To the Minister for Aged Care and Seniors, the Department of Health, Disability and Ageing, and everyone responsible for shaping Support at Home,
Australia’s aged care reforms promised dignity, independence, choice and control. But for many older Australians living with the consequences of Support at Home, there is a growing distance between those promises and everyday reality.
The fundamental question is no longer simply whether the new system is working as intended. It is whether the system was designed around the needs and rights of older people in the first place. There is a serious difference between reforming aged care and reorganising how aged care is funded, administered and controlled.
Real reform should improve people’s lives. It should make support easier to obtain, more responsive to individual needs, more affordable and more accountable to the people receiving it. Instead, Support at Home has introduced a complicated system in which older people must navigate assessments, service classifications, contribution rules, provider pricing, administrative requirements and restrictions on how their support can be delivered.
We are told that older people are at the centre of these reforms. But being at the centre of a policy discussion is not the same as having power over the decisions that shape your life.
Older people do not live their lives in neat categories of clinical care, independence and everyday living. We live in homes.
We need to eat, wash, dress, clean, shop, maintain our surroundings, get to appointments and remain connected to our communities. These activities are interdependent. A clean home can prevent falls and infections. Gardening can maintain safe access to a property. Transport can make medical treatment possible. Help with shopping and meals can prevent malnutrition and deterioration.
Yet Support at Home divides services into administrative categories that determine how they are funded and what consumers must contribute. The result is a system that can treat essential parts of independent living as optional or less important simply because they fall into a different funding category.
From a consumer’s perspective, this makes little sense. If the objective is to help older people remain safely at home, why create financial barriers to the very services that make remaining at home possible?
The introduction of consumer contributions for many services raises fundamental questions about fairness and the purpose of aged care.
Older people are being asked to contribute towards services that may be essential to their health, safety and independence. For someone living with disability, frailty or chronic illness, cleaning is not necessarily a lifestyle preference. It may be physically impossible to do independently. Gardening may be necessary to maintain safe access to the home. Help with meals may be essential to adequate nutrition.
Yet these services can attract some of the highest contribution rates. Although personal care became fully government-funded from 1 October 2026, the wider problem remains.
A person can be financially discouraged from obtaining preventative support, while the system continues to fund more intensive care after their health deteriorates.
There is also a troubling contradiction. Government policy encourages older Australians to remain in their own homes for as long as possible, yet some of the costs of doing so are shifted onto those least able to manage them.
The existence of hardship provisions does not eliminate this problem. Older people should not have to demonstrate financial distress before essential support becomes affordable. Independence should not become a privilege reserved for those who can afford the contributions.
Support at Home was intended to bring greater transparency and accountability to aged care pricing. Yet providers have considerable discretion in setting service prices, subject to requirements that prices be reasonable, transparent and agreed with participants.
Care management already receives a dedicated government-funded allocation of 10% from each participant’s budget. Nevertheless, consumers face service prices that can include administration, subcontracting and other delivery costs, making it difficult to understand exactly what they are paying for.
Older people may see substantial differences between what a worker receives and what is charged against their funding. There may be legitimate costs involved in delivering services, but consumers deserve to know what those costs are and whether they represent reasonable value.
The government’s decision to pause the introduction of price caps has intensified concerns about effective price protection. A budget may look generous on paper, but if service prices rise, the actual hours of assistance available can fall.
For someone dependent on regular care, that can mean fewer showers, less cleaning, reduced social support or essential tasks going undone. The true value of an aged care package is not the dollar amount allocated. It is the care and support that amount actually buys.
Self-management should be one of the strongest expressions of choice and independence within aged care. It recognises that older people are capable of making informed decisions, organising services and selecting workers who understand their individual needs.
Many self-managers successfully organised their support under the former Home Care Packages program. Yet under Support at Home, consumers can find themselves negotiating provider policies, service approvals, pricing arrangements and administrative restrictions that substantially limit their control.
A person may identify a suitable worker, negotiate an affordable rate and establish a reliable working relationship, only to encounter barriers imposed by the provider responsible for administering the funding.
Providers have legitimate responsibilities for safety, quality and compliance. But those responsibilities should not become a justification for unnecessary interference with reasonable consumer choices. There is an important distinction between protecting an older person and controlling them.
Self-management without genuine decision-making authority risks becoming little more than self-administration under someone else’s control.
Aged care policy often appears to assume that services are readily available and that consumers can simply choose another provider or worker when difficulties arise. That assumption does not reflect life in rural and remote Australia. In many communities there are few available workers, long travel distances, limited transport options and no practical alternative providers.
For some older people, the only suitable support worker may be someone already known to them, including a family member who is appropriately qualified and does not live in the same household. Restrictions on employing relatives, and provider concerns about conflicts of interest, need to be weighed against the reality of thin service markets and the relevant exceptions and safeguards.
A rigid interpretation of the rules can leave a person without support even when a suitable, willing worker is available. For someone with severe physical disability, going without services is not merely inconvenient. It can mean attempting dangerous household tasks, missing appointments, being unable to leave home or facing preventable injury.
A policy that works in a metropolitan area may be completely unworkable on an isolated rural property. Choice is meaningless when there is nothing to choose from. A genuinely equitable system must recognise that equal rules do not always produce equal outcomes.
