation Funding Agreements for the hospital and dental system.

To be eligible for a Home Care Package Australians must be over 65 or for First Nations people they must be over the age of 50 with some exceptions. Exceptions to the age cut offs include for younger people or people with disabilities not otherwise supported by other programs and persons on a low income who are homeless or at risk of becoming homeless aged 50 or over. This age drops to 45 if it is a First Nations individual who is also under these circumstances.

Providers have a responsibility to determine whether services will maintain the care recipient’s capabilities to be well and independent, safe in their home and connected to their community. Common care and services under the Home Care Packages Program include but are not limited to personal care, nursing, cleaning and household tasks, light gardening, in-home respite care and care management.

The emphasis in the Home Care Packages Program is on supporting age related functional decline. And what do I mean by that? Age related functional decline can be defined as a reduction in ability to perform activities of daily living for example self-care activities due to a decrease in physical and/or cognitive function associated with ageing. Age related functional decline if not supported appropriately can result in under-nutrition and dehydration, decreased mobility, loss of independence, accelerated brain loss, delirium, depression, pressure ulcers and skin tears and incontinence.

I want to emphasise that while the program is primarily intended to support complex ageing related needs the program may also support an older Australian’s disability related needs if they are not eligible for the NDIS. It can also support some younger people with a disability who are ineligible for other Government programs.

We have heard that providers are interpreting the recent updates in the manual as excluding the care needs of people with disabilities in some cases and so I really want to emphasise that care recipients with non-age related disabilities will be eligible for the same common care and services that other program users are eligible for if they cannot receive these supports and services through other programs like the NDIS. This is because those care recipients have entered the program with a valid aged care assessment and they have an approval from an ACAT and this has identified that their disability needs are either exacerbated by ageing or consistent with age related decline.

This means it would be most appropriate for the Home Care Package to fund care and services for the cohort which could include things like hydrotherapy to support dexterity goals, specialised foods to support nutrition and hydration goals and motorised wheelchairs or scooters to support mobility goals. There are a variety of reasons why people may not be eligible for the NDIS. For example they may have acquired their disability when they were over the age of 65 and that makes them ineligible.

Home Care Packages can also support some chronic disease management in recognition that diseases such as diabetes, heart disease, osteoporosis and COPD can be exacerbated by ageing. Supports for these individuals could include allied health services however we would point out that other avenues such as the Medicare funded Chronic Diseases Management Program should be used first. A Home Care Package can be used to supplement these supports.

If managing a care recipient with a chronic disease it is crucial to note that the Home Care Packages Program does not replace hospital in the home services. Specialist services such as tracheostomy supports would be an exclusion as they’re funded through other programs. Plus devices installed and monitored by a specialist medical practitioner like a pacemaker or a cochlear implant are excluded for the same reason.

[Visual of slide with text saying ‘Program Manuals’, ‘When and how are they updated?’]

I’m now going to pass over to Stephanie O’Halloran to talk about the Program Manuals and the process leading up to the January updates. Over to you Stephanie.

Stephanie O’Halloran:

Thank you Julia. Since the publication of the Program Guidelines in 2013 iterative changes have continued to be made to the Home Care Package Program guidance. Manuals are living documents updated from time to time to either respond to program changes or in response to your feedback. For example the 2013 Program Guidelines were replaced by the more detailed 2020 Manuals. Then subsequent consultation from 2021 culminated in the publication of the most recent 2023 Manuals. This was because while the 2020 versions of the Manuals provided greater clarity compared with the 2013 Guidelines both providers and care recipients continued to voice their confusion and frustration seeking more detailed guidance on what a package could be spent on.

Consultation on Manual updates. Our consultation journey took over 18 months to get to where we are with the released Manuals in January. It included the establishment of a Home Care and Assessments Operation Working Group which met monthly to discuss operational issues, membership including the Department, Aged Care Quality and Safety Commission, OPAN, COTA, National Seniors, ACCPA, or Aged and Community Care Providers Association, providers and care recipients.

