Personalised In-Home Care: Navigating Aged Care Support
This episode of Conversations with G&G is sponsored by Dovida Geelong, Bellarine and the Surf Coast. Dovida is a trusted local provider of in-home aged care, supporting adults across Geelong, Bellarine and the Surf Coast to live safely, independently and confidently at home.
To learn more, head to www.dovida.com.au/local-office/geelong or call the local Geelong office on 03 5201 9090.
An overwhelming aged care system often leaves Australian families feeling completely lost, emotionally drained, and deeply exhausted. When navigating the maze of the Support at Home program, finding a reliable provider who truly understands your family’s unique lifestyle changes can feel like an impossible task. Fortunately, a structured care management approach offers clarity, guidance, and immense reassurance.
In this episode summary of Conversations with G&G, we explore expert insights from local aged care provider Dovida Geelong, with Head of Care, Uma, discussing personalised in-home care and how it transforms the caregiving journey.
The Key Pillars of Quality Care Coordination
Person-Centred Assessment: Uma mentioned this involves looking at the client as the absolute centre and managing their specific needs in a timely manner.
Proactive Management: Uma emphasised that providers must aim for "proactive care management," which means identifying challenges early rather than waiting for an emergency to happen and then doing something about it.
Goal Alignment: Uma discussed this as a method to ensure you are supporting the client with what they actually need and want, versus what a provider simply thinks is good for them.
When a dedicated professional oversees these moving parts, the administrative burden shifts away from exhausted family members. Consequently, family carers can finally focus on simply being a supportive family member again.
Why Strong Care Partnerships Matter
As Uma mentioned during the interview, a true care partnership brings together families, participants, and care partners into a unified, collaborative circle. She beautifully described this ecosystem as a "circle of care," stating that as long as clients remain at the heart of that circle, the partnership simply cannot go wrong.
Moreover, Uma discussed this collaborative model as a way to directly address the dangerous carer burnout that impacts thousands of regional Victorian families every year. When everyone communicates openly and reviews goals periodically, minor issues are resolved quickly before escalating into serious clinical problems.
Common Challenges Families Face in Aged Care
Navigating the contemporary Australian aged care environment presents several significant hurdles for local families. Understanding these common pain points can help you prepare for the road ahead.
As Uma mentioned, when families call places like My Aged Care, they often get different people telling them completely different things. This complexity frequently causes families to feel completely lost. However, seeking early guidance from a local care partner simplifies the assessment pathway significantly.
Summary of Key Takeaways
Navigating aged care does not have to be a lonely, confusing, or exhausting battle. By embracing a collaborative care management model, local families can access reliable, evidence-informed support that keeps seniors living safely and independently in their own homes.
"True care management bridges the gap between complex government regulations and the heartfelt, human needs of an older loved one."
If you are currently balancing work, life, and the heavy responsibility of caring for an ageing parent, remember that professional support is readily available right here in our local community.
Learn more about the program or access resources to support your caregiving journey through the following links:
My Aged Care -https://www.myagedcare.gov.au
Carer Gateway -https://www.carergateway.gov.au
Department of Health and Aged Care -https://www.health.gov.au
Click the button below to listen to the podcast with Uma.
Full Episode Transcription - 19 Care That Feels Personal: Inside the Care Management Approach Feat. Uma
Giselle
Hello, and welcome back to another episode of Conversations with G&G.
Joining us is Uma from Dovida Geelong, who will share insights on effective care management, the importance of strong care partnerships, common challenges that families face, and how providers and families can work together to achieve better outcomes. Uma, thanks for joining us.
Uma
Thank you so much for having me.
Giselle
It's great to have you. So, can you talk to us a little bit about what you do at Dovida Geelong, your role and your experience, how you got there? A little bit about yourself.
Uma
Yep. So currently I'm a head of care. So anything client experience-wise like, you know, whether it's positive feedback, negative feedback, clients experience, you know, like service care and how the team is going to look after the client. So everything related to clients all falls under my responsibilities. So I navigate the team to deliver the best care, obviously.
