The Promises & Reality of Support At Home

Everyone wants the Aged Care system to be better. We all want people to live at home longer, and to do so safely. It’s most people’s wish and it is cheaper for the government and therefore the taxpayer. The redesign of the home care system into Support At Home comes with big promises, shorter wait times, more money, extra funding.

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It all sounds great, but what does it really mean? Let’s dig deeper into these promises and understand how they’ll affect older Australians and their families—and, eventually, all of us.

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Promise 1: Three month waiting list to access Support at Home

It’s hard to see how they’ll deliver on this promise, especially if the real measure of wait-time starts from the moment someone requests an assessment to the moment they actually receive support. The government’s reported wait-times don’t reflect this hidden gap. The reality is, the wait from saying, "I need help now" to actually receiving support can stretch up to two years. That’s unacceptable.

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For many, this delay forces them into Aged Care Homes earlier than necessary, results in repeated hospital visits, carer burnout, and immense frustration. Just ask anyone who’s still waiting to be assessed for Home Care funding. On top of that, we need a skilled and responsive workforce to meet the changing needs of older Australians—and right now, that workforce simply doesn’t exist.

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Promise 2: Greater funding with four additional levels of support up to $78,000 per year

The government has been heavily promoting the new top tier of support, $78,000 per year against the current top tier which currently sits at $62,000 per year. The key difference is that in the current system someone on the full Age Pension doesn’t contribute anything to the $62,000. Zilch. And in the new system everyone is required to contribute, even if you are on a full Age Pension.

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In both the current and new systems, funding must cover the provider’s fees for managing the package. In the current system, this fee is itemised separately as a Package Management Fee, while in the new system, it will be hidden, built into the hourly rate for services.

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• Current System: For the highest level of care, funding is $62,000. After deducting an average of 15% for administrative fees, about $52,700 remains for Care Management and direct services.
• Support At Home: After a 15% deduction for administrative fees (remember they are built-in to the hourly rate), $66,300 remains for Care Management and direct services.? Let’s then consider contributions and how much of this will be funded by the Government.

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Here’s a basic example removing Care Management of 10% and using common services for the highest level of care for a full Aged Pension customer:

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• 15% of funds going to Clinical Care: $9,994 – no contribution required
• 35% of funds going to Independence: $23,205 – 5% contribution ($1,160)
• 40% of funds going to Everyday Living: $26,520 – 17.5% contribution ($4,644)

Total Consumer Contribution: $5,801

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The actual Government funding is $60,499.? BUT if you are a self funded retiree, your contribution could ?be as high as $32, 818 meaning the Government contribution is $33,482.

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For self-funded retirees, contributions are 80% for Everyday Living costs and 50% for Independence.

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As a result, those who aren’t wealthy but don’t qualify for a pension will be most affected. Additionally, the lifetime cap for fees across home care and aged care homes has increased from $79,000 to $130,000.

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Promise 3: Twelve weeks of end-of-life care funding, in addition to any other supports

A new Classification component to support people to die in their own home will be introduced. It’s capped at $25,000 per year and will supplement palliative care services provided. Someone is eligible to access the extra funding after a diagnosis from a doctor that they have three months or less to live. This is a very welcome acknowledgement of the complexity of support that is required to support someone to die in their own home. And the wishes of many to do so.

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Promise 4: Care Management limited to 10% of the package of funds

Capping Care Management fees at 10% of a Home Care Package, as outlined in the proposed Aged Care Act, could seriously impact a Care Manager's ability to meet essential compliance standards. This is especially concerning given the current state of home care compliance—recent data from the Aged Care Quality and Safety Commission reveals that 36% of home services audited are non-compliant. Common issues include poor care assessments, inadequate documentation, weak communication, and insufficient ongoing reviews. Shockingly, 30% of complaints now relate directly to case management, coordination, and care planning.

As compliance requirements grow, slashing Care Management fees will limit the time Care Managers have to handle these crucial tasks. Capping fees restricts the level of service providers can offer, demonstrating a lack of understanding of the true role of Care Management.

On the one hand, the proposed Act rightly demands greater oversight, enshrines a rights-based approach, and defines quality care. But on the other hand, Support at Home strips providers of the capacity to deliver that level of care effectively.

Quality home care comes at a cost. As we shift to a user-pays system, consumers will expect—and deserve—better quality as they shoulder more of the true cost of care.

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Promise 5. Cap the hourly rates for services

The unit cost of a service delivered will be capped by the government. The administrative costs of delivering the service will be wrapped into the hourly caps, rather than charged and itemised as a separate fee which is the current practice. The hourly cost of the service will increase. We don’t know what these caps are as we wait for the Independent Health and Aged Care Pricing Authority to publish a price list which states the maximum that can be charged. While the caps sound good in principle, the inclusion of the ‘cost of business’ of the provider in the hourly rate could make them eye-wateringly high and remember consumer contributions are based on a percentage of the hourly rate, the higher the hourly fee, the higher the contribution required.

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It is also unclear how the fee caps will work for clients who are choosing to self manage their Home are Package.

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Promise 6. “No worse off” principle for those currently in the system

Once again, the devil is in the detail. The Daily Care fee in Home Care is something consumers can be asked to pay, but most providers currently waive it. This fee can be as high as $12.75 per day, even on days when no services are provided—that’s 17.5% of the Age Pension. The important thing to note is that providers have the option to either charge or waive this fee. While it’s already part of the current system, with the new program requiring contributions from everyone, we may start to see this Daily Care fee applied more frequently to existing users.

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“No worse off” is nice in theory however if your needs change and you need more funding, you will need to move into the new Support At Home program to be reassessed and then the co-contributions will apply.? There is significant risk that consumers choose not to be reassessed so they can maintain their contribution free status and consequently don’t access the supports they need.

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Promise 7. Separate funding bucket of Assistive Technology and Home Modifications

First off, can the government please stop calling it the "AT-HM system"? This confusing initialism only adds to the frustration for consumers and their families. That aside, the concept looks promising on paper. Providing immediate access to up to $15,000 for essential aids, equipment, and basic home modifications like rails is a positive step. This new initiative could really help older Australians continue living safely and independently at home.

Promise 8. It will be simpler for consumers and their families

If only they got one right, this would be it. Understanding the aged care system is notoriously difficult, and despite the Royal Commission’s recommendation to simplify it for families, that hasn’t happened. Government-funded Care Finders, meant to help families navigate the system, will still be available but remain few in number, with long waiting times. While a new, streamlined assessment system is designed to simplify things, it too will be outsourced. My Aged Care will continue to serve as the entry point for the program, leaving providers with the responsibility of explaining the complex home care system to often confused and overwhelmed consumers.