HELF is a test of leadership, not just a fee: How providers can design choice without creating a class system

From 1 November, the Higher Everyday Living Fee (HELF) becomes the official mechanism for residents or families to buy higher-quality everyday living services in residential aged care, such as food and dining upgrades, more frequent housekeeping, expanded activities and enhanced amenities. It is optional, it sits outside clinical care, and it formally replaces the old “extra” and “additional services” structures under the new Aged Care Act 2024.

What is at stake is not whether consumers can choose extras, as Australians make tiered choices in almost every service category, but whether leaders can design HELF in a way that protects dignity, equity and community for residents who do not opt in.

What HELF is (and Isn’t)

HELF offers residents optional, itemised higher everyday living services. It provides tailored, higher-quality services that are not part of clinical care and must be transparently offered and explained.

It replaces the “Extra Services” and “Additional Services” models, consolidating premium everyday living offerings under a single framework.

The new Aged Care Act 2024 also reframes the system around older people’s rights, stronger regulation and better access to complaints. HELF must operate within this culture.

What the sector is worried about

Many aged care leaders have warned that HELF could entrench two tiers of experience if implemented poorly, with better meals, richer programs and more comfortable environments for those who pay, and a bare minimum for those who do not. It is a fair concern and one that is being widely discussed across provider forums and reform briefings.

Added to this are the operational challenges: late-arriving rules, uncertainty around pricing, and workforce pressures as homes re-tool their offerings and communication. These pressures are real, and they highlight why CEOs must set a design standard now.

Leadership stance: Design for dignity at the base, differentiation at the margin

If you lead a residential aged care provider, here is the bar:

Make the base experience good on purpose.
Base (non-HELF) everyday living must be genuinely decent, with appetising food, engaging group activities, and clean, pleasant environments. “Baseline” should not be code for “leftovers.” HELF should add polish and personalisation, not subsidise a weak foundation.

Build HELF as a portfolio, not a grab-bag.
Create three or four clearly named bundles, such as Dining+, Lifestyle+, or Comfort+, with transparent inclusions and a simple daily price. Each bundle should connect to outcomes residents value: taste, social connection, autonomy or comfort. If you cannot explain the benefit in one sentence, it is not ready to be sold.

Protect inclusion for people with cognitive impairment.
Any structure that forces staff to turn someone away from an activity because they are not on HELF will fail ethically and operationally. Maintain a core activity roster open to all, and build HELF enhancements around it by increasing frequency, duration, facilitation ratio, guest performers or materials quality.

Publish the line between “included” and “enhanced.”
Use a single-page matrix at admission and on your website. Keep it in plain language, update it regularly, and align it with your complaints and resident rights communication.

Price with discipline and test comprehension.
Families often make decisions under time pressure. Co-design your HELF brochure with consumers and test whether people can clearly explain what is included, excluded and how to opt out or downgrade.

Measure your outcomes.
Track satisfaction, participation, nutrition indicators such as plate waste, and complaints themes across base and HELF services. If base metrics decline after launch, you are creating tiers that need fixing.

Close the governance loop.
Incorporate HELF into risk, quality and board reporting, including monthly uptake, churn, compliments and complaints by bundle, equity markers and corrective actions. Under the new regulatory model, this is not optional; it is good governance.

Context matters: How we got here

For years, providers could offer Extra Services at site level and later Additional Services at resident level. These regimes varied in scope and oversight and were often reinterpreted by regulators. HELF replaces them with a cleaner, rights-based structure under the 2024 Act and its Rules. That history explains both the sector’s muscle memory and the legitimate fear of inequity if the baseline slips.

Five HELF design tests for CEOs

Equity Test: Can every resident access a meaningful weekly program without HELF?
Clarity Test: Can a new family explain your base versus HELF difference after a five-minute briefing?
No-Stigma Test: Would a resident on base feel singled out in the dining room or activity space?
Outcomes Test: Do base participants’ satisfaction and participation stay steady or improve after launch?
Exit Test: Can residents downgrade or exit HELF easily, with pro-rated fees and minimal friction?

Where I land

HELF is not a moral hazard; it is a leadership hazard. It will show whether we can design choice without cruelty, offering a solid common life for everyone and personal touches for those who want them. That takes courage at the base, creativity at the edges and relentless transparency in between.

If we get this right, HELF can fund better everyday living without fracturing community. If we get it wrong, no fee schedule will save us from the culture we create.