I've been with the Dovida for five years, just over five years now. Started as a care manager, now care partner, and then moved into team leader and now head of care also. It's been a journey, but every journey has taught me valuable lessons. And here I am.
Giselle
You would have seen lots of changes in the past five years with all the reforms that have been happening in aged care. So, can you talk to us a little bit about what effective care management is and what clients can expect?
Uma
Well, basically as like I said, care management itself it’s like you know, how you are managing clients like, you know, needs like the what, what the challenges they might have as a family, as a client themselves. So effective care managers basically, you know, are you able to look at a client as a centre and how are we managing that client's needs, you know, in a timely manner.
You know, with the resources that we have and, you know, within the budget and things like that. And there's obviously proactive and there's, you know, proactive care management is obviously that's what we are going for. And I think that's the best way to, you know, deliver care rather than, you know, waiting for something to happen. And then, you know, doing something about it. So it's a care management, but there's a proactive care management. That's what we are basically going for.
Giovanni
Lots to unpack.
Uma
Yes. Yeah.
Giovanni
Sounds like a, such a, you know, a complicated and, involved process.
Uma
Absolutely. You know, care managing, because as you mentioned, it's not just the participant itself, but it's also families and everyone around this person.
Uma
Yeah.
Giovanni
Including managing relationships with other approved service providers.
Uma
Definitely. Definitely. Because when you, the client themselves is not just themselves, it's like there's, there's this connection with their lives. Like, who are they connected with? The community, their family. And also it comes with what do they need and where do we need to go? So you have to as a care manager, oh sorry care partner, you have to have a holistic approach to that particular person's needs. So yeah, so it's not just one thing. It's like a lot of things.
Giselle
And it's really aligning everything to the client goals really, isn't it? Making sure that, that the care partner can work with them to make sure that they achieve their outcomes. What they want to get in.
Uma
Exactly. And that's when that effective care management comes, like, you know are you getting the goals? Are you hitting those goals, you know? You can be like there, but what's the outcome of it. Like at the end result. Like, are we supporting the client with what they need versus, you know, what do you think is good for that client? You know what I mean? So it’s the client being at the heart of everything, really.
Giovanni
Yeah, absolutely. So going back to effective care management, right. Can you talk us through the end-to-end journey? Obviously, we start with meeting the participants' families and developing the care plan. Yeah. Can you talk us through all of that?
Uma
Yeah. Yeah. So obviously it starts from clients having the aged care funding. When they come to a provider like they sometimes are very lost in the sense that know what they need, but they don't know how to go about it. How do they get to those services? You know, what are the availabilities like? You know, like who's the best person to provide those services and stuff. So they come to a provider and as a provider, as a care manager, my role is to educate the client because the system itself is very complex. And you can see, like, you know, when you call, like a My Aged Care, you know, you have different people telling you different things.
So as a care manager, your role is to simplify, but at the same time personalise what this person needs and navigate this whole system for them.
Giovanni
I love that. That's in a nutshell.
Uma
Yeah, exactly.
Giovanni
What we do really day in and day out.
Uma
Exactly. And obviously from that journey, like, you know, your understanding the client, what they need and what availability is there. And then you make a care plan with the goals really targeting each individual's needs. And then you are working towards, everyday you're working towards getting the outcome that you want, with the clients obviously have to come along with them.
And then obviously the families as well, because there is like a family's involvement is huge. It’s like a partnership right? So it's like a client, families and the care partner partnership. And that's what it is.
Giovanni
It's a circle of care.
Uma
It's a circle of care. And as long as clients are in the heart of that circle, you can't go wrong.
Giselle
What are some of the things that a care partner would do to let the client and families know that they are achieving those outcomes? Like how do you even get there, to that point? What does the care partner do?
Giovanni
Yeah. And do clients even know what their goals should look like?
