As Australia braces for the implementation of the new Aged Care Act on 1 July 2025, the palliative care sector is sounding alarms over provisions that threaten to undermine the quality and accessibility of end-of-life care, particularly for those receiving support at home.
The Act’s Support at Home program, intended to help older Australians live independently for longer, introduces a rigid framework that risks leaving vulnerable individuals and their families stranded at their most critical moments.
While the inclusion of palliative care in the reform is a step forward, the program’s restrictive design – most notably the three-month cap on end-of-life funding with a possible one-month extension – has been labelled “cruel” by providers and experts, raising serious concerns about its impact on care continuity, family burdens, and overall dignity in dying.
These critical issues could be more effectively addressed by removing the timeframe for accessing this support and ensuring a needs-based approach that adapts to individual circumstances.
Three-month cap: A cruel constraint
The most contentious aspect of the Support at Home program is its End-of-Life Pathway, which provides up to $25,000 in funding for additional aged care services in the last three months of life, capped at three months with a possible one-month extension, totalling 16 weeks.
Camilla Rowland, CEO of Palliative Care Australia, has been vocal in her criticism, stating, “There’s no medical or clinical model that says the last three months of life is all someone requires.”
This arbitrary limit fails to account for the unpredictable progression of life-limiting illnesses, where patients may experience fluctuating symptoms or prolonged needs beyond the designated timeframe.
Rowland highlights the difficulty in pinpointing the final three months: “In many life-limiting illnesses, it’s very hard to identify specifically the last three months because people’s illnesses progress at different rates.”
For some, symptoms may be severe throughout this period, while others may only require intensive support in the final two weeks, known as the terminal phase.
The rigid cap disregards these variations, potentially reducing support when it is most needed and creating uncertainty and stress for older people and their carers. If a patient survives beyond the four-month limit, they revert to their original funding level, which, depending on individual circumstances, may equate to fewer hours of support.
However, the Department has allowed those returning to an ongoing classification to use their quarterly budget over a shorter period, meaning the actual level of support may not always decrease unless individuals exhaust a full quarterly budget, potentially at the highest Support at Home level.
Despite this, reduced supports, delays in reassessment, or uncertainty among providers and families about managing the transition back to an ongoing classification could contribute to carer burnout and avoidable hospital or residential aged care facility (RACF) admissions.
Rowland warns, “If supports are reduced, or if there’s a delay in reassessment, or uncertainty about how the return to an ongoing classification will be handled, people may end up in hospital or aged care facilities.”
This outcome contradicts the program’s goal of enabling people to remain at home and places undue pressure on families, who, as Rowland notes, “in many cases, will have already been looking after their loved one for many months, if not years.”
Industry voices like Adrian Morgan, General Manager of Flexi Care Inc., have described the policy as “heartless,” telling HelloCare that “pulling support at the most critical time could devastate families and older people.”
Financial and administrative burdens
The funding model raises further concerns. The $25,000 allocated for the End-of-Life Pathway is intended to cover additional aged care services in the last three months of life, not to provide 24-hour care.
Rowland questions its adequacy: “We’re not clear on how they’ve come up with that $25,000, particularly for the terminal phase weeks where people require a lot more supervision and support.”
Unlike the current My Aged Care system, where support for those on Level 4 Home Care Packages is needs-based and flexible, the new program imposes strict budgetary constraints, limiting adaptability to individual circumstances.
Additionally, the Support at Home program introduces significant consumer contributions, with up to 50% co-payments for “Independence” services like personal care and 80% for “Everyday Living” services such as cleaning or shopping.
For pensioners and self-funded retirees with limited discretionary income, these costs could force them to forgo essential care, risking health complications or social isolation.
Professor Kathy Eagar, a leading expert in aged care financing, has warned that the funding model’s reliance on contributions could drive seniors to unregulated “black market” care, compromising safety and quality.
The program’s administrative inflexibility exacerbates these issues. Reassessments for additional services can take six months to a year, leaving patients vulnerable during sudden changes in need.
Morgan cites a case where a client’s primary carer was hospitalised, requiring immediate professional support. Under the current system, funds were reallocated swiftly, but under Support at Home, such responsiveness is stifled, potentially leading to “malnutrition, hygiene decline, or falls.”
A step forward, but training gaps persist
Despite these criticisms, the inclusion of palliative care in the Support at Home program is a positive development. Rowland acknowledges this progress, stating, “We welcome the fact that they’ve identified palliative care, and they’ve included it. That’s really important.”
