As someone living somewhat comfortably with the effects of polio – until that support was abruptly cut off due to the age limit imposed by the NDIS – I have a great deal of firsthand experience with the impacts of poorly designed care policies and exclusion from essential supports.
On 17 January 2026, the Australian Self-Managed Support at Home (ASSH) Consumer Core Group met to collate feedback from our core members and more than 12,000 social media participants. The picture that emerged is a stark condemnation of the new Support at Home (SAH) program.
This initiative has failed to deliver meaningful in-home care, instead entrenching exclusion, financial hardship, and a continuation of neglect. At its heart, the SAH program is not fit for purpose.
A 2020–2021 study commissioned by the Royal Commission into Aged Care Quality and Safety found that 61 per cent of current income taxpayers were willing to pay an extra 1.4 per cent in income tax each year to secure universal access to satisfactory aged care. Yet the government has pursued the complete opposite, embracing privatisation and user-pays models that deny many access to vital services.
Co-contributions have caused severe hardship, prompting people to drop their packages or decline them entirely. Full pensioners face 5 per cent for Independence Support (such as showering and dressing) and 17.5 per cent for Daily Living Support.
Part-pensioners and self-funded retirees are hit harder, with contributions ranging from 5 to 50 per cent for Independence Support and 17.5 to 80 per cent for Daily Living Support (and 50 to 80 per cent for self-funded retirees).
The 10 per cent ‘platform fee’ or third-party invoice surcharge further depletes package funds, with providers refusing to negotiate. Many clients are now worse off.
Exclusions from a broad range of services make it difficult for people to stay in their own homes, often leading to premature admission to residential care facilities.
The policy shift under Labor, which began in January 2023, has sidelined the key question that once shaped in-home aged care: “Will this proposal support this person to have and retain capacity to live at home rather than require entry to residential aged care?” That compassionate focus has vanished.
Providers’ prices are outrageous. One admitted basing their list on government figures and simply adding 40 per cent. Where a third-party service costs $75, providers charge the package $150, pay the provider $75, and pocket the rest – an unconscionable practice that erodes care value dramatically.
Administrative failures abound. None of our core members has received statements for services after October 2025. Social media reports show November statements omitting third-party services; one member said none of their 14 November services appeared on the December statement, and no December statement had arrived by the time of writing.
Providers blame My Aged Care issues, but those paying co-contributions have no clarity on liabilities since the program began.
The hardship application process is a shambles, often taking months before denial, while fees pile up. Surely receipt of the aged pension already proves low-income status and hardship? Absurdly, SAH co-contributions cannot be claimed as expenses.
Eligibility for a fee reduction supplement requires remaining income after essentials to be less than 15 per cent of the basic Aged Pension per fortnight, just $176.80 for a single person (excluding supplements).
Assessments lack human oversight. Assessors can no longer override the Integrated Assessment Tool (IAT) algorithm based on clinical judgement or context, and they cannot view its internal logic.
Outcomes often mismatch observations, with similar clients receiving inconsistent classifications. Complex needs, such as dementia plus falls risk, are inadequately captured, constraining clinicians and risking safety.
Showering has been reclassified from Clinical to Independence Support, attracting co-contributions even for full pensioners, surely personal hygiene is clinical care.
Workers face delayed payments, leading to resignations and stress for clients. Providers refuse reimbursements for approved items, leaving older people to cover inefficiencies from October and November 2025 purchases.
One provider deducted 31 per cent from the $25,000 Short-term Palliative (end-of-life) pathway, $7,750, far exceeding the 10 per cent cap on care management fees.
Participants need an independent Compliance Body; the ACQSC complaints process is too slow. A doctor’s recommendation should suffice for items, without requiring OT, podiatrist, or physio input – doctors know patients best.
Disability is ignored unless tied to ‘ageing’, disadvantaging disabled older people like myself; this must be fixed urgently. The Commonwealth Home Support Program (CHSP), supporting around 820,000 people, rolls in no earlier than July 2027, straining the sector further.
The $1,000 quarterly rollover limit hinders funding respite without cutting other supports, worsening carer fatigue. One carer paid $2,300 for a single night’s respite.
Thousands remain hospitalised unnecessarily because timely in-home services are unavailable, not due to bed shortages, but SAH failure.
These problems demand an independent inquiry into billions wasted since 2018 on privatising aged care. The Auditor-General’s Report No. 37 2024–25 on the Future Fit Program revealed ineffective administration, poor governance, unethical procurements, and unachieved objectives, yet change has been minimal. Aged care costs have doubled from $20.1 billion in 2018–19 to $36.4 billion in 2023–24, likely exceeding $40 billion by 2025–26 (with rumours of $46 billion).