Uma
Yeah. So that's why like it's really important when you start the journey. Starting the journey means you know, getting to know the client, what do they actually want. And then putting that in a format where everyone understands, like this is what we want. Everyone consents to those goals. And then periodically you just meet, you catch up, you have that communication. You have like “where we are at? Have we met that target?”
You know, it's like a it's like a continuous communication. I think you can achieve that by, you know, whether you are catching up over the phone or in person, on a regular basis. Obviously, it has to be realistic how often you can catch up, and you know, amid that expectation.
But basically, the client needs to be advised, like where they are heading, and you know, it's just the journey itself. It's not like, you know, you don't see them for six months or don't have a conversation in six months and nobody knows where everyone's heading. So I think it's clear that communication is the key to it for everyone to know where they are.
Giselle
Yeah. And the goals can change too, I guess, because as you know, as people age, they might want to achieve different things or, you know, what might be at the forefront of their mind today might not be in a year's time.
Uma
Yeah, exactly. And that's why it's so important as a care partner to review those goals and review the care plans and, make sure that every, the current goals and care plans are up to date with the client's needs because there's like one fall can change their entire lives.
Giovanni
Very quickly.
Uma
Exactly. So it needs to be reflected in their care plan. So it's like a Bible, you know, for an individual person, like how do you follow that? Like you've got to follow that.
Giovanni
Yeah. So what's the minimum amount of touch points, I guess, a month? Is there any minimum that you set within your team?
Uma
Yeah. So it's a minimum one, once a month. Like, you have to have that touch point then. And thats obviously a minimum. Then there's a maximum where there's a hospitalisation, there's a respite care, or there might be a changing of carers. They might be changing clients' own individual circumstances with families and stuff like that. Obviously, the care partner's role is not to just run down and meet the client you know, go and visit them. But it's about when do the client need, but it has to be minimum once a month.
Giovanni
Yeah, as you say, because care providers are not expected to be an emergency service.
Uma
Absolutely. Yeah. Yeah. And that's what I think sometimes gets a bit confused because, you know, care partners are there always to listen to the clients and the families.
And sometimes you could be that person. They always reach out to you. But clarity has to be there. It's like, you know, if it's a triple zero call, it’s a triple zero call. It's not your care partners. You know, that's going to be obviously, you know, care partners are there to facilitate and help. But definitely when it's a it's an emergency, you call 000.
Giovanni
And also, Uma, from my understanding, there are some significant budget restraints as well. Particularly with care management and with the Support at Home program, now that has been capped at 10%.
Uma
Yep.
Giovanni
So we need, providers need to work within those budgets as well.
Uma
Yeah, definitely.
Giovanni
Which are allocated to us. And it's pooled but there's still always a finite resource.
Uma
And unfortunately, with that budget limitation, it could be no matter how much you want to, you know, support that client. Sometimes the budget plays a big role into what we can do and what we can't do. And that's when care management is also like important to navigate those challenges, direct the families and the clients to where they need to head or what other supports they might need, which is not beyond their budget or things like that.
But the 10%. Yeah, that cap 10% is a huge, you know, sometimes it's like you don't work within the 10%. You're providing much more than that 10%. But unfortunately, you know, there's a reality of that 10% that is there as well.
Giselle
Yeah. It sounds like the care management service is a really important service. And I mean, there are some people that, like their family or loved ones would be doing that.
Uma
Yeah.
Giselle
As opposed to having. I mean, even someone that doesn't have the government funding. It could be their friends or family that are arranging all these services. Any advice that you could give to those people that are currently on that journey, as opposed to having a care manager, or care partner, helping and assisting?
Uma
Yeah. So, yeah, these days, like, family members are already involved in that loved one's care, right? So they already come with this massive emotional, they know, like a tiredness, like they're already there and no matter how well they want to care for their, for their loved ones, sometimes the emotional, like there's a barrier in that, you know, you can't see beyond that.
