The study investigated the benefits and risks to: i) older people who self-manage their home care package; ii) their support workers; and iii) ways to mitigate these risks.

The findings highlighted how older people can successfully self-manage their aged Home Care Package and how risks can be managed. While self-management is not wanted by everyone, those who chose to self-manage reported benefits. These included having more choice and control over their support, especially being able to select support workers. Interviewees felt much safer selecting support workers who matched their needs and interests compared to having unknown rostered agency staff come to their home. Contracted support workers often worked for one consumer for years. 

Modern technology was an asset that facilitated self-management. Technology assisted with recruiting support workers, scheduling work, managing accounts and payments, and enabling providers to monitor spending and be alerted to any unusual payments or fraud. 

Self-management occurred within a complex service system where there was inadequate funding for community services and Home Care Packages as well as workforce shortages. These challenges impacted on older people in the study who self-managed and their family representatives. While workforce shortages were a major concern across the sector, most interviewees used informal networks and online recruitment services to find satisfactory workers. However, recruitment was a challenge for some interviewees from time to time.

Self-management required consumers and their family representatives to navigate complex family dynamics and manage support workers and other services. Some consumers had the confidence and skills to competently manage these situations after a lifetime of relevant experiences. Others were beginning to develop skills and sometimes felt challenged. Everyone needed access to information and advice from time to time, particularly those developing new skills.

Interviewees discussed the need to balance consumer’s protection and care with their right to ‘dignity of risk’, to build their capacity, and to choose their lifestyle. Multiple risks were identified with all aged care services, including self-management. Older people can be vulnerable to perpetrators of abuse from within and outside their families. Their rights can also be overridden subtly by others with well-meaning intent. These include service providers who want to minimise risks, surveillance and tracking technologies that are not transparent, and by families wanting to protect. 

Strategies to mitigate risks need to be individually tailored, with diverse and individual safeguarding strategies developed. Restrictive strategies should only be imposed when proven necessary and expressly stated with necessary consents provided, if necessary, through appropriate Guardianship mechanisms. 

Interviewees referred to instances of abuse reported in the media and linked these to consumers becoming isolated and neglected. They thought that risks of harm can be minimised, and safeguards maximised by the older person having a wide circle of personal and social connections. Numerous strategies for strengthening personal and social connections were suggested. 

It was considered essential to tailor safeguarding strategies to the older person’s needs and wishes. Safeguarding strategies included using aged Home Care Packages to support consumers to participate in their chosen social activity such as a book club or community group and asking each older person to nominate several people to become involved in their planning meetings or form a ‘circle of support’. Formal ‘circles of support’ consisting of unpaid family and friends were thought to provide excellent safeguards. In instances of family abuse, they provide a critical safeguard by including community members.

To maximise their safety, consumers needed relevant information and support to build their decision making capacity to make informed decisions. They needed to know that self-management is an option, and it comes with rights and responsibilities. They needed to understand the purpose of aged care support, how to use their personal resources and assets along with government support to remain living at home, statutory regulations, and home care provider responsibilities.