One of the most serious concerns involves the system used to assess older people’s needs and determine their level of support. The Commonwealth Ombudsman’s October 2026 investigation into the Single Assessment System and its Integrated Assessment Tool raised significant concerns about transparency, fairness, human oversight and the ability of assessors to respond to individual circumstances. These findings go to the heart of consumer confidence.
An older person’s needs cannot always be adequately understood through standardised questions and computer-generated recommendations. Two people with similar diagnoses may have entirely different abilities, environments, informal supports and risks. An assessor must be able to exercise professional judgement, particularly where an automated recommendation does not reflect the person’s actual circumstances.
Older people should also be able to understand how decisions affecting their lives were reached, and have access to meaningful review. An assessment system should assist human judgement, not replace it. When a person cannot understand or effectively challenge a decision about their care, the promise of individualised support becomes questionable.
Assistive technology and home modifications can make the difference between living independently and needing residential care. A suitable mobility aid, accessible bathroom, transfer device or other piece of equipment may prevent injury, reduce reliance on paid assistance and preserve independence.
Yet consumers can encounter complex eligibility rules, exclusions, professional assessment requirements, approval processes and delays. Some items that were previously funded through Home Care Packages may no longer be eligible under the new arrangements. Consumers may be told that equipment falls outside an approved list or is considered the responsibility of another funding system, even where that alternative funding is not available to them.
This exposes a fundamental weakness in policy design. A person does not become less disabled because their equipment falls outside an administrative category. Nor does their need disappear because two government programs disagree about responsibility.
There should be a clear, accessible exceptions process where equipment is clinically justified and likely to prevent deterioration or premature entry into residential aged care. The system should be asking what will help this person remain independent, not simply which rule prevents the purchase.
The new Aged Care Act places considerable emphasis on the rights of older people. This is important and welcome. But rights must be enforceable in practice.
What happens when a provider repeatedly fails to respond to requests for essential services? What happens when an older person is left without support while an approval decision is delayed? What happens when a consumer disputes a charge, challenges a provider’s interpretation of the rules or cannot find an alternative provider?
Complaints mechanisms exist, but older people need timely, practical resolutions, particularly when their safety is at risk. A complaint investigated weeks or months later may do little for someone who needs assistance today. Consumers should not have to become experts in legislation, regulations and complaints procedures simply to obtain the support they have already been assessed as needing.
We need stronger independent oversight, clearer provider obligations and effective powers to intervene when essential services are at risk. A right that cannot be exercised, defended or enforced is little more than a promise.
Support at Home is extraordinarily complex for the people expected to use it. Consumers must understand quarterly budgets, service agreements, contributions, service classifications, provider prices, assistive technology rules, reimbursement requirements and the different responsibilities of government and providers.
For people experiencing illness, disability, cognitive difficulties, sensory impairment or limited digital access, these demands can become overwhelming. Even highly capable older people can struggle to obtain clear, consistent explanations. And when providers interpret rules differently, consumers are left uncertain about their entitlements.
Digital systems may improve administrative efficiency, but they must not become barriers for people without reliable internet access, digital confidence or suitable devices. Older people should not be disadvantaged because they cannot navigate an online portal or repeatedly chase unanswered emails.
The burden of making the system understandable belongs to those who design and administer it, not to the people who depend on it.
Perhaps the deepest structural weakness is the continuing imbalance of power between government, providers, professional organisations and consumers.
Older people are regularly invited to consultations, surveys, advisory discussions and forums. We are thanked for sharing our experiences. But consultation is not the same as governance. It does not necessarily give consumers the authority to influence decisions, challenge priorities or determine whether proposed changes are acceptable.
Provider organisations have established structures, resources and regular opportunities to influence policy. Consumer advocacy organisations also contribute important work. But neither provider representation nor advocacy on behalf of consumers is a substitute for independent, direct consumer representation.
People who actually receive aged care have a form of expertise that cannot be gained through professional qualifications or policy development alone. They know how rules operate in real homes, how service restrictions affect daily life and how administrative decisions can cause unexpected harm. This knowledge should be part of decision-making from the beginning, not sought after decisions have effectively been made.
Policy expertise explains how a system is meant to work. Lived experience shows how it actually works.
We need an independent national consumer governance structure with genuine authority, transparent processes and representatives accountable to older people themselves. A seat at the table is evidence of presence. It is not proof of influence.
The problems within Support at Home cannot be solved simply by publishing more explanatory material or asking older people to be patient while implementation difficulties are addressed. Some changes require a fundamental rethink of the program’s design. We need:
Support at Home should not be judged mainly by how successfully government implements its administrative arrangements, how many people have been assessed or how much funding has been allocated. It should be judged by what happens in the homes of older Australians.
Can people get the assistance they need? Can they afford it? Can they choose who comes into their home? Are their decisions respected? Can they challenge unfair treatment without fear of losing services? And, most importantly, are they safer, more independent and better able to live the lives they choose?
There are dedicated providers, care workers and public servants who genuinely want this program to succeed. The government has also introduced measures intended to improve consumer protections. But improvements to individual rules do not remove the need to examine the underlying design of the system.
Older Australians are not simply recipients of services, units of funding or subjects of assessment. We are citizens with rights, experience, judgement and lives that remain our own. We should not have to surrender control over those lives in exchange for the support we need to keep living them.
The people who live with the consequences of policy should help shape the decisions that create those consequences. Until that principle becomes a reality, rather than another statement of good intentions, the promise of genuine aged care reform remains unfinished.
Yours sincerely,
Lesley Forster