Also some of you may recall we circulated a draft Manual in February 2022. In response to this we received 60 submissions and what we saw in this feedback were gaps in understanding of the legislation underpinning the program by both providers and consumers. We also undertook an assurance review of indirect and care management charges in the HCP Program in 2022. This review found that a significant proportion of home care providers had potentially funded excluded items and these excluded items included TVs and entertainment subscription services, air‑conditioners, kitchen appliances, holidays, non-specialised furniture, significant gardening expenditure over one month, using home care funds to cover contributions for permanent or respite care in a Commonwealth subsidised residential aged care facility, large household maintenance or renovations that were not specific to accessibility or age related functional decline, medicine and grocery charges.

We also in addition to this gathered feedback on a daily basis through the enquiries and Ministerial correspondence that my team receive on the program. To provide some context on enquiries and Ministerial correspondence last year we received over 1,400 pieces and we used the information in those letters to feed into the updates into the Manual. Furthermore we consulted internally with Departmental experts. So this included the Office of the Chief Nurse and Midwifery Office and Departmental dieticians and allied health professionals.

So what were the Manual updates?

So the outcome of all this consultation was that on the 13th of January 2023 we released updated Manuals and it clarified inclusions, exclusions, but also capping on care and package management charges, pricing guidance, unspent funds, interface with other programs such as residential care and palliative care and also the introduction of the Serious Incident Response Scheme which had come into effect back in December 2022.

However inclusions and exclusions remains the most frequently asked question.

Feedback. As I said before Manuals are living documents. Since the January updates we have once again begun the process of capturing all the feedback on the Manuals from a variety of channels. So this includes the questions that you submitted to us when you registered for this webinar today and thank you for that. Also many of you are using the Slido function to post follow up questions and please continue to do so. We will then carefully read through every comment to assist us with continuous improvement in our communication products.

Just for analysis or summary of the information that has come to our attention, so far we’ve in my team alone received 140 enquiries on inclusions and exclusions. That’s since January. Plus 70 pieces of Ministerial correspondence. And we’ve also participated in several provider forums and spoken to many providers directly too. We participated in the live question and answer Community of Practice or COP. And if you have not come across the COP yet we will make sure to send through a link in a frequently asked questions document which we will publish later this week.

Through all these channels once again it is evident on the need for more education to support you as providers to provide care and services in line with policy intent. And so as mentioned we will develop a detailed frequently asked questions or are in the process of developing and we will release it post this webinar to support you. So Julia and I will later speak to some of the frequently asked questions asked today as well. We also want to let you know that we will continue to make iterative updates to the Manuals to add more detail where needed to counter any confusion and ensure you have the best resources available to support you.

Back to you Julia.

[Visual of slide with text saying ‘Legislation’, ‘Inclusions and exclusions are established in legislation’]

Julia Atkinson:

Thanks Steph. So the next section I’m going to speak briefly about the legislation. It’s important to talk about this because we get this question why is this so important? Why is it important that providers and consumers are using package funds on inclusions and not exclusions? Why did the Department write this into the Manual at all and why can’t we simply purchase what people want with their package funds? The reason is that it’s legislated. So the Home Care Packages Program, it’s governed by the Aged Care Act 1997 and the Aged Care Quality and Safety Commission Act of 2018. Home care providers have a responsibility to ensure that Home Care Package funds are used in line with the legislation.

So in the Program Manual you’ll find that it does outline the legislation and it sets out the three types of legislation. There is the principal legislation which is the overarching law enacted by Parliament, the legislative instruments – these are subordinate legislation and they cover more detail on how the program operates – we also have determinations and those are instruments that the legislation enables and it gives us scope to further clarify specific facts and details about the program. Providers have a responsibility to be compliant with all levels of legislation not just the primary Act.

Inclusions and exclusions sit under the Quality of Care Principles 2014 while other aspects of the program such as the Home Care Agreements and pricing transparency are under the User Rights Principles of 2014.

