The Support at Home Hunger Games: How new home care rules are fueling a battle for clients

The highly contentious reforms that took effect under the new Aged Care Act have reshaped the entire sector, but few areas have felt the impact more sharply than home care.

The shift from Home Care Packages (HCP) to the Support at Home program has removed a major revenue stream for providers by eliminating package management fees and significantly capping what can be charged. While the intention behind the reforms was to put more funding directly into care, many providers have been forced to rethink their business models overnight.

As the sector adjusts, competition for clients has escalated. And according to one regional provider, that competition is starting to look less like community care and more like survival of the fittest.

Sophie, co-founder of My Support Australia, describes what she is seeing as nothing short of the “Support at Home Hunger Games”.

“Providers have lost a huge revenue stream. Some were charging up to the maximum 35 percent  for combined case management and package management. As a result of the recent changes 25 percent has  gone overnight. So they are now using different tactics to crawl back that income,” she says.

Turning clients into commodities

My Support Australia is a small, independent, family-owned home care and NDIS provider in regional Victoria, operated by Sophie and her husband Gareth, who is also a front line health care worker . Both are organ transplant recipients, and Sophie says their lived experience of navigating the health system influences their approach.

“We understand what good support actually looks like,” she says. “We have lived this.”

But on the ground, she says the tone of the sector has changed. In Facebook community groups across regional areas, families are reporting being aggressively targeted with incentives to switch providers.

In the days after Support at Home came into effect, Sophie says she noticed a sudden influx of paid advertising offering sign-on rewards, including reduced percentage on package management for a limited period of time, gift cards of several hundred dollars and even one offer of $1200.

At face value, she says, that sounds like a windfall to older people feeling the cost of living pressure. But for many, it is far from the bargain it appears to be.

“Someone needs to ask where that money is coming from,” she says. “A business is not going to give away $1200 out of generosity. If they have lost a major revenue stream, that money has to come from somewhere.”

Sophie is careful to emphasise that she cannot prove that sign-on incentives are funded directly from people’s home care budgets. However, she is urging families to check carefully.

“All I am doing is applying critical thinking. If a provider gives away thousands of dollars in incentives and has lost a major revenue stream, they will find a way to claw that back. It might not be obvious. But it has to come from somewhere.”

Behind the offers

To illustrate how offers can eat into a person’s care, Sophie describes a Level 1 package, worth around $10,000 per year.

After the 10 percent  case management fee under Support at Home, the participant has roughly $9,000 remaining. If onboarding fees or sign-on incentives are deducted, plus additional charges to bring in preferred cleaners or gardeners, that funding can rapidly fall to $7,400 or less before a single hour of care has taken place.

“The older person ends up getting fewer services,” she says. “Home care becomes a commodity, not a support system.”

Piling on the pressure

This shrinking of available care has broader consequences.

“If people cannot afford personal care supports, they might skip showers. They might not have skin integrity monitored. They might not have meals prepared or medications checked. So we will see more hospital presentations and more emergency call outs,” Gareth notes from his frontline experience in the health sector. .

“And once someone has a fall or ends up in hospital, getting them home again is harder because the support gaps are bigger. So then we end up with blocked hospital beds and pressure on residential care.”

Small providers, Sophie says, are also facing growing hostility from larger organisations that are protecting their client numbers.

“We have received legal threats simply because clients followed a care partner who changed jobs. People have the right to choose who supports them. But the sector has become adversarial and territorial. The older person is being treated like an account number, not a person.”

“At what stage did we accept this as normal?”

Sophie stresses that her purpose is not to attack other providers, but to start a conversation.

“We need to ask ourselves: when did we decide it was acceptable to commoditise care for older people? These are our most vulnerable community members. They deserve transparency, dignity and honest support, not sales tactics.”

Despite the upheaval, Sophie remains firm on one point: trust is built through clarity and communication. Before finalising new contracts, she has personally called each of My Support Australia’s care recipients.

“They were grateful just to have someone explain what is going on,” she says. “People want to feel like someone is walking this with them.”

The Support at Home reforms have been touted by the Government as simplifying care and giving older Australians more access to services. But in the scramble to stabilise revenue, some providers are now competing in ways that risk leaving older people worse off.

And as Sophie warns, unless the sector steps back and reconsiders what it stands for, the consequences will be felt not just in care plans, but in emergency departments, hospital wards and families across the country.

“We should not accept a system where getting help at home feels like a contest with winners and losers,” she says. “Home care was meant to be about people. We cannot lose sight of that.”