Is this thing even on? What is it going to take to get Mark Butler, Sam Rae and the federal government to acknowledge the badly designed elephant in the aged care room?
Now that the National Health Reform Agreement is finally nailed down, perhaps Mark Butler, Sam Rae, the prime minister and the DoHDA bureaucrats can turn their minds to the steaming pile of regret and expense that is the Support at Home Program.
There are two inquiries on the books.
The first is the Senate Standing Committee on Community Affairs inquiry into the transition of the Commonwealth Home Support Program to the Support at Home Program. Public hearings begin next Friday, 6 February, and the report is due on 15 April.
The second is the same committee’s inquiry into the Support at Home Program itself. Submissions close on 31 July, there are five so far, and the committee does not report until 24 November.
Yesterday, submissions to the Senate Community Affairs References Committee on the transition of the CHSP to the SAH program closed, and a quick analysis tells me people are not happy.
At the time of writing, about 4pm yesterday, there were 31 submissions to the inquiry.
I have read every one of them, readers, so you do not have to.
With the exception of one or two which offered broad support, not one of those submissions comes without a set of deep concerns and, in many cases, urgent recommendations for getting things right before they get worse.
Myself and others have written before about the inherent problem in the way people are assessed for inclusion in Support at Home services. You can read them here, here, here, here, here, here, here, here and here.
To summarise, the Department of Health, Disability and Ageing used external consultants, KPMG and PwC, to help design an Integrated Assessment Tool that would use an algorithm in a black box to turn a human assessor’s observations into a clinical needs assessment to determine which level of care package the client needed.
The same consultants were then employed to review the tool. And then the same consultants were used to test the tool on, it turns out, 22,000 living guinea pigs known as Australia’s senior citizens.
Then the DoHDA banned its human assessors from overriding the algorithm’s decisions, even when they were blatantly wrong.
Nothing has changed on that front since November 2025, when it first came to our attention.
In fact, according to a service provider I spoke to this week, prior to the introduction of the IAT their clients’ assessments were being accepted almost 100% of the time.
Now, 38% of their assessments are being rejected. “Something very weird is going on,” said my friendly provider.
As an aged care advocate said to me earlier this week, perhaps the IAT is working exactly the way the DoHDA wants it to, downgrading those with previously assessed high levels of need and therefore achieving the all-important cost savings.
Too cynical? Maybe.
Add to that the persistence of the DoHDA’s insistence on only paying 60% of the value of each home care package, with no real timeline on when the balance is going to be handed over. There are rumours of 17 weeks being bandied about. You can see why people are getting cynical.
The fact remains that the politicians and bureaucrats remain stubbornly unable, or unwilling, to concede that there are problems with their big, shiny new elephant.
Related
Transition from CHSP to SAH
Oh boy.
Let us be clear. The Commonwealth Home Support Program is one of the most successful parts of the aged care system and has been for four decades.
It provides vital early intervention home support services to people who just need a little help to stay in their home.
As the Commonwealth’s own Inspector-General for Aged Care said in her inquiry submission:
“The CHSP is currently the Australian government’s primary vehicle for preventing acute ageing, supporting older people’s preferences to age in place and keeping people out of higher cost and more intensive tertiary aged care and hospitals.”
In 2024–25, the CHSP supported approximately 838,964 people.
How do you reckon the current Support at Home system is going to cope when those hordes want to be assessed and allocated their package?
Professor Kathy Eagar sums up the problems of the transition very clearly in her excellent submission to the inquiry.
“My view is that the initial decision to close CHSP and fold it into SAH is not the right approach and my central recommendation is that the government abandons this plan and adopts a different approach going forward,” she said.
“The only criticisms [of CHSP were] that it is underfunded and neglected by successive governments.
“The first principle of program reform is ‘only fix what is broken’. Getting rid of a long-established and highly effective program that continues to work very well simply makes no sense.
“There is no possibility that the government will achieve its target to reduce waiting times for SAH unless the government maintains and develops the CHSP.”
And as we know, thanks to the Productivity Commission yesterday, those waiting times have blown out yet again.
Professor Eagar suggests improving CHSP by funding it properly, rather than trying to fold it into a Support at Home program that is already badly designed and struggling to cope.
But you would not know any of that if you just listened to Mark, Sam and Albo.
Who knows? Perhaps the two inquiries will provide the proof they cannot ignore, although waiting until April and, God help us, November seems less than ideal, assuming the reports are even made public.
The only other hope for those desperate for improvements is the Australian National Audit Office’s report into the effectiveness of the CHSP, which will be released in March.
The ANAO has a lot to say about aged care this year, with audits also expected of the residential aged care star rating system and the support of residential aged care provider viability.
“We owe Australian families a system that works on the day they need it, and every day after,” said Mr Rae the day after the new Aged Care Act kicked off.
Yeah mate, we do. But first you have to admit that things are not working the way they should and get on with swallowing your pride and fixing it.
I am off to watch Chitty Chitty Bang Bang, multiple episodes of Bluey and puppy videos on YouTube in a bid to dispel the cynicism. Have a good weekend.
This article was originally published in Health Services Daily and can be read here.
Love your work!!!
Blind Freddy could see the flaws; OPAN and COTA CEOs were supportive and encouraged not only the Swiss cheese Aged Care Act but also the ‘not fit for purpose’ SAH program.
We were told to stop being so dismissive and alarmist and await the review – well how has that gone?
It’s only the stamina of ground roots activists that continue to wipe away the smoke and mirrors and present facts, consequences and lived experience that have made any change and I applaud each and every one of them.
Aged Care, more likely Aged Neglect!!
Yes, you’re right about everything.
I’ve been harping about the demise of Meals on Wheels in my shire due to the Federal Government defunding shire councils since 2023.
Of course, Mark Butler didn’t care then when I wrote to his office, and his interest in aged care has waned even further since.
The light won’t come on for him and his advisors until they need aged care themselves.
The new system is an absolute disaster, I have seen first hand a relation who came on the new system late November 2025,she and her elderly partner are paying $600 a week rent,plus water and electricity, leaving them nothing at the end of a fortnight to use if some emergency occurs, applied first the hardship exception, and was told ,do not qualify, as she has $100 I her bank, also need a cleaner,and has to pay a subsidy which they cannot afford.
The old system worked,just needed some adjustments to stop certain providers over charging for services, but they are known doubling and in some cases tripping services charges,so people will run out of their money.
Whoever conceived this system what’s there jobs taking away.
$100 in her bank or am I reading this incorrectly?
I love your cynical articles – poignant, accurate (and delightfully funny!)
Thank you, Cate.
Enjoy Bluey.
The providers at least Australia Unity don’t know what they are doing.
An OT assessed and approved a chair lift for me. The Government approved and made funds available. A U put me under duress: I had to pay my part $2032, that includes a gap for the lift, and $1500 admin fee for AU, before they would place the order with Acorn. I paid immediately, but still waiting for the installation. This is now 4 weeks ago.
I have no idea what they hold up is. I complained to the Aged Care Quality Complaints Commissioner and local representative Carol Berry. No advancement!
I believe the hold up rests with provider Australian Unity
Thank you for telling it like it is. I think the realisation has to finally hit home that Govt. Ministers and bureaucrats have no capabilities (or willingness) to provide workable, sustainable and efficient models of care. They are all career politicians with a personal agenda which does not include accountability and responsibility for the work they are obliged to perform. The current lot is the worst we have every had to endure.
What can be expected from a Government which is out of touch with the people. They have been told over and over again,to adopt the findings of the Royal Commission. Unfortunately the village idiots are running the Government.