A rule change now in force means some older Australians are being asked to pay thousands upfront before they can receive care.
Support at Home began on 1 November and the rhetoric around it has focused on “choice,” “control” and a more streamlined system. But one detail in the self management model is already creating a financial fault line, and it has nothing to do with assessment pathways or service lists. It comes down to one thing: which provider you sign with.
Under the new arrangements, providers are now allowed to require self managing clients to pay for their services upfront and only seek reimbursement afterwards. It sounds procedural. In practice, it is a line between people receiving care and people going without.
For older Australians on the pension, the sums are brutal. A month of mixed support can easily reach between $2,000 and $5,000. Expecting people to advance that money, hold the cost on their own bank card and then wait for reimbursement is not empowerment. It is a barrier.
And the stories beginning to surface show exactly how that barrier plays out.
Self management has always had a place, especially in regional and remote parts of the country where formal providers simply cannot staff the distance. Local contractors, neighbours and community workers fill the gaps. Until now, most self managing clients could send invoices to their provider and the provider would pay those suppliers directly from the package.
Support at Home has disrupted that arrangement. Providers can now insist that the older person pays first. They can choose whether to continue paying suppliers directly or push all payments through the older person and their family. The government’s logic is tied to managing co contributions and tightening oversight. The practical effect is cash flow pressure on the very people the program is meant to support.
A funded support plan does not help if the person cannot float thousands of dollars a month to keep services going.
This is where the system becomes uneven. Some providers are stepping in with workarounds. Others are not. The new rules give them the discretion to decide how self management operates. Two older Australians with identical needs and identical budgets can have two entirely different experiences depending on who holds their funds.
For some, the provider continues to pay suppliers directly. For others, the provider tells them to pay invoices upfront and wait to be reimbursed after co contributions are deducted. For people on tight incomes, that wait is not a minor inconvenience. It is the point where their support stops.
The policy did not set out to create this divide. But that is where it has landed.
People living remotely have always been forced into self managed models because formal staff are hours away. Under the new rules, they now need the cash flow to act as the financial bridge between their workers and the provider.
If they do not have it, the system leaves them stranded. The care exists on paper, the funding exists in the portal, but the support never reaches their home.
This is how a national program fractures. Not through intention, but through the small details of how it is implemented, and who carries the cost of those details.
Support at Home has barely begun, and the reality is already clearer than the policy documents. Self management is no longer just a matter of organising your own workers. It is a financial risk calculation. Providers now decide whether clients must pay upfront. Older Australians who cannot raise a few thousand dollars each month may find themselves locked out of the care they have been approved to receive.
Is this not a dastardly, underhanded ploy to have the client go back to having the Provider organise their SAH package when they find that they cannot come up with such large sums of money upfront? Also wondering how long it would take for the client to be reimbursed …