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, like food and dining upgrades, more frequent housekeeping, expanded activities, and enhanced amenities. It’s optional, it sits outside clinical care, and it formally replaces the old “extra” and “additional services” constructs under the new Aged Care Act 2024. 

What’s at stake isn’t 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 don’t opt in.

What HELF is (and isn’t)

• Optional, itemised “higher everyday living” services. The Department’s factsheet is explicit: HELF offers residents tailored, higher-quality everyday living services; it is not a clinical co-payment and it must be transparently offered and explained.
  A replacement for “Extra Services” and “Additional Services.” The legislative framework moves away from the legacy models and consolidates premium everyday-living offerings under HELF. 
• Operating within a new rights-based Act. The Aged Care Act 2024 reframes the system around older people’s rights, complaints access and a stronger regulatory model; HELF must live inside that culture.

What the sector is worried about

A growing chorus of leaders warns HELF could hard-wire two tiers of experience if implemented poorly: better meals, richer programs and nicer environments for those who pay; a bare minimum for those who don’t. Diana Horvatovic’s Australian Ageing Agenda column captured this risk in vivid terms, a “cabin-class” drift that undermines community. It’s a fair caution, and it’s not the only one being aired across provider forums and reform briefings. 

Add to that the operational fog: late-landing rules, pricing questions, and workforce stretch as homes re-tool their offers and messaging. Those pressures are real, and they’re precisely 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 provider, here’s the bar:

1. Make the base experience good.
   Base (non-HELF) everyday living must be genuinely decent: appetising food, engaging group activities, clean and pleasant environments. “Baseline” is not code for “leftovers.” HELF should add polish and personalisation, not subsidise an anaemic core.
   
2. Build HELF as a portfolio, not a grab-bag.
   Curate 3–4 clearly named bundles (e.g. Dining+, Lifestyle+, Comfort+) with transparent inclusions and a clean price per day. Tie each bundle to outcomes residents value: taste, social connection, autonomy, comfort. (If you can’t explain the benefit in one sentence, it’s not a product yet.)
   
3. Protect inclusion for people with cognitive impairment.
   Any schedule that forces staff to “turn someone away” from an activity because they’re not on HELF will fail ethically and operationally. Run a core roster that is open to all; layer HELF enhancements around it (frequency, duration, facilitation ratio, guest performers, materials quality).
   
4. 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 with the Rules, and align it to your complaints pathway and resident rights communication. (The regulator will expect clarity under the new framework.)
   
5. Price with discipline, then test comprehension.
   Families often make decisions under time pressure. Co-design your HELF brochure with consumers; test whether people can correctly repeat back what’s included/excluded and how to opt out, downgrade or stop.
   
6. Instrument your outcomes.
   Track satisfaction, participation, nutrition proxies (plate waste), and complaint themes across base vs HELF. If base metrics dip after launch, you’re creating tiers –  fix it.
   
7. Close the governance loop.
   Fold HELF into risk, quality and board reporting: monthly uptake and churn, complaints/compliments by bundle, equity markers (who’s missing out), and corrective actions. Under the new regulatory model, this isn’t nice-to-have; it’s prudent.
   

Context matters: how we got here (briefly)

For years, providers could offer Extra Services and later Additional Services (broader, resident-level options). These regimes varied in scope and oversight and were periodically re-interpreted by regulators; HELF replaces them with a cleaner, rights-framed 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

• Equity test: Can every resident access a meaningful weekly program without HELF?
• Clarity test: Can a new family explain your base vs HELF difference after a 5-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 rise post-launch?
• Exit test: Can residents downgrade or exit HELF quickly, with pro-rated fees and no friction?

HELF isn’t a moral hazard; it’s a leadership hazard. It will reveal whether we can design choice without cruelty – delivering a solid common life for everyone and bespoke flourishes for those who want them. That requires courage at the base, creativity at the edge, and relentless transparency in between.