Aged care: Guide to self-managing home care

The CHSP often includes things like community transport, cleaning, meal delivery, meal preparation and help with showering.

A care needs assessment is required – by health professionals under the Regional Assessment Service or RAS – but there is no financial assessment to determine how much you should pay for your services under the CHSP.

Approved service providers receive different pots of government money for different services. Not every provider can offer more than one service.

What do Commonwealth Home Support Program (CHSP) services cost?

For each type of service there is a standard (maximum) fee, a part pensioner discounted fee and full pensioner discounted fee.

Self-funded retirees pay the standard fee, which is an amount up to the full cost of the service delivered to the care recipient as determined by the provider.

Examples of discounted fees for part pensioners and pensioners might be $10–15 an hour for a cleaner, someone to take you shopping or to assist with showering.

Depending on the service, the standard fee set by the provider may be close to or more than you would pay if you found someone privately, such as through word of mouth.

Many people could and do remain at home for years getting highly subsidised support services under the CHSP while paying very little. They might top up the care they need by paying privately for additional services they can’t access efficiently through CHSP.

According to the Department of Health, the average spend by the 800,000 CHSP users is about $2,600 a year. While about half use one of the CHSP service types (domestic, transport, personal care), about 6% use five or more.

Depending on a person’s care needs and the number of services received, they may find themselves dealing with more than one provider.

In some cases, quite a high degree of coordination of services may be involved. There is also the possibility that the provider’s CHSP funding runs out and they are unable to guarantee the same level of service for as long as a person may need it.

What CHSP services are available?

Commonwealth Home Support Program services provided in the community may include:

• Social support – social activities in a community-based group setting
• Transport – help to get out and about for shopping or appointments

Services provided at home may include:

• Domestic assistance – household jobs like cleaning, clothes washing and ironing
• Personal care – help with bathing or showering, dressing, hair care and going to the toilet
• Home maintenance – minor general repair and care of your house or yard, for example, changing light bulbs or replacing tap washers
• Home modification – minor installation of safety aids such as alarms, ramps and support rails in your home
• Nursing care – a qualified nurse comes to your home and may, for example, dress a wound or provide continence advice

Some CHSP services can be provided either at a community centre or in your home. 

These can include:

Food services

If you are finding it difficult to prepare meals, services may include meals at a community centre, help with grocery shopping, preparing and storing food in your home and delivering meals to your home.

Allied health support services

If you have particular health problems, for example with speech or walking, or need help with ongoing problems resulting from an accident or illness, you may be able to access allied health services. They include:

• Physiotherapy (exercises, mobility, strength and balance)
• Podiatry (foot care)
• Speech pathology
• Occupational therapy (help to recover or maintain your physical ability)
• Advice from a dietitian (healthy eating)

What happens when your care needs increase?

In time, the services offered by the CHSP may not be enough for your needs. It is generally at this point a person is assessed for a Home Care Package.

There are four levels of Home Care Package*:

• Level 1: Basic Care. Total annual budget $14,242
• Level 2: Low Care. Total annual budget $22,260
• Level 3: Intermediate Care. Total annual budget $43,627
• Level 4: High care. Total annual budget $64,025

*Budgets current as at July 2023

These budgets include the annual basic care fee of between about $3900 and $4400 per year (between $10.88 and $12.14 per day depending on the package level), which the government expects everyone to pay.

Once a person has been approved for a package they must wait until one is assigned.

There are still thousands of people waiting for a Home Care Package at the level for which they were approved for. However, the current wait time for a package at possibly a lower level than the one approved for has been reduced to about six months from 12 months.Once you are assigned a package you must find a government-approved service provider to administer it and arrange the delivery of requested services.

What will I pay for a Home Care Package?

Unlike the CHSP, Home Care Packages are income tested, with fees applicable for a package holder whose annual income is above a $31,140.20 threshold for singles or $24,117 for each member of a couple.