So you might be wondering what the legislation says and there’s a link on the slide here. You can go and have a look if you are somebody who finds legislation interesting which would be a rare case but you never know. And there is an excerpt on the slide out of the Quality of Care Principles. The precis and points for this conversation, Quality of Care Principles describes the care and services that must be provided and Part 3 of the legislation outlines that a package must include care management and it must include at least one service from the inclusions list. And this covers off the common care and services such as nursing domestic, support, allied health, mobility and dexterity aids and light gardening. This section also outlines that other care and services can be included in the package as well but only if these other care and services are not on the legislated exclusions list and if such services can be provided within the resources available, so within the limit of package funds.

The legislation also states that the use of telehealth and digital technology such as remote monitoring can be considered an inclusion under the package as well.

It also states in the legislation that the care and services must be consistent with the care plan and must comply with the Aged Care Quality Standards.

In Schedule 3 1.1 of the Quality of Care Principles there is further detail about the care and services that can be provided. The following services are listed as inclusions. Personal services such as bathing, grooming and dressing, activities of daily living such as assistance with cleaning spectacles, assistance with nutrition, hydration and meal preparation and diet, management of skin integrity, continence management, mobility and dexterity supports such as providing a quadruped walker.

Part 1.1A specifies the requirements of care management and mandates that this is a service that all providers must provide. Schedule 3 Part 1.2 outlines the supports that may be provided based on assessed needs and Schedule 3 Part 1.3 outlines the clinical services that may be provided. Schedule 3 Part 2 outlines the excluded items.

[Visual of slide with text saying ‘Inclusions’, ‘Supports and services covered by the program, if aligned with assessed care needs’]

So we’re commonly asked how does a provider identify which services are included especially under the ‘Other Services’ category?

And so to support you in the first instance we’ve designed an inclusions and exclusions framework and this was published in the Program Manual in 2020. The inclusions and exclusions framework is intended to assist providers with the decision making process around other care and services. The framework is a flowchart and it’s on page 73 of the Provider Manual. There’s an excerpt on the slide which is a little bit small but it gives you an idea of what you’re dealing with and you can have a look at the full flowchart on page 73. There’s also a template in the Manual that providers can print off to use to document their discussions with their care recipients.

So the flowchart includes some simple questions that you can ask yourself and your care recipients when trying to determine if something is an appropriate inclusion of an ‘other’ service. The questions include things like how does the support align with the intent and scope of the program? How does the support align with the assessed care needs of the individual? How does the support balance risks, costs and benefits and what alternative supports might exist, for example other programs or other funding sources?

So while the inclusions and exclusions framework is a good resource and we find that many providers are successful in using this we do acknowledge that providers have been unsure or hesitant about some certain exclusions. And I want to cover off on three particular ones today where we’ve had a lot of recent questions. This includes specialised foods, allied health and goods, equipment and assistive technology which we tend to refer to as GEAT. And so I’ll take you through a little bit of detail so that you can understand what is possible and appropriate to use package funding for under these items.

So you may recall that earlier we talked about in the legislation part of the inclusions list is assistance with nutrition and hydration.

This does include the provision of specialised foods. Specialised foods are substances listed under the Food Standards 2.9.5 Food for Special Medical Purposes. And it may also include some substances listed under 2.9.3 Formulated Supplementary Food. These are foods that are prescribed by a treating health professional such as a dietician or GP for age related conditions like dysphasia or cognitive impairment. These products are designed to address situations where the intake of energy and nutrients may not be adequate to meet an individual’s requirements and are intended for the dietary management of a disease, disorder or medical condition that cannot be achieved without the use of this item.

Some examples of specialised foods that are allowed under the Home Care Packages Program include Resource Plus, Ensure Plus, Nepro LP, Nutren Diabetes, Glucerna Triple Care can and Resource Thicken Up. By law these products must be prescribed by a health professional operating within their scope of practice and must only be consumed under medical supervision. Other substances such as Sustagen Hospital which is listed under Standard 2.9.3 when prescribed by a treating health professional may also be provided.

Allied health. So allied health is an inclusion under the Home Care Package Program. Services such as podiatry, physiotherapy, chiropractic and hydrotherapy are included and they may be included for people experiencing age related functional decline. They may also be included to support somebody experiencing disability related decline where they cannot access that support through any other program.

