Stuck in survival mode: How Support at Home is distorting care

The new Aged Care Act was meant to make access to services simpler and fairer. Instead, it has triggered one of the most disruptive shake-ups in home care to date.

The transition from Home Care Packages (HCP) to the Support at Home program has stripped out a major income stream for providers by removing package management fees and tightening caps on what can be charged. The goal was to direct more funding to frontline care. In practice, it has left many providers scrambling to redesign their business models overnight.

As the dust settles, a new kind of contest has emerged — one that looks less like care and more like competition.

Sophie Morell, co-founder of My Support Australia, calls it the “Support at Home Hunger Games”.

“Providers have lost a huge revenue stream. Some were charging up to 35 per cent on package management. That is gone overnight. So they are now using different tactics to crawl back that income,” she says.

The new currency of client competition

My Support Australia is a small, independent home care and NDIS provider based in regional Victoria, run by Sophie and her husband Gareth, a paramedic. Both are organ transplant recipients, and their personal experience navigating the health system shapes how they operate.

“We understand what good support actually looks like,” Sophie says. “We have lived this.”

But in recent months, she has noticed a dramatic shift in behaviour across the sector. In regional community Facebook groups, families are now reporting aggressive marketing tactics and sign-up incentives.

Within days of the reforms taking effect, Sophie says she saw a wave of advertising offering rewards to switch providers — reduced fees, large gift cards and even cash incentives of up to $1200.

At a glance, these offers seem appealing, especially in the middle of a cost-of-living crisis. But she urges caution.

“Someone needs to ask where that money is coming from,” she says. “A business is not going to give away $1200 out of generosity. If they have lost a major revenue stream, that money has to come from somewhere.”

Sophie stresses she cannot confirm that incentives are funded directly from people’s care budgets, but she wants families to apply common sense. “If a provider gives away thousands of dollars in incentives and has lost a major revenue stream, they will find a way to claw that back. It might not be obvious. But it has to come from somewhere.”

When marketing eats into care

Sophie illustrates how easily incentives can erode available support. A Level 1 package, worth about $10,000 a year, drops to around $9,000 after the 10 per cent administrative fee under Support at Home. Add onboarding costs or incentive deductions, and that balance can shrink to $7,400 before a single service is delivered.

“The older person ends up getting fewer services,” she says. “Home care becomes a commodity, not a support system.”

Gareth sees the impact from the frontline. “If people cannot afford personal care supports, they might skip showers. They might not have skin integrity monitored. They might not have meals prepared or medications checked. So we will see more hospital presentations and more emergency call outs,” he says.

And those hospitalisations create a domino effect — longer stays, delayed discharges and growing strain on residential care.

Small providers under pressure

While families face confusion, small operators are also feeling the squeeze. Sophie says some larger organisations are becoming increasingly territorial as they fight to protect their client base.

“We have received legal threats simply because clients followed a care partner who changed jobs. People have the right to choose who supports them. But the sector has become adversarial and territorial. The older person is being treated like an account number, not a person.”

For Sophie, this is the heart of the problem. “We need to ask ourselves: when did we decide it was acceptable to commoditise care for older people? These are our most vulnerable community members. They deserve transparency, dignity and honest support, not sales tactics.”

Rebuilding trust through clarity

Despite the uncertainty, Sophie believes rebuilding trust is possible. Before confirming new agreements, she and Gareth personally contacted every My Support Australia client to explain the changes.

“They were grateful just to have someone explain what is going on,” she says. “People want to feel like someone is walking this with them.”

The Support at Home reforms were designed to simplify access to care and deliver more value to older Australians. But as providers race to recover revenue, the balance between competition and care is being tested.

Unless the sector re-centres on its purpose, Sophie warns the fallout will show up not just in care plans, but in hospitals and homes nationwide.

“We should not accept a system where getting help at home feels like a contest with winners and losers,” she says. “Home care was meant to be about people. We cannot lose sight of that.”