One year after the new Aged Care Act took effect, Aged Care Minister Sam Rae says the reforms are working, and that the algorithm at the centre of home care assessments is making the system fairer.
Rae made the case on ABC Radio Melbourne on Friday 6 November, in an interview with Rafael Epstein.
He acknowledged the system “can still improve further”, but defended its core features: the Integrated Assessment Tool (IAT), interim funding and the government’s handling of waitlists. Several of his claims sit uneasily with government data and the Commonwealth Ombudsman’s recent findings.
Epstein opened with Sue from Northcote, a Support at Home client who broke her leg. She needed a wheelchair but was told she would first need an assessment, two weeks away. She bought one herself and cannot be reimbursed because the purchase was not approved.
Rae said someone with a broken leg would usually be assessed in hospital, where median waits are “under a day”, and offered to follow up her case. When Epstein pointed out that Sue’s problem was getting equipment at home, Rae said people “need to get assessed according to their needs” to ensure “a fair distribution” of resources and protect “very precious taxpayer dollars”.
Equipment gaps have been a recurring issue under the new program. HelloCare has reported on CPAP machines being excluded from Support at Home funding, which state health ministers linked to older patients staying longer in hospital. The Inspector-General of Aged Care has also called for independent review of the $15,000 lifetime cap on home modifications.
Epstein cited about 150,000 people waiting for all or part of their funding. Rae said the figure was “about 100,000”. The difference is interim funding.
Most people approved for Support at Home start on 60 per cent of their funding and are removed from the official waitlist at that point. Using the counting method in place since 2017, HelloCare put the waitlist at 153,909 in August, against an official 100,191. Rae said the number on interim funding fell to zero at the end of June but is growing again. Providers have questioned the practice: Flexi Care’s Adrian Morgan told HelloCare some clients stayed on the reduced rate for up to five months.
Rae also described a 10-month average wait raised at the Senate inquiry as “quite outdated”, saying the longest waits are now six to eight months. Other recent measures point higher. The government’s own Wait Times Report, released in May, found an average of 364 days from application to services starting. OPAN found the median time from assessment to services had risen from 118 to 245 days, and Four Corners reported in August a median of 10 months from approval to care.
Rae’s six-to-eight-month figure matches the Department’s estimate for standard priority, where most people sit. He said urgent cases “always” receive care within a month. Four Corners reported in August that only 88 of more than 100,000 people waiting were classified as urgent.
The interview didn’t touch on deaths in the queue. Department data shows 6,436 people left the Support at Home priority system in 2025-26 because they died, up 34 per cent on the previous year, though the two years cover different systems.
Epstein asked three times whether about $1.5 billion in unspent aged care funding would stay in the portfolio. Rae attributed the underspend to transition delays and workforce shortages, called it “a relatively modest portion” of a roughly $44 billion budget, and said he could not “presuppose what the budget process will do”.
He pointed instead to the $3.7 billion added in May. HelloCare’s budget analysis noted $1.1 billion of that was provisioned rather than committed, and health economist Sabrina Lenzen wrote that the package would not solve the waiting list because the delays are “primarily a supply problem”. The new Act’s co-payments are also projected to save $18.8 billion over the forward estimates.
Epstein asked three times whether the algorithm had made things better or worse. Rae said the approach is “definitely improving the fairness of the system”, producing “fairer”, “faster” and “more accurate” outcomes.
Ten days earlier, the Commonwealth Ombudsman found the Department’s actions in running assessments, “including the implementation of the IAT”, had been “unreasonable”. The report said a reasonable person would “lack confidence that the system is in fact fair and consistent”, and noted that automated decisions cannot be overridden “even if they are clinically inappropriate”.
Rae’s main evidence was assessment wait times, which he said have fallen from up to 10 months to a median “consistently under one month”, a figure he also used in March. Four Corners reported a median of 36 days, with 98,606 people waiting, in August. Either way, assessment speed is a separate question from whether the outcomes are right.
Responding to the Ombudsman, Department Secretary Blair Comley wrote that “aged care funding is limited”, noting assessors had placed 20 to 25 per cent of people in the top funding level against a forecast of 15 per cent. Critics say this shows the algorithm is being used to keep outcomes within budget. Rae’s own framing, that the system ensures taxpayer dollars “are being spent where they need to be spent”, is consistent with that reading.
Clinicians and advocates have raised concerns throughout the year. The Australian and New Zealand Society for Geriatric Medicine described the tool as “unsafe”. Professor Kathy Eagar told Four Corners it should be scrapped. An 80-year-old Melbourne man with advanced MND had his weekly care cut from 14 hours to about nine and a half after reassessment.
Rae said the government is “following all of the recommendations” and has “already put in place” an escalation pathway. HelloCare has reported the pathway starts in January, and when it was announced in July its triggers and timeframes were still unsettled. A review of the algorithms is due in the first half of 2027.
Epstein asked whether the government was choosing between “letting people die without help, or blowing the budget”. Rae replied: “This is about dignity.” Epstein noted that many listeners did not feel the system was dignified.
The sector has been similarly critical. In a July poll of about 150 aged care managers, 94 per cent said Support at Home had made things worse, though the organiser stressed it was not a scientific study. Families have also reported steep increases in daily fees under the new co-payment model.
Rae said the old system was broken, “and I think people have forgotten that, and I’m glad that people are starting to forget that”. The Royal Commission did recommend a single assessment system. Whether the version now in place delivers the fairness Rae describes is a question the Ombudsman, clinicians and many older Australians are still asking.