Allied health services can also be provided when they are required to assess the need for aids and equipment. They must be delivered by an accredited provider and they cannot concurrently be funded by another Government program. What I mean by that is you cannot use the package to pay for a gap payment but if there is no other funding available for example someone has exhausted their chronic disease management plan or are not eligible for that funding you can use the package for that item.

Allied health professionals must be registered with the Australian Health Practitioner Regulation Agency or AHPRA or are self-regulated by another national professional association.

So the next area that we do get some questions on is goods, equipment and assistive technology which is a program inclusion. And common GEAT items that we would see funded under the program include things like shower chairs, commode chairs, specialised eating utensils, enteral feeding equipment, mobility scooters, walkers and other mobility equipment.

If an individual has been assessed as requiring equipment for example a walker or a personal monitoring device it is important that providers teach them how to use the device correctly, and that training is also included. Providers should also factor in the maintenance and servicing costs within the package budget when they plan for the purchase.

I would like to emphasise that an OT assessment is not required for every single piece of GEAT although I acknowledge there are certain items that really should be assessed by an OT and this might include something like a mobility scooter. GEATs such as jar openers, long handled shower sponges and sock aids can be provided if consistent with the care plan and do not need to be prescribed.

If you’re unsure whether or not an OT assessment is required you may wish to consult the Assistive Technology Essentials Guide which was developed by Independent Living Assessment in partnership with Dr Natasha Layton of Monash University and this was developed as a quick guide for CHSP providers. While the document was developed with CHSP in mind it is also a useful guide for Home Care Package providers and we’d encourage you to take a look.

The Guide includes a traffic light framework which outlines what kinds of GEAT are considered low risk and do not need a prescription, which would be recommended to seek some advice from a trained professional on appropriateness and use and which are strongly recommended only to be used when prescribed by an allied health professional. Prescribed GEAT is generally higher risk and higher cost and could cause harm if used incorrectly or configured incorrectly. A link to this document is on my slide.

[Visual of slide with text saying ‘Exclusions’, ‘Supports and services NOT covered by the program, with some exceptions’]

So now that we’ve covered some of the commonly misunderstood inclusions I’ll move on now to some commonly misunderstood exclusions.

And I’ll come back to the legislation. The legislation requires that the following services must not be included in a package of care and services. And these include the use of package funds as a source of general income for the care recipient, purchase of food except as a part of enteral feeding requirements, payment for permanent accommodation including assistance with home purchase, mortgage payments or rent, payment of home care fees, payment of fees or charges or other types of care funded or jointly funded by the Australian Government, home modifications or capital items that are not related to a care recipient’s care needs, travel or accommodation for holidays, cost of entertainment activities such as club memberships or tickets to sporting events, gambling, payment for services and items covered by the Medicare Benefits Schedule or Pharmaceutical Benefits Scheme. And those are all legislated exclusions. An excerpt of the Quality of Care Principles is on screen now.

So next I’ll step through a few examples of excluded items where we have seen some confusion arise in the past.

We regularly get asked why we don’t cover medications in the program. Home Care Packages Program does not cover medicines. That is the role for the Pharmaceutical Benefits Scheme. This rule has been in place since the beginning of the program as the program is not a medications program. It’s important to distinguish between vitamins and supplements classified as medicines such as fish oil, fibre powder and magnesium under the Australian Register of Therapeutic Goods which are excluded and vitamins and supplements categorised as specialised foods such as Fortisip and Souvenaid which are regulated under the Food Standards Code some of which are included which I touched on earlier.

The definition of a medicine can also be extended to substances that seek to be registered on the ARTG but the substances’ efficacy and safety is indeterminate. These are excluded. The Australian Government already funds a multi-billion dollar Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme. Commonwealth funding for services and items under the oversight of the MBS or PBS is determined under these programs. Decisions on what should be funded in these programs and how much they should be funded are subject to relevant skilled advisory committees and lots of oversight. For this reason medicines that are not funded under the PBS cannot be funded under a HCP instead. Home Care Packages should not be used as a way to bypass these well-established mechanisms.

