The program supports older people with complex care needs to live independently in their own homes. It uses a consumer-directed care approach to make sure the support suits a person’s needs and goals. The support is provided through a Home Care Package – a coordinated mix of services that can include: There are 4 levels of Home Care Packages – from level 1 for basic care needs to level 4 for high care needs. The Australian Government provides funding for Home Care Packages under the: If you’re an older person and want to find out more, go to about Home Care Packages on the My Aged Care website. To find out if you're eligible for government-funded aged care services, you can apply for an assessment online. We know that most people want to stay at home for as long as possible as they get older. To support this, the program subsidises: The program provides services that sit between: Approved providers work with care recipients to plan, organise and deliver Home Care Packages. Find out what you need to do before you can provide home care services. The program supports older people with more complex needs to stay at home. They must: If eligible, we will tell the person the level of Home Care Package they have been approved for. We assign Home Care Packages to people – not providers. This means a person can choose a provider in their area that best meets their needs. It also means the person can take their package with them if they want to change providers. We prioritise people we have approved for a package in our national priority system, based on:Why the program is important
Who provides the services
Who is eligible
How the program works
Assigning packages
National priority system
- their assessed priority for home care (either medium or high)
- the date of their approval.
There is a lot of demand for Home Care Packages. A person may need to wait for a while before we have a package available to assign to them.
Home Care Package funding
The total amount of funding in a Home Care Package budget is made up of:
The Government and the care recipient pay these amounts directly to the provider.
Services and prices
Providers set prices for each of their Home Care Package services. They can provide services in-house or subcontract other organisations to provide services.
Providers must:
Providers use a person’s Home Care Package funding to pay for the cost of the services. They must make sure the person:
- has enough funding to cover the cost of the planned services set out in their care plan
- gets the full benefit of their Home Care Package.
Who oversees the program
The Department of Health manages and develops policy for the program. We also:
Services Australia:
- administers payments to providers on our behalf
- reviews and adjusts fee, subsidy and supplement rates
- provides online claiming services for providers.
The Aged Care Quality and Safety Commission:
- assesses and monitors home care services to make sure they meet quality standards
- resolves complaints made about these services.
[D] Select for Text Description.
Scenario 2. Mr. Andrews is a 70-year-old man with congestive heart failure and diabetes. He uses a cane when walking and recently has had some mild memory problems. His primary care physician, Dr. Busy, is part of a small group physician practice focused on primary care. The primary care clinic includes a laboratory, but they refer their radiology tests to a nearby radiology center. Mr. Andrews also sees Dr. Kidney, a nephrologist, and Dr. Love, a cardiologist. Both specialists are part of a specialty group practice that is not affiliated with Dr. Busy's clinic. Their specialty practice includes an on-site laboratory, radiology clinic, and pharmacy. Mr. Andrews has prescriptions filled at the specialty clinic pharmacy after his appointments with Drs. Kidney and Love and picks up medications prescribed by Dr. Busy at a pharmacy near his home. Mr. Andrews has a daughter who lives nearby but works full time. Because he has trouble getting to the grocery store to do his shopping, he receives meals at his home 5 days a week through a meals-on-wheels senior support service. His daughter has hired a caregiver to help Mr. Andrews with household tasks for two hours three days a week.
During a recent meal delivery, the program staffer noticed that Mr. Andrews seemed very ill. He called an ambulance, and Mr. Andrews was taken to the emergency department. There he was diagnosed with a congestive heart failure exacerbation and was admitted. During his initial evaluation, the admitting physician asked Mr. Andrews about which medications he was taking, but the patient could not recall what they were or the doses. The physician on the hospital team contacted Dr. Busy, who provided a medical history and general list of medications. Dr. Busy noted that Mr. Andrews may have had dosing changes after a recent appointment with Dr. Love. In addition, Dr. Busy noted that Mr. Andrews may be missing medication doses because of his forgetfulness. He provided the hospital team with contact information for Drs. Love and Kidney. He also asked that a record of Mr. Andrews' hospital stay be sent to his office upon his discharge.
Mr. Andrews was discharged from the hospital one week later. Before going home, the nurse reviewed important information with him and his daughter, who was taking him home. They went over several new prescriptions and details of a low-salt diet. She told him to schedule a followup appointment with his primary care physician within 2 days and to see his cardiologist in the next 2 weeks. Mr. Andrews was very tired so his daughter picked up the prescriptions from a pharmacy near the hospital, rather than the one Mr. Andrews usually uses.
Scenario 2. Visual Complexity: High Fragmentation: Moderate Patient Capacity: Low
Care Coordination Need: Extensive
2 McDonald KM, Sundaram V, Bravata DM,et al. Care coordination. In: Shojania KG, McDonald KM, Wachter RM, and Owens DK, eds. Closing the quality gap: A critical analysis of quality improvement strategies. Technical Review 9 (Prepared by Stanford-UCSF Evidence-Based Practice Center under contract No. 290-02-0017). Vol. 7. Rockville, MD: Agency for Healthcare Research and Quality, June 2007. AHRQ Publication No. 04(07)-0051-7.
3 Taplin SH, Rodgers AB. Toward improving the quality of cancer care: Addressing the interfaces of primary and oncology-related subspecialty care. J Natl Cancer Inst Monogr 2010;40:3-10.
4 Adapted from information published by the National Quality Forum.
5 Adapted from information published in: Antonelli RC, McAllister JW, Popp J. Making care coordination a critical component of the pediatric healthcare system: A multidisciplinary framework. New York: The Commonwealth Fund; 2009.
6 Adapted from information published in: McDonald KM, Sundaram V, Bravata DM, et al. Care coordination. In: Shojania KG, McDonald KM, Wachter RM, and Owens DK, eds. Closing the quality gap: A critical analysis of quality improvement strategies. Technical Review 9 (Prepared by Stanford-UCSF Evidence-Based Practice Center under contract No. 290-02-0017). Rockville, MD: Agency for Healthcare Research and Quality, June 2007. AHRQ Publication No. 04(07)-0051-7.
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Internet Citation: Chapter 2. What is Care Coordination?. Content last reviewed June 2014. Agency for Healthcare Research and Quality, Rockville, MD.
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