Self-managing Support at Home: what you can do and what the provider still does

What does self-managing Support at Home mean?

Self-managing Support at Home means the older person, or someone helping them, takes on some of the day to day running of their services. That can include choosing workers, booking and scheduling services, and handling invoices. A registered provider still holds the funding and stays responsible for the care.

Self-management is not a separate programme and it is not all or nothing. The Department describes it as a way to get more choice and control over the services received, and the activities vary from person to person. One person might only want to set their own schedule. Another might choose every worker and pay every invoice.

Whatever is agreed has to be written into the care plan. The provider must agree to the arrangement, and spending is limited to services that are in the older person's support plan and on the Support at Home service list. For what the funding can and cannot pay for, see what you can spend Support at Home on.

Self-management changes who does the organising. It does not remove the provider.

What can you self-manage under Support at Home?

Under Support at Home, a participant can self-manage parts of their care that suit their needs, preferences and abilities. The Department lists choosing and coordinating services, managing workers and schedules, paying invoices and seeking reimbursement, managing the budget, finding their way through the aged care system, and sourcing assistive technology and home modifications.

The Department's list of self-management activities is:

• Choosing or coordinating services, according to needs and budget.
• Managing their own workers and scheduling services.
• Paying invoices for services delivered and seeking reimbursement.
• Managing their budget.
• Finding their way through the aged care system.
• Sourcing assistive technology and home modifications.

Each of these is optional. The older person and the provider agree which activities the older person takes on, and the care plan records it, including who is responsible for rostering. Anything not handed over stays with the provider.

Self-management happens inside the Support at Home rules. The quarterly budget, the classification from the aged care assessment and the service list all still apply. For how the eight classifications and quarterly budgets work, see Support at Home explained.

What the registered provider must still do

A self-managing participant still needs a registered provider. The provider receives the funding, develops the care plan with the participant, carries out care management every month, and remains responsible for every worker who delivers a service, including workers the participant chose. The provider can refuse an arrangement it cannot run within the rules.

The Department's guidance to providers sets out these obligations:

• Care plan: develop the care plan with the participant, including any self-management arrangements, before or when services start.
• Care management: deliver at least one direct care management activity each month, which means communicating or meeting with the participant or their registered supporter.
• Workers: take responsibility for all workers delivering services, including third-party workers, and make sure they meet workforce requirements such as worker registration.
• Compliance: meet all regulatory obligations. The Department tells providers not to agree to a third-party worker arrangement if they cannot meet these requirements.

Useful questions for this conversation are in questions to ask an aged care provider.

Does self-managing reduce the care management fee?

No. Self-managing does not reduce the care management amount. For ongoing Support at Home services, the Department deducts 10% of each quarterly budget for care management, and this applies whether or not the participant self-manages. The provider must still deliver care management activities to meet its obligations.

The 10% is a fixed deduction set by the Department, so it is not something to negotiate with the provider. For what happened to the old packages, see Home Care Packages: what happened and what replaced them.

What self-management can change is the price of individual services. Service prices must include labour, travel, consumables and administration. Where a participant uses a third-party worker under a self-management arrangement, the price is the actual cost of that worker plus a provider overhead capped at 10% of that cost. The overhead can be negotiated lower, and the total must be agreed beforehand.

Can you choose your own workers or a sole trader?

Yes, if the provider agrees. A participant can ask to use a third-party worker: an aged care worker who is not the provider's employee but is engaged by the provider to deliver a service. The provider engages the worker, directly or through an associated provider, and stays responsible for them.

This is how a known local cleaner, gardener or support worker who runs their own business can be paid from a Support at Home budget. The worker has to meet workforce requirements, and the provider must be able to meet its own regulatory obligations while using them. If it cannot, it can decline.

Organisations that deliver funded services on behalf of a registered provider are called associated providers. The Aged Care Quality and Safety Commission says registered providers must give the Commission certain information about their associated providers, and remain responsible for the quality, safety and compliance of services those associated providers deliver.

Registered providers themselves are registered in one or more of six categories. The two that mainly cover help at home are category 1 (home and community services) and category 4 (personal and care support in the home or community). An organisation or a person can apply to the Commission to become a registered provider.

Do you still pay contributions when you self-manage?

Yes. Self-management does not change participant contributions. Contributions depend on the type of service and the older person's income and assets: clinical care has no contribution, while independence and everyday living services carry a means-tested percentage. This applies to services delivered by third-party workers too, calculated on the final agreed price.

Because the price of a third-party service includes the provider's overhead, a lower negotiated overhead also means a lower contribution on that service. A lifetime cap applies to non-clinical contributions. For how contributions, the cap and hardship help work, see what aged care costs.

Risks and responsibilities of self-management

The main risk of self-management is workload. Whoever self-manages takes on scheduling, chasing replacements when a worker is sick, checking invoices and watching the quarterly budget. If services are booked outside the support plan or the service list, the provider cannot pay for them from the budget.

Things to weigh up before taking it on:

• Cover gaps: if a chosen worker is unavailable, someone has to find cover. Agree in the care plan who does this.
• Paying and claiming: if the older person pays invoices and seeks reimbursement, they carry the cost until they are repaid.
• Budget tracking: spending is limited to the quarterly budget, and 10% of it goes to care management first.
• Approval: a provider can decline a worker it cannot engage within the rules, so a preferred worker is not guaranteed.
• Changing needs: the monthly care management contact is the check that care still fits. Use it to raise concerns early.

The older person keeps the protections in the Statement of Rights whether or not they self-manage. If something goes wrong with a service, the provider is responsible for fixing it. See complaints and your rights. Free, independent help is available from the Aged Care Advocacy Line on 1800 700 600.

Who self-managing Support at Home suits

Self-management tends to suit people who already have trusted workers, want control over who comes into the home and when, and have the time and confidence to organise services and check paperwork. It suits less well when the older person's needs are changing fast or when nobody close by can take on the admin.

It can also be partial. A family might choose the workers and set the schedule, while the provider handles invoices and finding cover. The arrangement is recorded in the care plan, so it can be discussed with the provider if circumstances change.

Steps to set it up:

• Step 1: Confirm the older person has a Support at Home classification through My Aged Care.
• Step 2: Ask registered providers whether they support self-management, which activities they allow, and how they handle third-party workers and overhead.
• Step 3: Agree which activities the older person or family will take on, and who rosters and finds cover.
• Step 4: Check the care plan records every self-management arrangement and every agreed price before services start.
• Step 5: Use the monthly care management contact to review how it is working.

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