So what can care recipients do and how can providers support care recipients to access medicines especially if they’re not on the PBS? If there is no other affordable way for a care recipient to access the medicines they require their treating physician can consider making an application to the Drug and Therapeutics Committee of a local public hospital to request assistance with the cost of treatment. State and territory Governments assist with the cost of operating public hospitals and this can include assistance with the cost of medicines that patients may be unable to afford. Where a medicine is not listed under the PBS the medicine will have to be supplied as a private prescription for which individuals will have to pay full price. Pharmacies may charge differently for these non-PBS medicines so care recipients may wish to shop around. If a care recipient has private health insurance they may wish to contact their insurance provider and see if the cost of a non-PBS medication is covered under their current policy.

Another topic we regularly get asked about is heating and cooling. As I touched on earlier the program is not set up as a general income program. General household items are defined as services, goods or supports that people are expected to cover out of their general income throughout their life regardless of their age and therefore it’s not appropriate for these items to be funded under a Home Care Package.

This is outlined in the legislation. Heating and cooling costs or the installation, repair and maintenance of heating and cooling appliances are all expenses that people must pay throughout their lives regardless of how old they are and so they’re not directly related to ageing. There are alternative supports available. There is an energy rebate tool that provides a list of services that may assist with access to electronic appliances including a no interest loan scheme and there is a link to this tool on the slide.

Another topic we receive questions on are natural therapies. The Department is undertaking an ongoing natural therapies review looking at the clinical effectiveness of natural therapies. More information about the review is available on the Department’s website and you can see a link to that on my slide. Therapies under review include the Alexander technique, aromatherapy, Bowen therapy, naturopathy, reflexology and Tai Chi. These are alternative therapies that are not classified as allied health modalities by AHPRA or a Department recognised national board and therefore they’re exclusions of the Home Care Packages Program. Without sufficient evidence these natural therapies cannot be funded under Home Care Packages. However I will note one notable difference in this one. Yoga and Tai Chi, we recognise that there are some allied health professionals that use the movement patterns as a part of fall prevention exercises. In this context such therapies would be appropriate if they are being administered by an AHPRA registered practitioner.

So whitegoods, electrical appliances and general household appliances are also typically excluded under the Home Care Packages Program. Similar to heating and cooling if the purchase is unrelated to a person’s age related care needs then it is considered a general income purchase and therefore excluded. Examples might include refrigerators, televisions, microwaves. These are considered general income expenses. There are some exceptions for specific circumstances including for example items designed specifically for people experiencing frailty such as a tipping kettle. Where hygiene is impacted and support is required for laundering washing machines and driers can be considered to be provided if the care recipient suffers from permanent and severe incontinence.

Where a care recipient cannot afford whitegoods and other household appliances support may be available through state and territory Government rebates, Services Australia or through the no interest loan scheme that I mentioned earlier. Where a care recipient lives in state or territory Government subsidised housing the relevant jurisdiction may support access to subsidised whitegoods.

So cleaning and home maintenance, we do get questions about what constitutes minor or major cleaning and home maintenance so I’ll run through some of that now. Minor home maintenance is services that may be provided where the care recipient was previously able to carry out the task themselves but can no longer do so safely as they’ve become older. More extensive home maintenance such as home maintenance that would require a tradesperson, this is typically the responsibility of the homeowner. These more extensive home maintenance items would generally fall under general income expenses that Australians are expected to pay for throughout their life regardless of age. Examples of more extensive home maintenance that would not be included include replacement, maintenance, servicing and cleaning of water tanks, solar panels, fencing, roofs, hot water systems and swimming pools.

What’s the distinction between minor and major electrical and plumbing work? So minor electrical work would include things like changing a lightbulb, repairing a wire in a smoke detector or installing and fitting an emergency alarm with the exception of a smoke alarm and other safety aids and assistive technology. Those are included. Major electrical work is work that involves rewiring and would typically require a qualified electrician and are excluded. On the plumbing side minor plumbing would include changing a washer, unblocking a toilet, installing easy access taps, shower hoses or shower heads on a rail and those are included. Major plumbing works are those that exceed these examples and would typically require a trained plumber.