But if there is a care manager, the care manager role they're the subject matter expert. So they are living in that in that environment every day. They know the changes coming. They know the specific need the client has. They have all the resources that they, they are they know in their books. And it's like, you know, when you go to a specialist, like you go to the specialist and you listen to that specialist because, you know, the specialist has all the knowledge. It’s the same as care managers.
They know they have all the knowledge about the client or about the program itself. The budget, you know, they’re navigating that every day. As a family member, you're not listening to, you know, what the department has change or is making the changes. Like you, you just don't have that time. So, you know, I think it's really important to understand that, you know, yes you might be fully capable of understanding government legislation or the program itself, but the program is huge, it's a huge thing.
Giselle
It is.
Uma
As a care partner you are making the clients, like it’s individualised care, and they're focusing on that particular client itself and not in a, there is no barrier in terms of like they must not, it's not like they're not empathetic, they’re empathetic, but they still will guide you to make the right decision for the client.
Giselle
Professional. Yeah.
Uma
Yeah.
Giselle
And they can also assist with referrals to allied health professionals in arranging those types of appointments as well, which can take a lot of time for someone else to be doing it, especially if they've got kids themselves or they're working in and they also need to arrange those.
Uma
Yeah, absolutely. Because you're navigating your own personal life, right? So as a care partner, you know, which provider is immediately available, which provider can take a longer time. And you have a pool of connections. And so you can pick the ones that are right suited for this particular client. So it cuts down that in a time frame like, you know.
Giselle
Like searching. Yep.
Uma
Absolutely. And in a busy life like as for the family and that's where you are. You want somebody to look after. Take care of all of that. And for you, I think that's the benefit of having a care partner. Because they will do all of that, and they are there also to listen to you when you need somebody to, you know, express how the changes are happening and how, you know, navigating everything can be overwhelming. And then that's where as a care partner, you know, you can be the extra person in your life or, you know, a parent's life or in a loved one's life.
Giselle
Yeah.
Uma
To share that.
Giovanni
Do you think that having a care partner that lives in the local community is, is a very, very important aspect of the care?
Uma
Absolutely. There's a lot of stories where, you know, you are only talking to somebody on the phone. You have never seen that person in real life. So when you have a local, you know, provider or local care partner who can go and see you every month, not every month, like, you know what I mean? Just when needed as well. It brings a different type of connection. You are seeing a client in their own home, in the their environment, physically.
And I think that's a great opportunity to bond and assess and, you know, like, I can give you an example like, you know, currently, you know, with My Aged Care or the clients who are waiting to have a package, you know, assigned. They are doing a telephone assessment. Right? You can't, you can't holistically, you know, like, assess somebody on the phone, you just can't. And people have, sometimes, you know, clients might say, “I'm okay,” but if you physically see this person, they're not okay.
Giselle
Yeah.
Uma
So it's the same with the care management to having a local provider. It gives us that opportunity to really see clients in their real world. And then I think that's really important. And that's why I like choosing a provider who's local is also like, you know, one of the best things you can do.
Giselle
Yeah, it's so true because as soon as you walk into someone's home, you can see, oh, the dishes, you know, they're not maintaining the home, there's dishes in the sink, there's off food in the fridge. And that's where caregivers as well can come in handy because they're the eyes and ears and can see what's going on. And they're trained to do that.
Uma
Exactly. And you can't do that on the phone.
Giselle
And you can't do that on the phone. And sometimes family members might not, see that because they don't have the training.
Uma
Yeah.
Giselle
They haven't been trained to look out for those things. And, if they see them every day, sometimes you get a bit blasé about it and it just turns normal.
Uma
Yeah. And they will say, “well that's just my dad”, or “that's just my mum” or, you know, whoever. And, then think some of those things that care partners can pick up or the caregivers can pick up are not really important. You know, it's just gets forgetting because they've always seen this person in that manner. And I think that's why like having somebody being able to go into the home and, be there in person is so important.
Giselle
Yeah, I think sometimes one of the challenges is, though, that people don't like people going into their home as well.
Uma
Yeah.
Giselle
I think that can sometimes be a bit of a barrier.
