When the Commonwealth Home Support Program (CHSP) was folded into the single national entry point of My Aged Care (MAC) more than a decade ago, the promise was simple: one door, easier navigation, faster help. Since Labor’s new aged care reforms came into effect early last November, that door has become the only door, and for many older people and the services trying to support them, it has turned into a chokepoint.
Under the new rules introduced alongside the Support at Home (SAH) program and the Aged Care Act, providers are now prohibited from delivering Commonwealth-funded CHSP services to anyone who hasn’t first been registered and assessed through MAC. That applies no matter how small the request, even someone who simply needs Meals on Wheels or a lift to a medical appointment.
Previously, these kinds of low-level, high-value services could take referrals directly from hospitals, GPs or family members. Now everyone, regardless of need, goes through the same four-step MAC process: registration, a roughly two-hour in-person assessment using the notoriously shrewd Integrated Assessment Tool (IAT), an algorithmic eligibility check, and a second algorithm to determine whether they’re funnelled into CHSP or SAH, a decision assessors cannot override and applicants have no say in.
The result, according to the CHSP Alliance, is two long and worsening queues: one to get an assessment, and another to get a service once approved. The Alliance estimates around a quarter of a million older Australians are currently waiting for support to live safely at home, with average waits for Support at Home now sitting close to a year.
The CHSP Alliance, a coalition of more than 200 organisations and individuals spanning consumers, unions, health professionals, home support providers and researchers, argues the system has drifted a long way from its original purpose. In its position statement No Wrong Door to Primary Aged Care, the Alliance writes that MAC “has been the subject of extensive and sustained criticism over the decade,” a view reinforced by a recent review from the Inspector-General of Aged Care.
Paul Sadler, the Alliance’s Co-Convenor and Chair of Meals on Wheels Australia, frames the stakes in practical terms: streamlining CHSP access is meant to “benefit both potential service users and taxpayers by significantly reducing waiting lists and times,” and, he argues, would have knock-on benefits for the more complex and costly Support at Home and residential care queues too.
Fellow Co-Convenor Professor Kathy Eagar AM points to what the Alliance sees as the core design flaw: routing every person, regardless of how simple their need, through a single gateway. Their proposed fix is a “no wrong door” model, allowing GPs, hospital discharge planners, Aboriginal Medical Services and CHSP providers themselves to register people and make eligibility calls directly, rather than requiring every enquiry to pass through MAC first.
Part of the frustration is proportionality. The IAT contains more than 450 questions and 220 text boxes, yet, on the Alliance’s account, only 23 of those items actually determine whether someone is approved for CHSP or Support at Home. For someone who just needs a home-delivered meal or a ride to the shops, that’s a lot of process for a low-risk, low-cost service.
Whether that’s a flaw or a feature is a genuine point of contention. A comprehensive, “just in case” assessment can be defended as a way of catching hidden risk, such as frailty, cognitive decline or safety issues, that a person’s stated request might not reveal.
The Alliance’s counter-argument is that primary aged care needs a “just in time” approach instead: nimble, responsive to changing needs, and treating the first assessment as a starting point rather than a one-off gatekeeping event. Where that balance should sit is likely to be one of the more contested questions as government considers reform.
It’s also worth noting the Alliance’s own position isn’t unanimous. Of its 40 Foundation Members, 37 endorsed the No Wrong Door statement, one (the Australian Nursing and Midwifery Federation) abstained, and two, the Older Persons Advocacy Network and the Older Australians and Their Aged Care Advocates, declined to endorse it, while still supporting the broader push for reform.
That split suggests the sector agrees the current system isn’t working, even if there’s less consensus on exactly how to fix it.
The federal government’s decision last month to retain CHSP rather than fold it entirely into Support at Home was welcomed by the Alliance as a first step.
Whether ministers are willing to revisit the MAC-only access model, potentially requiring amendments to the Aged Care Act 2024, is the next question the sector will be watching closely, particularly as waiting-list data for CHSP itself still isn’t routinely collected, making the true scale of the problem hard to pin down.