For cleaning, cleaning to keep the home safe and liveable is included under the Home Care Packages Program. Similarly to the other examples if it was cleaning the care recipient was previously able to carry out themselves but no longer can it can be included. For example if they used to clean their own windows but they no longer can because of their ageing related decline then that can be included. Other inclusions include things like dusting, vacuuming, mopping, making beds, ironing and laundry.

More specialised cleaning is typically excluded, for example carpet cleaning or cleaning of blinds. Some specialised cleaning may be provided in the following circumstances. If soft furnishings have been soiled due to severe and permanent incontinence specialised cleaning can be provided.

If there is a remediation of hoarding or providing one off decluttering and cleaning to ensure that the home is safe for both the care recipient and the home care worker entering the home this is included.

Care recipients can typically use their package for cleaning for light cleaning or the exceptions that I noted above if it has been an assessed care need, is documented in their care plan and is not already covered by insurance or other Government supports.

So this wraps up some of the big confusions we’ve had around inclusions and exclusions and we’d encourage providers to revisit their care plans with care recipients and Home Care Agreements to make sure that you’re meeting the legislative requirements of the program. If you find you’re providing excluded services you should cease this and discuss it with your care recipient in your next monthly cycle of account submissions.

[Visual of slide with text saying ‘Question & Answers’, ‘Commonly asked questions about inclusions and exclusions’, ‘Thank you for submitting’]

So I will next invite Stephanie O’Halloran back to the stage to join me for a section on some frequently asked questions where we’ll jump into a little bit more detail on some very specific things, and this will include some of the questions that we got through the registration process. So thank you again to everybody who engaged in that. So hi Steph. Welcome back.

Stephanie O’Halloran:

Hi Julia.

Julia Atkinson:

So the first question that we have is to get more specific on home modifications. Can you tell us more about what is and isn’t acceptable to be included as far as home mods are concerned?

Stephanie O’Halloran:

Yeah. Absolutely. So put simply home modifications or capital items that are not related to a person’s ageing related care needs are excluded under the Home Care Packages Program. So this is modifications for aesthetic reasons, for example more expensive tile choices, heated towel rails or replacement of flooring that’s non-slip. These items are excluded. Plus significant changes to the floorplan of the home such as adding a new bathroom or extension.

However Home Care Package funds may be used to pay for the clinical assessment and liaison between a clinician and builder/architect to ensure appropriate plans are developed to support a care recipient’s ageing related care needs and goals. So home modifications can be funded under the Home Care Packages Program in clinically justified circumstances. These include to improve safety and accessibility and promote independence, for example widening doorways for wheelchair access, removing shower hobs and installing an ambulant toilet.

These modifications may require an occupational therapist, physiotherapist or other health professional operating within their scope of practice to ensure the modification is fit for purpose. The home modification must be agreed with the care recipient in the care plan and they must be in line with the Building Code of Australia and be provided by qualified tradespeople with appropriate licencing and insurances as per your state and territory Government laws.

Thanks Julia.

Julia Atkinson:

Thanks Steph.

So the next question we have is about pets. We’ve had a lot of people who would like to know why are pet services excluded and are there any exceptions?

Stephanie O’Halloran:

So pets are considered general income expenses and they are excluded from the program. The exception would be if the animal is an assistance animal, assistance dog specifically. And if you look at this slide here we have the Health Direct website which is funded by the Australian Government and that has the definition of an assistance dog.

Sorry Julia.

Julia Atkinson:

Sorry Steph. I was going to say if someone has an assistance dog can they pay for the maintenance of that dog with their Home Care Package?

Stephanie O’Halloran:

Yes. So the provider would need to go through the inclusions and exclusions framework and establish that the maintenance costs for that assistance dog is not being funded by any other Government program and then it may be considered as an inclusion under those circumstances.

Julia Atkinson:

Great. Okay. Thanks for that. So the next question is around gap payments. Can the Home Care Package funding be used to cover the gap for other Government funded programs?

