Why are there underspends in client’s community care funds?

The move to ‘consumer directed care’ and the allocation of funds to the individual is part of the policy landscape in Australia – but the early evidence is showing that these allocated funds are not being fully spent in delivering care.

This raises the question of whether providers have effectively assessed and managed the change management needed to encompass this model of care support.

How big is the problem?

A recent analysis, by Stewart Brown, identified that across Australia there are $220 million of unspent client funds in packaged care. They calculate that this translates to an average of $3,612 across all community care packages.

The analysis identified that this average underspend varies considerably by package level

  • Level 1 Average unspent funds per client was $2,209
  • Level 2 Average unspent funds per client was $2,497
  • Level 3 Average unspent funds per client was $2,948
  • Level 4 Average unspent funds per client was $7,426
Source Stewart Brown

This is a staggering amount of money not being used to meet care needs. There are signs that with time we are getting better at fully spending the allocated funds and this is a positive trend but …

Why are clients not fully using their care budget?

For a client to understand whether they have funds available to meet their goals they rely on timely and accurate details on the balance of their funds.

Lets think about how we manage our own budget –  We

  • have access to your statements,
  • know when money is coming in,
  • know what you are spending with each purchase,
  • make choices of priority, need and desire when making a purchase,
  • are clear about the total funds available at any given time,
  • are confident that we have planned out our expenditure for the period over which the money is available, and
  • get advice when we need it.

But in this case we are not ‘managing our own budget’ there are many others involved in the management of this money –  there are the case managers, finance managers and the aged care provider (organisation).

Not withstanding this, if we assume that clients have access to the right information and that it is updated at regular intervals and they are still not spending the money to meet their needs the question still remains ….

managing client budgetsWhat might be stopping them spending?

In retirement there are a number of financial concerns shared by older people in retirement, these include that they do not feel confident

  • about having enough money to meet their needs,
  • about maintaining financial security throughout their remaining lifetime.

Could these same concerns be influencing their decisions on spending in their care packages? Are they trying to save some funds for a ‘rainy day’? Some reports argue that no all clients will/do have the interest or capacity to play an active part in budget and care management.  1

One (case manager) reported that although the consumer had a surplus, the carer refuses to spend the money despite strugglingand is waiting until things get really bad’.1

The other issues might be they are not fully across all the health and care options available to help them meet their goals and aren’t getting the full picture through case managers?

But the client isn’t the only one in the picture

The changing role of case manager

Financial  support

The fact that working  from a ‘funds available’ basis is not embedded in the case management model signals a change to the preparation or development of case managers. This role of case manager including an element of ‘financial’ manager is new to most, and for some will not come naturally. Case managers need to add to their skills set the ability to work with clients to meet their goals and balance the financial realities of the package.

Empowerment and shared ownership

There is an onus on package providers to up-skill their case managers on the sharing of program ownership and control with clients. Case managers need to embrace the benefits of client empowerment in consumer directed care and the shift in focus away from the traditional health model  of support. 2

In all of this the conflict that exists between meeting the client’s goals and managing the money wisely must be factored into the change management plan. The changed role of case managers needs to be managed sensitively with them playing an active part in the change management plan.

Overall there is a need to invest in building the ‘values, attitudes and organisational culture change’  that is needed to support consumer directed care through a well planned change management plan.

In trying to tackle this problem providers need to work with clients to find ways of meeting their goals and planning out the expenditure of the package.

Stewart Brown recommends (I’ve paraphrased here)

  • demonstrate by % used the balance of total funded income & resident fees
  • actively encourage usage of the funds, demonstrate this by setting a weekly target and showing how this is being met in the accounts/reporting (target of 95% of allocated amount)
  • Case managers actively working with client to use the funds available.
Source Stewart Brown

Others have provided some legal advice about the management of these funds (3)  focussed on managing the exiting client.

Whats the danger with unspent funds?

The funds allocated for community care packages are not high but if they are consistently under-spent there is a danger that the Government to re-calibrate down the funds allocated . This is a danger for the consumer and the provider alike.

If we accept that the allocated dollars in a package meet current care needs then the concern is that clients are missing out on much-needed care, support or treatment. The real losers are clients.

They are loosing out now as they aren’t accessing their full package value and potentially they may lose out into the future, if the package value is reduced.

Government’s initial response

The initial response of the Australian Government has been to issue some updated advice to providers

  • “From 27 February 2017 a client’s unspent home care amount (less any exit amount) will transfer with them to their new provider, or be returned to the client (or their estate) and the Commonwealth.
  • If a client ceases home care with your organisation, you must provide them with a written notice of their unspent home care amount within 56 days after their cessation day.
  • The time and manner in which you will need to make payment of a client’s unspent home care amount will depend on the circumstances under which they leave.
  • You must keep records of the written notice provided to the client, as well as records relating to the payment of unspent home care amounts.”
Source Unspent Home Care Amounts – Australian Govt

So the pressure is on to meet client needs and goals while spending the funds allocated to them in the care system.

Government is seeking further input into home care reform

The Australian Government is currently seeking views on the further reform of home care – maybe there are suggestions that can be made to better manage care package use and spending?

What needs to happen to assist Case Managers and organisations?

I’d love to hear your views on how we are tackling this issue. Have you seen some successful strategies or approaches? Share your comments below.