In what was her final appearance before a Senate committee as Inspector-General of Aged Care, Natalie Siegel-Brown delivered a sobering assessment of the Support at Home programme, warning that a reform designed to keep older Australians living independently in their own homes is instead accelerating their decline and pushing them prematurely into the very residential care facilities the programme was meant to help them avoid.
Appearing before the Senate Community Affairs References Committee’s inquiry into the Support at Home programme, Siegel-Brown did not mince words. “The current design and administration of Support at Home appears not to be achieving this intended purpose,” she told senators. “Indeed, in key respects, it may be undermining that.”
What made the evidence particularly striking was Siegel-Brown’s admission that her own office had not grasped the full scale of what was coming. In its 2025 progress report on the implementation of the Aged Care Royal Commission’s recommendations, her office had flagged a number of unintended consequences. But she told the committee last night that what has unfolded in practice has exceeded even those concerns.
“While my office predicted many of these unintended consequences in our 2025 progress report, we simply did not foresee them on the scale we are now witnessing,” she said. “Nor did we anticipate the full scope of issues.”
The consequences, she argued, are not only harmful to older people’s wellbeing. They are making the aged care budget more expensive, not less, by funnelling people into costly residential care and hospital settings that better-designed home support could have helped them avoid.
Central to Siegel-Brown’s critique is the damage being done by delays. Older Australians are waiting too long for assessments and too long for services, and those waits are not a neutral inconvenience. They are causing people to deteriorate.
“Delayed access to that very support is perversely, inevitably promoting older people’s decline and likely fast-tracking their entry into hospital and residential aged care,” she said, describing this as happening at the expense of both human rights and the economy.
She offered a pointed illustration of how administrative settings are compounding the problem. A pair of crutches valued at around $50, recommended by a GP, can end up costing the system approximately $1,800 once the required occupational therapy assessment is factored in, with a three-month wait on top of that. In the intervening period, she noted, the risk of falls for the older person increases significantly. “We’ve just paid 36 times the value of that support that that person could have had right then.”
One of the sharpest criticisms Siegel-Brown levelled at the programme concerned the Integrated Assessment Tool, known as the IAT, which is used to determine what support a person needs. She described aged care as having become an outlier among Australian health and social systems in its refusal to trust clinical judgement.
“From Medicare, chronic disease management to allied health access, Australia routinely trusts clinicians to determine who needs support and what that support should look like,” she told the committee. “Aged care is now the outlier. It’s a system where clinical judgement informs the data entry, but not the decision.”
She also raised concerns about telephone-based assessments limiting assessors’ ability to properly observe a person’s functioning, safety and living environment, and questioned whether recent procedural changes to allow reviewers to return assessments for correction were sufficient to address the tool’s fundamental weaknesses.
Senator Ruston pressed the point directly, asking whether running a second assessment through the same algorithm would simply produce the same flawed result. Siegel-Brown conceded the concern was valid. “Why would the second production from the algorithm be any different to the first?” she acknowledged. “Unless you’re manipulating what you put in.”
The urgency classification system drew particular scrutiny. Siegel-Brown explained that a person must score five out of six points to be classified as urgent, with points allocated for factors such as living alone, having a cognitive impairment, being an Aboriginal or Torres Strait Islander person, or having already waited more than six months while residing in a small town or remote setting. That last criterion, she noted, is a compound of two factors, immediately excluding the vast majority of the population.
“95 per cent of the population have just lost one point because they wouldn’t be in a small town or a remote setting,” Senator Allman-Payne observed. Siegel-Brown confirmed that was correct, which goes some way towards explaining why, out of around 100,000 assessments conducted since the programme began, only 129 people had been classified as urgent.
On co-payments and financial hardship, Siegel-Brown was equally direct. She described the means-testing model underpinning Support at Home as fundamentally inequitable, noting that it does not ask people to contribute based on what they have, but based on how much care they need.
