Frustration with navigating government subsidised care builds – Aged-care reforms supercharging a changing home care landscape

The government messaging with Support at Home has been to reshape a system so that those with means contribute more and those without can continue to receive support to stay at home. With the rubber hitting the road however, cracks are inching forward from decisions. Which services are counted as what, and the sheer time it has taken to process aged care packages are becoming sure fault-lines. From ballooning waitlists and a My Aged Care that has now been publicly chastised by the Inspector-General of Aged Care, advocates and industry leaders are near hoarse from calling for change. Yet it is in a quieter shift that home care providers must also take vigilant note, increasingly families and seniors are looking to private home care providers to meet needs. Core factors such as timeliness, flexibility and accessibility are becoming bigger client deciders. It looks to be that as a result of the confusion of My Aged Care, its “faceless” front, and avoiding “eternal” waitlists, many families are choosing to opt for the more expensive option of private care.

Not stuck waiting

Speaking with media, Belinda is a daughter who has been through the ups and downs of trying to navigate aged care for a senior parent. She describes her father Ivan as being proudly independent. Even through the diagnosis of dementia that brought difficulty into his and their family daily life, his core personality and wishes were clear and the whole family wished to support his drive for independence.

Belinda shares that the hope and pursuit of aged care became wanting to safeguard him in being connected, safe and importantly at home, not stuck on a waiting list.

It is worthwhile for providers with government funding to take considerable stock of the shifting attitude of potential clients this side of the new act. Belinda and her family are clear, they decided to opt with a private provider so as to avoid engaging with government-subsidised care entirely.

MoneyMag has spoken to private provider leaders, the numbers are in and it’s stark. Private company Just Better Care in Melbourne and Hobart shared that private clients have jumped 87% over the course of the past 12 months. 

Instead of waiting for a package that may not arrive in time, Ruba Fattouh, director of Just Better Care in Parramatta shares, “this choice lets them focus on what mattered most: nursing care at home and companionship.”

What matters most

Insight into the consumer base is a non-negotiable for providers seeking to enter into this time post November 1 with sustained strong performance. Just Better Care’s recent country-wide survey put the question to Australians in their mid-60s, on the horizon of retirement and considering aged care plans, what mattered most to them?

Reviewing the report shines an invaluable light on why the potential shift away from wading through a confusing My Aged Care digital platform, and interminable waitlists, is making its mark in changing client choice.

Unequivocably staying at home was the pinnacle of the list. Government messaging has noted this to some degree, and industry leaders and advocates have known this since the dawn of time, human-beings feel most comfortable at home, and so the goal and structure of the sector should be aligned to support this. Between policy and practice in the routine, unintended consequences are building.

Quality of care came in second place, and surprising to some of the survey personnel, it was only in third spot that low cost and affordability made it onto the list. This is a critical point of feedback the sector must acknowledge.

With how Support at Home actually functions, at its core, it must accessibly, clearly and most importantly, in the routine, work to support seniors to stay at home and protect their independence, and do so underpinned by quality.

The survey found that while participants routinely shared that they believed private care was only a possibility, “mainly for the wealthy”, the overall results show that families and seniors are willing to increasingly consider private care, through sacrificing savings, to realise independence and quality.

As the new structure, waitlist times and co-payment pricing model of Support at Home entrenches in Australia, a moral and ethical question arises for government and the sector, is this the direction that the country should be moving in?

A complex and frustrating process

The growing concern is that through unintended consequences of government policy and reform, the options for families without significant wealth are being cornered into impossible decisions to support loved ones in their later years.

The Inspector-General of aged care last week tabled a report into the digital platform of My Aged Care. Asking, “is the doorway into aged care open to everyone? Is it easy to find, easy to use, and fair? And crucially: Does it reflect the rights and dignity now enshrined in the new Aged Care Act 2024 (the new Act)?”

The resounding answer was no.

“The findings are clear: for many, it is not and does not. Enhancements have been made and a lot of effort invested in improving the doorway, but still, many older people — particularly those from diverse backgrounds, remote communities, or with limited digital literacy, struggle to access and navigate the system.”

