A false dawn: Fears Support at Home won’t solve home care’s problems

The incoming Support at Home program may not be the transformative saving grace the Australian Government is after, as there are fears the new home care program lacks critical details that make it an effective person-centred model.

Support at Home will replace existing home care services such as the Home Care Package (HCP) Program from July 1, 2025, as part of the government’s far-reaching aged care reforms. 

Speaking to hello leaders, Flexi Care General Manager Adrian Morgan said he’s worried that people are being sold on the big picture yet critical details show that some Support at Home elements will be more problematic to implement. 

“I’m left with the impression that Support at Home is not the solution to the problems we currently have with home care. Home care is a very broken system but I don’t think that Support at Home does enough of what we need and does a bit too much of what we don’t want,” Mr Morgan said.

Among the leading issues with home care is the prolonged wait times for assessment and access to a Home Care Package, plus the fact supply does not meet demand. 

The government plans to support an additional 300,000 people through Support at Home over the next decade while reducing wait times to three months by 2027.

Yet Home Care Package wait times have gone up in 2024. My Aged Care data from August showed that the expected wait time for an approved Level 1 package (basic care) was one month and between 9-12 months for Level 3 (intermediate) and Level 4 (high care) packages.

As of October 31, older people can expect to wait 3-6 months for Level 1 packages and between 12-15 months for Level 4. Mr Morgan said waiting lists are out of control. 

“Even at the end of 2027, they’re still talking about a three-month waiting list. That is too long for older people to wait to receive urgent services. That’s completely unacceptable for Home Care Packages,” he said. 

“People don’t want to be forced into residential care but if they can’t get the services they need that’s where they might end up. Or they go to hospital which is even worse.”

He added that reassessment requirements under the new home care program would also remove some important flexibility that HCPs provide. This includes accessing a new service type without reassessment.

Instead, older people will have to be reassessed by an independent assessment organisation if they want to access direct care if they haven’t initially been approved for it.

“While you’re waiting to be reassessed that potentially turns into a chronic infection. That program rigidity has real implications,” he said.

The good, bad and the unintended consequences 

It’s not all bad as Support at Home is set to reduce significant wastage in unspent funds. StewartBrown estimates a whopping $4.1 billion of unspent Home Care Package funds is sitting in the coffer, an average of $14,517 per client.

Under Support at Home, quarterly will reduce this waste, although Mr Morgan said he would like the 10% carryover allowance increased to 25%.

He also praised the new End-of-Life and Restorative Care pathways and the Assistive Technology and Home Modifications (AT-HM) Scheme that will no longer require people to save funds for equipment or home modifications. 

But once again, the devil is in the detail. Mr Morgan said the Restorative Care Pathway services cap is too restrictive as it could delay early access to necessary interventions. He’s worried that any delay could cause deterioration and result in costlier healthcare or avoidable residential care or hospital entry. 

Unintended consequences like this can arguably be found throughout Support at Home. Mr Morgan said those who designed it had ‘nothing but good intentions’ but certain things have not properly been thought through. 

One is the care management cap reduction from 20% to 10% of a care recipient’s quarterly budget. While the government has proposed providers pool funds, Mr Morgan said this is already happening and won’t help.

He said the people who require the most care management are often higher-needs clients or have limited family support and will suffer the most.

“At least 15% of the package value goes on care management and there’s nothing left over to do the job properly. You don’t want to seem like a call centre. That’s not good for older people,” he explained. 

“One of the roles of care management that’s less appreciated is particularly for people who have mental health issues or anxiety. A lot of what the care manager can do is reassure them, talk through their concerns and their worries and help them feel that things are okay.

“I know the care managers in my organisation, we call them care partners, they spend not an insignificant amount of time simply listening, supporting or encouraging.”

Being able to dedicate time to clients over the phone will be increasingly important as changes to aged care services come into effect. Many care recipients are anxious about whether they can afford care while paying co-contributions if they’re not eligible for the ‘no worse off’ principle that prevents existing care recipients from paying more for their services. 

This concern relates to a commonly held view that many people will be forced to choose between services that fall under independence or everyday living categories such as gardening, personal care or shopping. 

Mr Morgan believes services like showering or supported shopping will fall by the wayside if they have other pressing financial expenses. Cuts to both could result in serious consequences. 

“A lot of people will not be able to afford up to 80% of the cost of everyday living services. This could mean they just pay for groceries to be delivered and they lose social contact which was what that experience was always about,” he said.

“Even more troubling is the personal care where people won’t shower when they need. It’s easy to imagine somebody won’t be able to afford even the 5% payment for the pensioner. That has implications for deterioration in health and hygiene. What happens then is they end up in the hospital or a nursing home and they don’t need to be there.”

Mr Morgan called on the government to continue sharing information so they can be informed and keep residents informed. He said they must also keep listening and hearing that there are problems with Support at Home so they can resolve them, as seen by the removal of gardening and cleaning allocation caps.