“Two people with exactly the same income are asked to pay very different amounts simply because one is frailer, sicker or further along the trajectory of decline,” she told the committee. This, she said, departs from the equity principle applied across other areas of Australian social policy.
The consequences are showing up in the data. In the first two months of the reforms, hardship applications rose by 88 per cent. “What this points to is not a failure of principle, but a failure of design,” she said. “Early data suggests that hardship is not an edge case. It’s a serious risk of becoming a structural feature of Support at Home.”
She acknowledged that the government’s decision to exempt showering, dressing and continence support from co-payments was welcome, but argued that independence requires much more than personal care. “Maintaining independence goes further. It requires cleaning, meals, transport and social support. Yet they still remain subject to co-payments.” The result, she said, is that those who are already most economically vulnerable are the ones most likely to go without the very supports that sustain their independence.
Seventy-five per cent of people accessing Support at Home are part or full pensioners, she noted. For them, co-payments are not a marginal contribution. They are a genuine financial barrier, and one that is driving some older people to give up on home support entirely.
Despite the gravity of her critique, Siegel-Brown was careful to frame her evidence as solution-focused rather than adversarial. “I want this to work,” she said. “I think the budget is enough to make it work.”
Her priorities were clear. The single most important shift, in her view, is to reconceive Support at Home and the Commonwealth Home Support Programme as the primary infrastructure for prevention in aged care, rather than as a last resort activated at the point of crisis. Getting support to people earlier, at lower intensity, slows decline, eases pressure on residential aged care and delivers significant economic dividends.
She pointed to the Nordic countries and Japan as examples of what is possible when a system is designed around this logic. Denmark, she noted, has introduced a national approach so successful at supporting people at home that it has legislated against building any new residential aged care facilities, and has reduced its hospital footprint to roughly a third of what it once was.
The barriers to achieving that outcome in Australia, in her assessment, are not primarily financial. They are administrative. Complexity, waiting times and co-payments are together deterring older Australians from accessing support until their needs have escalated beyond what home care can address. Removing those barriers, she argued, would not simply be the right thing to do for older people. It would save money across the entire aged care and healthcare budget.
She also called for urgent reform of the means test to remove co-payments for the poorest older Australians, a human override mechanism for the IAT, greater pricing transparency and accountability from providers, and the immediate exemption of Stolen Generations redress payments from Support at Home means testing, noting that these payments remain counted as assets for home care even after the recent budget decision to exempt them from residential aged care assessments. “We are penalising people for accepting an apology,” she said.
The hearing closed with senators from both sides of the chamber offering warm tributes to Siegel-Brown, who confirmed it was her final committee appearance in the role.
Senator Ruston told her: “The older population of Australia should be very thankful that they’ve had you looking after them for the last 18 months.” Senator Allman-Payne echoed those sentiments and noted she was looking forward to Siegel-Brown’s upcoming National Press Club address.
Siegel-Brown’s parting message, however, was not one of farewell so much as urgency. The system, she told the committee, still has the capacity to deliver on the ambitious promise of the new Aged Care Act, with its landmark commitment to compassion, dignity and the rights of older people to age in their own homes and communities. But only if the government acts quickly to change course.
“It’s still possible to realise the noble ambition of the Aged Care Act,” she said. “Every single dollar of the existing $40 billion aged care budget could support more older people to receive services they genuinely need, with shorter wait times.”
The committee is due to report on 24 November 2026.
Very timely and informed critique and suggestions for change from the Inspector General. Let’s hope the Committee are able to put forward the recommendations in a way the government can accept. Otherwise the changes including algorithm assessment risk increasing risk and decline for seniors in need of care and quality of life. Mary Lyttle AM
At last someone who speaks the truth and has a real understanding of the shambles the government has created
Agreed, although she has stepped down now! Maybe it was because she spoke the truth???
The real challenge in our Aged Care system, is how on earth could it get worse, after so many enquiries including a Royal Commissin into it???