Stephanie O’Halloran:

No. This is a strict exclusion under the legislation. Gap payments cannot be funded. And this includes the gap payments for state and territory Government programs, for example the Victorian Government SWEP Program. Our program cannot be used to pay the gap. State Government delegates often have discretionary powers to support people who can’t pay the gap so I would encourage providers and care recipients to reach out to their relevant state or territory Government program to find out what support they offer.

Julia Atkinson:

Okay. Thanks. So coming back to gardening can you tell me a little bit more about what is considered light gardening as opposed to heavy gardening I suppose?

Stephanie O’Halloran:

Sure. So providers are required to maintain the home and garden in a condition of functional safety and provide an adequate level of security. Some minor light gardening services can be provided where the person was previously able to carry out the activity themselves but can no longer do safely. For example maintaining access and egress pathways through a property, lawnmowing, weeding of established garden beds, yard clearance where there are issues of safety and access, essential pruning for access areas.

More extensive gardening services are the responsibility of either the homeowner or the landlord or tenant. And so this would be maintenance of an entire garden. This is an exclusion. As is extensive tree or garden pruning, mulching gardens or installing raised garden beds. They are also exclusions.

Julia Atkinson:

So electronics like laptops or smartphones, can these be purchased if they’re specifically for social and emotional wellbeing?

Stephanie O’Halloran:

So laptops, phones and similar electronics are typically excluded under the program. Telephone and internet costs except for setting up the connection are also excluded.

There are exceptions for the purchase of IT equipment including tablets, laptops and internet subscriptions to help older people communicate with their providers, families, carers and social groups under the following circumstances. So if the person is at risk of homelessness, if the person requires medication management – and see page 68 of the Provider Manual for more information on that – or for social inclusion purposes. And that’s consistent with the Commonwealth Home Support Program noting in the Commonwealth Home Support Program or CHSP this support is capped at $500 per care recipient per year or up to $1,000 in exceptional circumstances. So when you’re running through the inclusion/exclusion framework then come to value for money this is a good comparator.

Julia Atkinson:

Great. Okay. So what about hearing aids? Are they included or excluded?

Stephanie O’Halloran:

So hearing aids are a unique case in the program. So you would recall when Julia took you through the excluded items if it’s already funded by the Australian Government it is excluded. So most care recipients hold pension concession cards and where a care recipient holds a pension concession card they cannot access hearing aids through the Home Care Packages Program. This is because they’re eligible for the Hearing Services Program and the Hearing Services Program is broader than the basic hearing aid. And so if a care recipient needs an upgrade please encourage them to see their audiologist and their audiologist can connect with a delegate of the Hearing Services Program.

Now the exception is because our legislation also covers hearing services as an inclusion self‑funded retirees or those persons on a part pension who do not hold a pension concession card may be able to access hearing aids through the Home Care Packages Program. But in order to do so the provider must run through the inclusion/exclusion framework and when you get to the value for money component consider what the Hearing Services Program pays for a fully subsidised hearing aid and a link to that will be published on our Frequently Asked Questions which we’ll release this week.

Julia Atkinson:

Okay. Thanks Steph. This is the last frequently asked question for today coming up. But as we said earlier we will take away all of the questions we’re getting on the Slido and aim to make sure that these are covered in our future communications. So the last question for today. What about remedial massage? Is this an inclusion or an exclusion from the program?

Stephanie O’Halloran:

Cool. So remedial massage is classified as an inclusion as it’s typically an allied health service.

However a person needs to have an assessed care need in order to access it. And again you would run through the inclusion/exclusion framework. So a care recipient can access remedial massage under the program when the service is required due to age related functional decline and cannot access disability supports in line with best practice guidance for the treatment delivered by an accredited provider and not currently being funded by another Government program.

Julia Atkinson:

Okay. Cool. So remedial massage okay if there’s an assessed care need and there’s an AHPRA registered practitioner. Great.

Stephanie O’Halloran:

That’s correct. Cool. Thank you so much Julia.

[Visual of slide with text saying ‘If you have further questions’, ‘Read the Frequently Asked Questions’, ‘Leave your questions on Slido’, ‘Email us on hcpmanualsfeedback@health.gov.au’, ‘4 April 2023’]

So as flagged we will be compiling a Frequently Asked Questions document to be released later this week. So we have the questions that you submitted prior to you entering this webinar when you registered. So thank you for that. But also hit up the Slido and continue to ask us questions and we’ll read through all those carefully.

