Support at Home is a complicated, opaque, inefficient scheme for all – part two: devoid of financial and logical sense

Support at Home has brought in sweeping changes to how home care operates across the sector, for hundreds of providers and staff, impacting seniors and wider society. Examining these in a series is to highlight the very real impacts of legislation on the ground, and the equally real need for reform.

As the weeks and months have gone by, providers on the ground are having to respond to the ever increasing impact of the Support at Home changes. They do, however, have more data to present just how ineffective, cost-wise, the scheme is compared to previous offerings. 

The Commonwealth Home Support Program has been well publicised within the sector as being effective, within cost and process, for seniors using it to meet needs, and the providers providing that care. The growing movement to help prevent the CHSP from being folded into SaH is now reaching new heights. Directly in line with this is the data being presented by aged care leadership. 

Adrian Morgan is the General Manager at Flexi Care, a home care provider. Louder than any request to overhaul SaH to make sense for senior, sector and providers, are the stark numbers of inflated cost to run the program, offered up by the people within providers. In equal perplexity is the continued use of the IAT algorithm and the black-box which is its decision matrix. Morgan shares the confusion that hundreds of provider leaders are facing, and bearing alongside their clients, in the attempt to meet real need within a persisting opaque system.

Cost – simply ineffective

The data regarding Support at Home and programs which it is set to replace, namely the Commonwealth Home Support Program, are as clear an indicator of policy landing poorly as any.

Morgan is clear in what he shares. Within the operations of his organisation he has seen telling and unavoidable cost repercussions of providing care under the new scheme.

When it comes to the comparisons of cost under CHSP and Support at Home, there is an overt and costly difference, for seniors, for the sector, for the taxpayer. 

“Personal care has risen 21.4% higher under Support at Home, domestic support has risen 29.4% higher, nursing has lifted by 17.3% and social support is an alarming 42.0% higher”.

He is frank, “these differences won’t be the same across all providers because there are so many factors that influence the cost of providing services, but I’m confident that all organisations would experience noticeably higher costs under Support at Home than under CHSP.”

Reporting from the scene

Little thrives in darkness, this premise equally translates to aged care schemes. And yet a growing scheme trend is the opaqueness of Support at Home assessments and reassessments.

For those whose conditions have decidedly worsened, “half of the people who have been re-assessed since 1 November 2025, of our clients, about half of them have been rejected, at the moment the rate is running at 52%”.

Morgan sees a stark and jarring shift, “up until the end of October, those people, and us, had the very reasonable expectation that an increase would have been forthcoming”.

“The algorithm, and the IAT, is hitting hard”.

For Morgan, the splits providers are needing to sustain, in trying to provide excellence in care with a system that is pulling further away from objective need, is unsustainable and perplexing.

“People who require assistive technology and modifications, things like wheelchairs, beds, things like that, they and we are finding that they’re just not getting approval for the funding that’s required”, he shares.

“We’ve had people needing things that might cost $6000 or $7000 and they’ll receive an assessment back with an approval under $2000”.

“We are all very confused, it’s very frustrating. And not only are they not getting approval at the level that they need, they’ve also got to then go on and make a personal contribution.”

A black box

Morgan describes the scenes in his organisation, likely mirrored by hundreds across Australia. Stupefied confusion when assessment and re-assessments are returned. For analysts and experts across sectors, the base ingredient of ‘not fit for purpose’ is the opaque mystery behind how the ‘sausage’ is made.

“All they say to seniors, and by extension providers, ‘you didn’t get the right number of points under the IAT’”.

“‘So you don’t meet the algorithms requirements’, and so you don’t get the higher funding’. That’s all we’re getting. Seniors [and us] don’t really think that’s a proper explanation but it’s what they’re saying”, he shares.

It’s put to Morgan that now it’s become a matter of trying to play the game of the system, he replies, “that’s certainly one interpretation, yes.”

“You’ve certainly now got a bit of a guessing game. Because you don’t really know where the goalposts are. You don’t know really what is required to achieve a particular level. It’s not publicly available.”

Providers analysing data

Morgan shares that for their clients, to be in a position to provide the best, to understand this new world, they’ve at length tried to get to the bottom of it, “we’ve certainly analysed the data in a fair bit of depth.”

But the strange new reality persists, “[Comparing] the people who have not been given their upgrades and comparing it to the people who have been given the upgrades, we really can’t see a clear pattern between those two groups.”

For a scheme that was intended to hit squarely in the bullseye of fairness and transparency, the opaqueness of the IAT’s assessments is an ever-growing point of loud silence and distrust.

“There are some that look to us, based on the answers they gave in the IAT, you’d think they would be getting a higher level and others you’d be thinking, ‘I wonder why they got a level as high as they did’”.

Morgan raises this issue that bodes poorly for a system, and seniors, who acutely deserve fairness in needs met and the allocation of resources to do so, “so it’s really, [IAT’s decisions] it’s cutting both ways”.

Within a new dawn that the aged care act was meant to usher in, transparency and reliability were meant to be bastions of trust. Particularly for those desperate to stay at home, out of expensive hospitals, and at-capacity residential aged care, even within worsening conditions, re-assessment in Support at Home was set to be the answer, “but it’s very…it’s not predictable”.

The numbers speak for themselves, SaH is proving to be costly and ineffective to run by providers, impacting operations and seniors in pursuit of excellence in home care. The IAT algorithm, in its opaque decision matrix, also continues to prove a challenge to the transparency and fairness the Commission’s findings recommended for a healthy and robust sector.

Part three to follow next week: Preventative care measures ignored, alongside ill-prepared SaH processing systems, is sector and seniors poorly treated. In addition, societal impacts grow as providers, staff and seniors grapple with changes.