Support at Home Changes - November Newsletter
From June to September 2026, the Senate inquiry into the Support At Home Program held public hearings in many states and territories around Australia. With 271 submissions from care providers, peak bodies and individuals who access aged care services, there was a vast array of perspectives and feedback. One common theme identified was concerns with the financial contribution to personal care services. It became overwhelming evident that the personal cost associated was a significant barrier for individuals to access the service.
I think it’s important to explain that even prior to Support at Home, aged care services were means-tested. Previously under Home Care Packages there was a means-tested ‘Income Tested Fee’ that was payable for everyone except those on a full aged pension. It could be anywhere from $1 to $37.70/day and was payable every day regardless of what services you received. Consumers would know this figure upfront and would often consider their Income Tested Fee when deciding if they wanted to take up their Home Care Package.
I fundamentally agree with means-tested contributions, however as someone who was previously coordinated services for clients, I know it can often be a barrier to accessing much-needed services.
HOW WERE THE FEES STRUCTURED UNDER SUPPORT AT HOME?
When Support at Home rolled out in November 2025, services are classified into three categories with varied co-contributions:
Clinical Care: includes all nursing and allied health services e.g. OT, podiatry, speech pathology, exercise classes.
Independence: personal care (previously) + in-home respite, social support, transport, bus trips, day programs and massage.
Everyday Living: shopping assistance, house cleaning, garden maintenance, meal preparation, home maintenance and laundry services.
Full pensioner | Part-pensioner and self funded CSHC holder | Self-funded non-CSHC holder and means not disclosed | |
Clinical Care | 0% | 0% | 0% |
Independence | 5% | 5-50% | 50% |
Everyday Living | 17.5% | 17.5-80% | 80% |
Based on this framework any individual accessing personal care services (showering, continence support, dressing, eating, hygiene and assistance with self-administration of medication) would pay a contribution to this service. Full pensioners would pay 5%, part-pensioners from 5-50% and self-funded retirees would pay 50%.
This means, if a provider is charging $100 for a 30 minute personal care visit a full pensioner would pay $5, a part-pensioner would pay $5-50 and a self-funded retiree would pay $50.
Having worked in home care for many years now, I can tell you that personal care services are often one of the most needed and equally the hardest to convince clients to engage with. Most ageing individuals are happy to accept help with cleaning and gardening, but when it comes to someone helping you shower or dress you, it’s a much harder sell. So not only are we asking individuals to consider a very personal service, we’re then telling them it’s going to cost them more money too. This funding change quickly lead to a decline in personal care with many new Support at Home clients choosing not to engage with much needed services.
Whilst in-home services don’t miraculously keep you at home forever, I have seen time and time again that those who gradually increase help in the home are likely to remain at home longer. Personal care services (showering, dressing, medications etc) are often an integral step in this process, with greater support leading to decreased risk of falls and a longer time at home.
SO WHAT’S CHANGED FROM 1 OCTOBER?
What has changed is that personal care has been reclassified into the ‘Clinical Care’ category, hence removing all co-contributions - hooray! Now all pensioners, non-pensioners etc can access personal care services without having to pay anything.
This removes a small part of the barrier to access personal care services and makes it a much easier ‘sell’ when convincing someone to accept some help with showering, dressing etc. I’m hopeful that even with my clients this will help them engage with personal care services and ultimately allow them to remain at home longer.
WHAT’S NEXT?
Whilst this is a wonderful step in the right direction, there are still several improvements needed to the Support at Home program. The main concern I’m monitoring is the review of the assessment algorithm.
I’ve read several transcripts of the experts who presented at the South Australian inquiry (Dr Kathy Eagar’s is particularly compelling) and they shared their concerns with the new algorithm. Essentially the new assessment algorithm has several design flaws and significantly undermines the expertise of the trained assessor operating the tool.
Previously assessors could use a framework to assess an individual, but use their own clinical knowledge and evaluation of the person in front of them to determine what level of a support was suitable. Now the assessment algorithm does this work for them and has demonstrated many scenarios were appropriate funding is not provided.
Dr Kathy Eagar showed an example of two fictional individuals who had identical ‘needs’ scores and ‘functional’ scores one point different. The one with a functional score of 24 was assigned a level 5 Support at Home package ($40,809.27/yr) and the one with a functional score of 25 was assigned a level 8 ($80,294.00/yr). That’s a 51% funding difference for a single ‘functional’ point.
This has lead to a review by the ombudsman who has deemed the algorithm ‘neither fair nor consistent’.
I don’t have any wonderful solution to this, but safe to say it’s very current and topical in the aged care space right now. I’m hopeful that with continued advocacy by wonderful experts like Dr Kathy Eagar, we’ll improve this broken algorithm and ensure everyone can access the services they need.
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Big love, Kate.
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