[Visual of slide with text saying ‘Next steps’, ‘1. Read and share resources’, ‘2. Talk with your care recipients’, ‘3. Stay up to date’]

In terms of the next steps in addition to the communications activities we’re planning additional updates to the Manual including areas for exceptions to exclusions. So that’s going to cover the washing machine example that Julia alluded to earlier and we’re also going to clarify that where a care recipient is not eligible for another Government program for example due to disability care needs and they have been assessed as requiring aged care by an ACAT to support them with functional decline and activities of daily living needs their needs can be accommodated by the Home Care Packages Program.

So how can you stay up to date?

Look out for our FAQ document which we’ll be releasing this week. And we’re also going to be preparing a fact sheet for care recipients. So keep an eye out for that too. Plus today’s webinar for providers is being recorded and will be published on the Department’s website.

We’re also planning an event with OPAN for care recipients on the 18th of April. Julia will be a panellist at that webinar.

The panellists will be taking questions and looking to help people better understand what is and isn’t included under a Home Care Package and to empower them to have informed conversations with their provider. Plus we’ll continue to do more aged care newsletter updates, social media posts and the engaged consumer newsletter to promote various activities. And if you haven’t already done so we encourage you to sign up for the Aged Care newsletter and to sign up to the Engagement Hub.

Another resource is the Community of Practice. So if you haven’t already done so I’d definitely encourage you to sign up for that too where you can have discussions on all aspects of program management. Furthermore the Department is also planning a program assurance review in the second half of 2023 regarding inclusions and exclusions and this review will aim to take stock of how providers are applying the inclusions and exclusions following the updated guidance.

Over to you Julia.

Julia Atkinson:

Thank you Steph. So the last thing I want to just talk about briefly is we understand how important it is for care recipients to understand the scope of the program as well as providers do as we appreciate that a mismatch between expectations can really cause distress and confusion for everyone. And so again we’d encourage you to talk to your care recipients and share with them the additional resources that we will also be sharing through our channels. Let your care recipients know about the OPAN webinar on Tuesday the 18th of April from 1:00 to 2:00pm. Once released please share the care recipient fact sheet. And if you have been having questions that are outlined in the Frequently Asked Questions please share that as well. Have conversations with your care recipients if there is confusion about why a support is excluded and encourage them to subscribe to the monthly EngAged newsletter.

So that’s all from us today. Thank you so much for joining us. We really hope that you have found this information valuable and useful. We’d encourage you to rewatch the webinar if you like and get your colleagues to watch the webinar too if they are finding that they are involved in these conversations and are looking for more information. And if you want more information please feel free to reach out to us. So there is an inbox on the slide that comes to my team and Steph’s team and we endeavour to answer all of those enquiries in a timely manner. If you cannot find the answer in our Frequently Asked Questions please do reach out. We do our best to respond as best we can.

I will just quickly mention that when the webinar finishes today a short survey is going to pop up on your browser. It will take about a minute to answer and there’s three questions. We would really appreciate it if you could take a moment to respond to that one. It will help us improve our future webinars as we’re always in a constant state of wanting to get better at these post COVID and I hope you can give us some tips.

So with that that’s all we have for you today. Thank you so much again and have a lovely long weekend. Thanks everybody.

Presentation slides

Presenters

Julia Atkinson
Acting Assistant Secretary, Home Care and Assessment Branch, Department of Health and Aged Care

Stephanie O’Halloran
Director, Home Care Operations, Department of Health and Aged Care

About the webinar

The webinar covers:

  • general program scope
  • updates to the provider manual
  • clarification on inclusions and exclusions
  • advice for having conversations with care recipients on what can and cannot be covered
  • answers to common questions.

To accompany recent updates to the HCP Program Operational Manual: A Guide for Home Care Providers, we have published a Frequently Asked Questions fact sheet will support providers and care recipients to clarify what is included and excluded under the HCP Program.

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