Uma
Yeah. But that’s when the family like, you know, like coming together and really, looking at how best to approach the situation because families have a lot of insight into their loved ones. And how do we work together? You know, that's what this, partnership comes through. Like, you know, you in partner with the with the families to get the best outcome for their loved ones, and they give you information that you can work with as a care partner and say, okay, well, combine that information with my own experience and then in how to facilitate that, you know, that home visit or does the loved one want to be there to make it easier?
Or what are the little things that the clients as that families know is like, you know, my dad would love you to start talking about this footy or whatever that may be. You know what I mean? So that sort of partnership is so important.
Giselle
Yeah, yeah, it's a really good tip.
Giovanni
And we've been hearing more and more recently, self-management as a viable option for some participants.
Uma
Yeah.
Giovanni
Which I can see how that could be. Definitely, there's a space for those kinds of options as well. But in your opinion, where is self-management a good fit and where it's not in your opinion?
Uma
Yeah. Well, the good fit is like, they might think, like, you know, previously there was a different, in a previous program like before, Support at Home, it was like the whole, you know, self-management was basically with the families, think that they might save some funds, which goes to care management. And then they can put that towards the care and services. But now it's a flat to 10% regardless of whether you are self-managing or not self-managing. So that, that minus that, that just like it's not even counted anymore.
But having like somebody who is able to invest a lot of time, educating themselves about the program, you know, understanding all the changes on time, navigating budgets and looking for services and providers themselves. If you do have that amount of time, which I think it’s unrealistic, nobody really has that same amount of time. And I think if you can devote that much time, then self-management might be an option.
But if you don't have that time, you don't want to stress about some cancellation and having to navigate the best suited caregiver for you, you know, for loved ones or which, you know, a provider is available within the region or what programs there, you know, the government might be running that could be suited for your loved ones, like if you don't have that knowledge and that time to investigate.
I think self-management is not for you. You know, it's definitely somebody you have to you should be with somebody who is the industry expert, and they know who can really help you in that space.
Giovanni
And also, a consideration that at the start, you might feel very well capable of doing all of that and navigating all of that. And yes, you might have time, but things can change really quick.
Uma
Yeah, absolutely. And especially if the client declines. If you have, if, if your own situation, you know, is declining or your loved ones declining and you are already emotionally so overwhelmed with those changes on top of that, you are then like, I have to organise care for my loved ones next week, or, you know, I have to cancel days or whatever that may be.
And where is the budget sitting right? The budget plays a big role in care management. So basically, you know, if you don't have that sort of, you know, help or you know, someone to take over like self-management is not an option for you. I think it's best to go with the provider who can help you in that space.
Giovanni
Yeah. And you mentioned that, yes, the 10% now flat cap management fees are across the board. So the cost is not relevant anymore.
Uma
Exactly.
Giovanni
But there is an element of, for example, caregiving services. Right. So providers like Dovida, for example, charge, you know, over $100 an hour. Because that will need to cover other administration fees that that before it was covered under, you know, the package management fees. And there are providers out there that could do the same thing for $23 cheaper an hour.
Uma
Yeah.
Giovanni
What would you say to that?
Uma
Well, I think, I think like for example, if we look at Dovida, for example, you know, that the, the per hour rate you are paying, they are not just there like the caregivers are there as, as a somebody who can look at your loved ones and in a holistic manner.
They're not just there to shower. They can also look at what other things are happening. And there's an element of the accurate feedback. You know, they're giving you feedback straight away. You know, you have somebody overseeing that feedback in the office and you know, like immediately taking actions and making sure those particular information is going to wherever they need to go, whether it's a family, whether it's a doctor, or, you know, whoever that may be.
Just like, so there's a prompt action happening once the service finishes. Whereas if you are, you know, organising your own care for you know, you're hiring somebody else, where is the, you know, like there's a chance that that information is not getting fed back to, or you know what I mean. There's a sense that things are not happening as quickly as somebody who's fully managing your package and they're responsible for all that, you know, carers and all that sort of thing.