“Over the course of the review, my Office heard that whilst My Aged Care is intended to provide the ‘front door’ to the aged care system, for many older people seeking to access aged care services, the experience is more akin to navigating a maze,” Ms Siegel-Brown, the Inspector-General said.

The review, and office of the Inspector-General, found that My Aged Care is “poorly understood, insufficiently promoted, onerously complex to navigate and not appropriately tailored to the needs of the whole of the target population.”

Coupled with ballooning waitlists that have been the focus of multiple senate enquiries, the cracks of the Support at Home system show that families turning to private aged care is not a choice at all but a last option to support loved ones in their pursuit of dignified and quality care.

Bungled definitions

Minister Rae has publicly stated the government’s intention to establish an equitable and sustainable way forward for aged care, for seniors and the nation’s coffers.

“In designing this program, we had to have the conversation that successive governments have shirked – how we make the sector sustainable not just for our parents and grandparents, but for our children and grandchildren in generations to come, too.”

“Of course, government continues to fund 100% of clinical care for older people under Support at Home.”

“Those who can afford to contribute to independence and everyday living supports are now asked to do so, while those of lower means receive extra support.”

He continues, “we’ve worked to strike a balance that makes both financial and ethical sense – asking those with capacity to make a co-contribution, so the system can continue to support those without.”

“The new funding model will ensure aged care remains viable, accessible and high quality in the long term – something far from guaranteed under the old system.”

However a system’s efficacy is found in the metal of its implementation, under the Support at Home structure, all non-clinical services come with a co-payment price-tag, in some cases 80% of the cost per hour. For the thousands of families who are just out of the hardship exemption the new system has come as a startling shock.

Free market challenges

Compounding the issue is that through the government allowing a free-market price setting time until July 1 2026, prices for services are wildly fluctuating and have risen above prior expectations. Hello Leaders has heard from families looking at costs of between $100 – $150 per hour for a shower.

This means, in order to maintain personal hygiene, which medical and clinical experts have linked to maintaining health, staving off infection and other deteriorating health conditions, a pensioner may be looking at $52.5 a week to maintain cleanliness, which for a single person would be over 10% of their weekly income, before rent, food and medical expenses.

Kathy Eagar, respected advocate and academic puts it plainly.

“We are one of the wealthiest countries in the world. We should not be asking older people to choose between a shower and a meal. It’s unethical.”

It is those just outside of hardship cut-offs that are facing impossible decisions; Covering rent or showering, buying nutritious food or co-paying for transport to get to the GP. Avoiding compounding deterioration and potentially ending up in hospital or RAC early, which comes with its own tax-payer price tag, is seemingly becoming increasingly difficult.

Eager shares the opportunity that is present for both government and advocates, “Government has the right to set policy. Experts have the right to tell them they are wrong. Citizens have the right to object. No government gets every decision right, especially in an area of complex policy reform. Smart governments change their policy when they realise that they have it wrong.”

Re-orienting for sustainable good and choice

For the numerous providers who operate closely with government subsidies, the need for reform in this area is critical. As seniors and families continue to face impossible decisions, impacts on financial viability for many providers will become pronounced.

Jeremy Curtis is an aged care analyst, he warned that many small to mid-sized providers, “who thought they were ready…aren’t.” Now week five past the enactment of change, growing pains of the new systems are bearing their teeth, with “operational reality” impacting bottom-lines and functional viability.

He challenges, “providers who act early – tightening scheduling, fixing claims leakage, aligning finance and workforce, and resetting consumer experience – will not just stabilise under Support at Home, they’ll outperform.”

Yet in the face of providers who have poured themselves into positioning into a place of readiness ahead of November 1, ready to take on the growing demand for care of seniors who want to stay at home, the obstacles that are detouring potential clients away is not only galling, it is fundamentally unnecessary.

My Aged Care, as challenged by Inspector-General Siegel-Brown, must have its “system issues” addressed immediately. The portal, set up to be the single-point of entry into navigating aged care must be clear, concise and easy to use. Waitlists for Support at Home must be brought under control, and definitions of care, such as showering re-assessed.

Australia’s seniors, their families and the sector that seeks to provide quality care, must be allowed to support all, including those just outside of hardship parameters.