The most you can be asked to contribute towards your package as an income-tested fee is $12,682.70 a year, with this same capped income tested amount applying for each package level.

A further expense is the administration and case management fee charged by the chosen provider, which is capped at 35% of the Home Care Package budget.

The case management fee (now capped at 20% of the package) is to cover the cost of regular home visits to ensure your needs are being met, coordinating all the services, finding suitable carers, responding to requests for equipment purchases or changes to any schedules. The package management fee (capped at 15%) is to cover the cost of administration.

Given the choice of whether to pay more for possibly not much more help, anyone on a lower-level package paying an income-tested fee often has no real incentive to switch from the CHSP to a Home Care Package.

However, it is often the case that those assessing you for a higher-level package will be looking to see if you are using the funds already allocated.

The benefit of being allocated a Home Care Package is that the money is allocated to a person, supposedly to spend on the goods and services needed to remain independent in their own home.

It is run as consumer directed care – where ideally the consumer gets to make the call on what’s provided, by whom and when.

Self-management of home care

For many, the sure way of saying who comes into your house when it suits you is to handpick someone and negotiate directly how much and when.

The self-management of Home Care Packages for aged care is slowly gaining momentum. It is something that the disability sector has had for a while now under the National Disability Insurance Scheme.

Anyone allocated a Home Care Package must still sign a service agreement with a provider to access the money.

There are four main self-managing providers – Home Made, Trilogy Care, Empowered Aging, Local Guardians – although some full-service providers may offer a level of self-management.

Fees range from 8% (plus a $500 fee) to 15% of a Home Care Package and the providers will help you design your care plan and budget.

The idea is you find your own workers either through one of the online platforms, such as Mable or Hireup, or other networks such as friends and neighbours or allied health providers.

Often the rates set by the individuals will be lower than those charged by providers, which combined with a low administration fee and no case management fee leaves more to spend on care and services.

It is up to the approved provider as to who they will pay on your behalf and most will insist they have an Australian Business Number, police check and insurance.

Workers found on the online platforms will have all of these, due to it being a condition of joining the platform. Most workers on the platform will also have references that have been checked.

The fee you pay covers the cost of compliance, financial reconciliations and government reporting.

How does self-management work?

Once you choose a provider, this is what happens:

• The provider prepares a care plan and a care budget based on the approved package
• When you have an expense (such as a new walker) or care worker invoice you may need to check with them to make sure it will be paid
• You hire the care worker, or cleaner, or purchase equipment as needed
• You collect invoices, receipts and supporting documentation if required
• You email (or send) the invoices or receipts to the provider, or you may arrange for your support worker or service to invoice the provider directly
• The provider will assess your month’s claim against allowable costs in your care plan and check available funds
• The provider will reimburse you by transferring money into your bank account, or by paying your supplier, as per your instructions
• Payments and reimbursements are limited by the funds available in your client account
• The provider will send you statements explaining payments and reimbursements, their fees, received government subsidies and the running balance of your care funds. Your monthly statement will indicate what funds you have available and therefore how much you can claim the following month.

What are the potential savings of self-managed care?

The table below provides examples of the costs, benefits and hours of care of Home Care Packages (Level 2 and Level 4) for aged care delivered by most providers compared with self-managing your Home Care Package.

Level 2	Most providers	Self-managed
Government subsidy	$18,063*	$18,063*
Income-tested fee	$10,000	$10,000
Package management fee	$5,650	$2,400
Available funds to spend	$12,413	$15,663
Service cost per hour	$70/hr	$50/hr
Hours of care per week	3 hours	6 hours

Level 4	Most providers	Self-managed
Government subsidy	$59,594*	$59,594*
Package management fee	$20,857	$8,900
Available funds to spend	$38,737	$50,694
Service cost per hour	$70/hr	$50/hr
Hours of care per week	10 hours	14 hours

*Government subsidy is an estimate