Oh, that’s because governments use them to pretend they are doing something and to defer any action, then ignore most recommendations (of most if not all Royal Commissions).
And too add on top of this failure. Support workers are leaving the industry more now than ever. More trained support workers are now having to travel to at home clients up to 5 or 6 clients per day as domestic assistance and only 10% PC work, yet there is now more pressure on workers who are now having to clean back to back, three of four vaccums a day. In an hour shift many have to change the bed, clean the bathroom/toilet, vac and mop. Workers are burnt out, client’s becoming super picky. Workers getting paid half of what a ‘Cleaner’would earn and that’s not even adding fuel costs .
Very actual and timely criticism. Need to act urgently as the consequences could be devastated
And when you eventually get assessed they draw up a list of items you actually need and put them forward for budget approval. Then they come back and say certain items can not be funded because they are outside the budget limit. The remaining items are subsequently approved and one would think that they should be supplied within a short reasonable time. But no! A few items are delivered but all sort of excuses are made for the other items not being supplied. And each time you go and follow up, the excuses change depending on who answers the phone. Excuses include but not exhaustive: –
The items are not safe and have been withdrawn from supply ( but next time you are told that they are out of stock, then we can not get them from the supplier where you actually tried the items with the Occupational Therapist as we are not permitted to get them from that supplier, then our books are closed for this Financial Year and will have to be supplied next year, etc, etc.
I get the feeling that they are more interested in getting fees ( both from the government and your co-payment) than actually providing you with the service and supply of necessary items in a reasonable time and to do reports.
The whole process is extremely slow, very frustrating and you spend enormous amounts of time following up. The Providers do not seem to follow up themselves unless they bare prompted.
In the meantime your condition deteriorates because the equipment you need to prevent this is unnecessarily delayed or not supplied at all.
The Inspector General is certainly one of the more knowledgeable and sympathetic politicians and it’s a pity she isn’t Minister for Ageing. People living in outer regions need her advocacy to rectify the disadvantages of the Community Transport Fee structure for recipients of the Support at Home package. Package recipients are charged 600% more than other passengers simply because they receive a package. One government-subsidised organisation CTST has been authorised to undertake this fee structure, dipping in to funding which should be spent on maintaining the health and well-being of the individual.
I posted the following comment on the similar recent article by ‘Community Care Review’ but they don’t publish the comments publicly anymore only on LinkedIn- hardly democratic!
We have made multiple submissions over the years and have warned repeatedly about some of these issues. Hopefully Hellocare will publish.
“I have had a long experience of dysfunctional systems and have been drafting submissions for a Group ‘Aged Care Crisis’ for several years. We have warned that the system was not working for years and more recently that aspirational recommendations and an excessive regulatory response compounds the problems and can be counterproductive if the underlying problems are not addressed.
The Nordic countries were warned about the dangers of this as well as about market dominance in about 2013. But they also differed in that aged care was directly managed locally with central support. Increasing local expertise gave rise to better oversight and immediate action. The market was directly accountable and had to respond to local on site bodies. This has been the best in the world.
The Royal Commission actually recommended a disseminated management model with central support as advised by the Gratton Institute (ignored by government). The Gratton institute later supported our advocacy for local advisory committees with a central body representing these communities. They would appoint delegates to central committees ensuring Communities had an independent voice. This would be a far more responsive and innovative system. We could still easily move in this direction.
I agree with everything that Siegal Brown is saying and note that in the past she has also advocated for greater citizen oversight of care using empowered community visitors.
Natalie Siegel-Brown is a national asset. Along with Prof Kathy Eagar, they are the only people who have consistently and calmly, demonstrated the lack of intellectual capacity in both the Government and Public Service in implementing the recommendations of the Royal Commission.
Asking full pensioners to contribute to their home care is a national disgrace.
Thank you, Natalie and Kathy.