Fragmented records obscure the full picture, shielded as intellectual property. AusTender entries show massive spends, like $990,902 to Ernst & Young for a Single Assessment System study, part of a $1.458 billion program rife with conflicts.
The 2019 Royal Commission Interim Report exposed “Neglect”, with My Aged Care bewildering older people and forcing repeated storytelling. The 2021 Final Report detailed long waits for packages, risking decline, hospitalisation, and death. Since SAH’s 1 November 2025 launch, after billions spent, neglect has morphed into denial and delusion.
The program is unaffordable, with user-pays punishing those who need it most.
Minister Sam Rae says he is monitoring the situation, praising the Council of Elders as the voice of older people. Yet their terms require reflecting diverse needs and protecting the vulnerable.
The Aged Care Transition Taskforce’s December 2025 report admits assessment flaws, wait times, high prices, and workforce issues. Government warnings about scams feel ironic, as we have already been scammed by the system.
Parliament must govern decisively. Labor needs an urgent review now. Implement an immediate moratorium on co-payments to relieve distress while fixing departmental and provider chaos. Evidence shows the program was not ready on 1 November 2025. Mistakes are fixable, but vested interests perpetuate harm.
We need fresh perspectives to dismantle this neoliberal outsourcing legacy. Australia deserves a system that honours the Royal Commission’s warnings, not one that inflates costs while abandoning our elders.
As a support care worker I’m owed almost $700 for services. I have actually raised a case regarding negligence with the ACCC. It’s an absolute disgrace and I’m contemplating leaving the industry.
Well said it’s a debacle.
In relation to overcharging, or excessive costs, I would like to raise one issue that is, to me, very serious. Sometimes a shortage of staff leads to a true need to employ ‘agency’ staff. Agencies have been known to charge double the fee to the provider. So if the cost is, say, $50 for the agency staff member, the agency charges another $50 on top of that, for each hour worked. This can be really expensive, but some clued-up providers worked out (or were instructed) how to maximise their own profits by setting up their own agencies. So the first 50 goes on the care worker, and the second 50 comes straight back to the provider. This is one serious rort. I see that the new SAH guidelines have a clause or two that says that providers must declare if they are related to the agency in any way, such as by parent company agency, for example. This is promising, but nowhere does it say that any action will be taken against any provider who sets up their own agency, either by themselves, or by way of a parent company. In the context of a mere 10% fee for each service, however, this kind of rort is likely to channel mega bucks back into the pockets of the providers, if they are allowed to go down this road. The money, of course, comes out of the client’s allocation. I would like some more information about what steps the government is taking to stop this kind of thing from happening. If a provider could send a staff member at a cost of $50 per hour, then what would stop them from using one of their very own ‘agency staff’ rather than an ‘everyday’ staff member?
Once cost pressure is framed as “choice” or “consumer contribution”, the harm disappears from view. People do not lodge complaints, they quietly opt out, downgrade care, or move earlier than planned. The system records compliance, not loss.
From a governance lens, this is a slow-burn failure. It will not show up in incident data. It shows up years later through preventable hospitalisations, carer exhaustion, and people exiting the system altogether. Cost is not removed, it is displaced to somewhere more acute and more expensive.
I spend a lot of time looking at how systems interpret silence. Too often silence is read as coping, rather than unmet need. That is how exclusion gets engineered without anyone explicitly deciding to exclude.
If dignity and ageing in place are real goals, affordability has to be treated as a design constraint and a risk signal, not an individual resilience test. Otherwise the system stays “functional” while people quietly fall through it.
Appalled at the hoops aged people must jump through to then find they are probably better off financially to leave this awful mess called MAC.
Sadly, the elderly have become a commodity. Aged Care should never have been privatised!
As the article outlines, there is so much wrong with Support at Home that an immediate inquiry is required.
One only has to read the thousands of comments across social media to see what harm is being done. SaH recipients are distressed, frustrated and deeply concerned about their futures. The elderly will not be able to age in their own homes. Instead, they will be forced, prematurely, into residential care facilities (RCF). Residential care facilities are already stretched beyond capacity, and we are hearing RCF are declining admission to people who are unable to pay the RAD or who have advanced dementia.
Member, Australian Self-Managed Support at Home (ASSH) Consumer Core Group.
It’s heartbreaking that so many older Australians who just want to stay in their own homes are stuck waiting for care that comes too late—or not at all.
After a lifetime of working, raising families, and contributing to their communities, they deserve dignity, choice, and timely support, not endless paperwork and waiting lists.
Aging at home should be a comfort that provides ongoing independence, not anxiety about whether help will arrive and if it will be affordable.
We can and should be doing better.
Thank you Sharon!