The Act’s Strengthened Quality Standards, particularly Outcome 5.7, mandate that providers recognise and address palliative care needs, ensuring dignity and symptom management. However, the sector’s readiness to meet these standards is questionable.
Rowland points to a critical shortfall in training: “We know that very few aged care providers have yet embarked on ensuring, particularly their RNs, the registered nurses who are their team leaders, are trained in palliative care.”
With 400 people dying of life-limiting conditions daily in Australia, the majority of whom are seniors, the demand for skilled palliative care is immense and growing.
The government’s funding of programs like End of Life Directions in Aged Care (ELDAC) is a step toward upskilling providers, but Rowland stresses the need for further investment to backfill staff and provide clinical supervision.
“The training exists, but it’s the money to backfill those RNs and provide clinical supervision that’s required,” she says.
Balancing hope and hard realities
The Support at Home program is not without merit. Its focus on early interventions, such as assistive technology and home modifications, and its aim to integrate the Home Care Packages and Short-Term Restorative Care programs into a unified system are commendable.
The Single Assessment System, already in place, streamlines access for existing clients, and transitional arrangements ensure continuity for current Home Care Package recipients.
For Aboriginal and Torres Strait Islander communities, the inclusion of culturally safe services is a vital step toward equity.
However, these positives are overshadowed by the program’s punitive elements. The three-month cap on palliative care funding, described as “cruel” by providers, risks forcing patients into hospitals or residential care, undermining the Act’s promise of independence.
The financial burden of co-contributions and the lack of flexibility in reassessments further threaten care quality. As Morgan warns, “These are curable flaws, but without change, we’re marching towards preventable crises.”
A call for change
Palliative Care Australia and peak bodies like COTA have submitted proposals to shift the End-of-Life Pathway to a needs-based model, but as of May 2025, no changes have been confirmed.
Rowland notes, “We don’t know whether they’ll change it by 1 July or not, or whether they’ll trial it using their existing rules and perhaps see what happens.”
This uncertainty, coupled with the government’s apparent reluctance to engage with providers’ concerns, has fueled frustration. Comments from industry stakeholders reflect this sentiment, with one provider calling the program “a disaster about to hit” and another urging a delay until 2026 to refine its flaws.
As the 1 July deadline approaches, the government must act swiftly. Extending palliative care funding beyond the arbitrary four-month cap, capping consumer contributions at more affordable levels, and investing in comprehensive training for aged care workers are critical steps.
Without these changes, the Support at Home program risks failing Australia’s seniors, leaving them and their families to bear the burden of a system that promises care but delivers constraints.
In Rowland’s words, “We’re at risk of seeing carers break down if they’re not given sufficient support, or people end up in hospital, which is what we’re trying to avoid.” The clock is ticking, and Australia’s palliative care sector deserves better than a reform that could turn hope into hardship.
To limit access to PalCare is as shortsighted as it is an offence against best clinical practice. This is the bureaucratic tail wagging the clinical dog. This is what happens when you subject clinical care to the oversight of political control. Okay, we all knew the Royal Commission into aged care was nothing other than a talkfest that would inevitably end in greater bureaucracy and less practical care, but please can we not target the most vulnerable of the vulnerable?
There seems to be too many changes being carried out to allow people to prepare and understand what is happening.
As things stand at present there are hundreds of aged residents attempting to get a provider of services as they all say they are full and cannot manage anyone else.
It is causing unneccessary fear for many aged people. The system is too complicated as it is and will be worse if more care is not taken to improve the system.
Just knowing how to apply for help is in most cases an arduous task and can take a long time to find any organization that will enroll new people.
There should be more training for people involved with aged care and all who work in this field should be fluent in speaking english and understanding english.
It is no good having extra staff who cannot understand the aged person .
Thankyou for your article Jacob. Having cared for my husband with complex health needs including stroke, Alzheimer’s and cancer for over two years, I am tired. I see little in the Support at Home program that will ease my day. I believe grandfathering of costs will soon be eroded by hikes in service charges. I hope the govt recognises the SAH program is severely flawed in areas that will challenge my capacity to care for my husband and take care of myself. I implore the PM to delay implementation of SAH to rectify the potential to do great harm and cause unnecessary stress to older Australians. Value and include our voice PM, listen to us and we will inform real change that meets each individual’s needs
When I first started in aged care, it was made up of 2 areas, 1 the nursing home palliative 2 the hostel. Now it is altogether and doesn’t work. Aged care has become like mini hospitals. It was better when assistant in nursing worked as they had more education and training not like carers they can be anyone. I worked in aged care for 25 yearsand it has been deteriorating for a long time