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The Tempatations of ‘Private’ Care

Brian HerdBy Brian Herd, Partner at CRH Law, our Lead Legal Professionals at Heather Hill Pathways.

“A riddle wrapped in a mystery inside an enigma” so said Winston Churchill when ruminating about Russia’s intentions at the start of World War 2. In today’s context, he could just as easily have been describing our aged care system.

Being both a lawyer and a decision maker for a number of older people receiving care as I am, I can speak from professional and personal experience about the voyage through the murky and muddy world of caring.

The sheer volume and opaqueness of the regulation and the costs of aged care have sent me off on paths and tributaries that are just exhausting and a management challenge to say the least. I often feel like those early historical explorers embarking on their voyage of discovery across this wide brown land.

Just this week, for example, I stumbled on the Continence Aids Payment Scheme – a little known government subsidy payable (with conditions of course) to people suffering incontinence to assist in the purchase of incontinence aids. Needless to say it requires the completion of another set of forms and bureaucratic inquisitions.

I have been daunted by a ceaseless pursuit to understand the aged care systems (and there is more than one) and all that they have to offer not to mention the strings and stings that come with the offers. With all due respect to the My Aged Care website, I have discovered reams of words and a raft of regulation that could keep me occupied for endless hours of eye glazing research, only to determine, tentatively in many cases, that my client is not eligible (until of course they change the rules again).

It got me thinking about the cost/benefit of all the effort and frustration to find the right pidgeon hole for each client and whether, ultimately, it was worth it. With one of my clients, for example, some 50% of the government subsidy for her home care package is taken by the home care provider, not to pay for the cost of care but in what is describes as their ‘administration fee’.

Private Care

So it was, I turned to that underworld of care – private care. Put simply, it is care provided essentially by an unregulated and unsubsidised segment of the care community. Most of the members of this group are people we are very familiar with – informal, unpaid carers – family members, friends and neighbours providing care to people at home. There are apparently over 2,000,000 of them.

But there is another developing subset of this group – the private paid carer or, as they are sometimes called, “support worker”. Best described as outriders in the care industry they are individuals who advertise themselves as just that, individuals, able and available to provide care for a fee outside the regulated environment of the traditional subsidised home care system.

By way of example, a support worker’s internet site states that she is “…only happy if you are happy” and “I believe I can give you a better care so you can stay in your own home as long as possible.” She states that she has a current police check in place, can work seven days a week between 9.30am and 9.30 pm, has a TAFE Certificate 3 in Individual Support, intermediate cooking skills and a First Aid Certificate. Her charges are $20 per hour.

Cost Comparison

I then compared her cost with that of a home care provider. If she was to provide 24 hour 7 days a week care, it would cost $3,360.00 per week. If a home care provider did so, they could charge some $7,200.00 per week. Even if we took into account any subsidy payable towards the home care providers cost, it would still well exceed that of the support worker.

Question – is the significant saving in money of the private support worker value for money when compared with that of the home care provider?

In pure monetary terms, the answer is obvious. Even on the measurement of what I call “form phobia”, the simplicity of the support worker compared to the bureaucracy of the home care provider is attractive. But what if we applied other criteria to the comparison? What are the risks associated with the support worker that may not apply to the home care provider and are those risks worth the savings?

Risk Comparison

With a home care provider at least, you have the protection of a government regulated and cost regulated system not to mention the onerous requirements placed on home care providers in terms of the quality of care they are obliged to provide.

With a private carer however, there are some ‘issues’:

  1. They are essentially unregulated and not subject to a quality of care regime
  2. If you engage them are you employing them or are they independent contractors.  This is a pregnant issue as it gives rise to questions such as, if they are your employee will you have to ensure you meet your obligations under tax law, superannuation law, workplace health and safety law and what are your insurance obligations to cover them?
  3. What if they get sick?
  4. What sort of insurance will they need to cover the services they provide?
  5. Should you document your arrangement with them?

Conclusions

The world of the private carer is undoubtedly expanding especially as it offers a significant saving in cost and bureaucracy. Adult children will subliminally be attracted to it for the savings on their inheritance. It’s all very tempting.

However, it comes with both risks and uncertainties that could leave you in a legal minefield if something goes wrong.

As for me, I don’t have the privilege of making the decision as if it was my care that was being decided. I have to make the decision for other people and, in that respect, I cannot afford to be a risk taker. I will stick to the system for better or worse and in sickness and in health.

As for you – it’s your choice (but, please, before you succumb to temptation, get some advice).

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