So I think that's a there's a huge difference in how, you know, if you, you know, you, you get what you pay for, kind of, you know, as well, like, why are they cheap? Like, why are they not doing it, you know?
Giselle
So I guess there are questions to be asked and to compare. So, even things like do they have an after-hours service, like what happens if I need to call the provider at 10:00 at night? Will someone pick up.
Uma
Yeah. Or. Yeah.
Giselle
You know, there are so many things like how are the caregivers trained, how are they monitoring their performance, what are they doing?
Uma
Of course. And if a provider, say for example Dovida again as an example, if we have a carer call in sick, Dovida will look at the pool of caregivers to replace with a suitable caregiver. But whereas if you are, you know, hiring your own, then you need to find another person and you don't know whether that person has enough information about their loved ones and are they trained well enough, have they got that experience?
Whereas within Dovida, like we have, you know, like instruction, like, you know, manual for the for the clients, how to care for them. You know, we have a team looking after giving them a heads up, like, “hey, these are the specifics about the client.” You know, you know, all that personal touch that we do and I think that's as a family, that's what you want.
You want that, you know, sense of like, I have somebody who can look after my loved ones. So I think that's really important to not to forget of those things as well.
Giselle
And plus like a provider, you know, would support the caregivers as well. Like, so we've got a whole team that's dedicated to making sure that the caregivers are well looked after. They are well-trained, we follow up after services to make sure that they're documenting correctly. And so that's a lot to take on if you're doing it by yourself.
Uma
Yeah.
Giselle
And you might not even know how to do it because it's a skill set.
Uma
And we also know about the caregiver's journey, right? What have they done? What services have they done and where are they at?
Giselle
Yep. Their experience.
Uma
Their capacity. Their capability. Do they speak different languages? Do you know what I mean? Like there's a whole history that's there with the provider. So it's a it's not just it's not filling out the roster.
Giselle
Yeah its not easy.
Uma
It's about beyond that. Yeah. Really.
Giovanni
Yeah. Yeah. So what we're saying is that cheap is not necessarily better for you, you know, even though on paper it might look like you might be able to get a couple of extra hours a week. Maybe 1 or 2 extra. But is it really worth it?
Uma
Yeah. If you don't have the right carer, I don't think anything is worth it because, you know, you want to. Exactly. You want to know that someone going into your loved one's home is that person is there fully. Like they're doing the right thing. They understand your loved ones' care.
Giovanni
It’s backed up by a local, reputable provider that is there for you.
Uma
Absolutely. That’s been proven. Exactly, exactly. And then and all the carers are locally living as well. So they know the local, you know what's happening and then have the local knowledge as well.
Giselle
Yeah. Amazing. It's amazing.
Giovanni
Yeah. So in a nutshell, why don't we just, summarise in a couple of minutes, what does good quality care management look like?
Uma
Yeah. Well, good quality care management is basically, as I said, the client being at the heart of that centre in the centre of the heart. Sorry. And then, knowing okay, what does this client actually need? What's the goal? What's the main goal the client needs? It's not just the need, but what do they want?
So every decision has to be made to achieve those goals for that particular client. The individualised goals. Right. So as a care manager, care management is basically looking at the needs, looking at the services this client needs, looking at what's available and making it, like so, you know, utilising them to achieve the final outcome for the client.
And them being heard, you know, them feeling like I am, you know, I am in a partnership with this, you know, with this organisation or this care partner, and I've been heard. I haven't been just told what to do, but I'm equally in, you know, I'm participating in my own care. And I, I have been given that opportunity and I'm still getting the outcome that I want, really.
And if a care if a client is talking, saying this is what I'm getting, then that's the best effective care management and outcome.
Giselle
Thanks so much for that, it's been wonderful having you.
Uma
Thank you.
Giselle
Full of knowledge. And it's just nice listening to you and your journey. And, thanks for being with us.
Uma
Thank you so much for having me.
Giselle
Thank you.