Table of contents
- Upcoming aged care reform
- Concerns as raised by our supporters
- How these concerns could be addressed
- Scenarios to consider
Upcoming aged care reform
Where people live as they age significantly affects their wellbeing, health, and connection to community. Most older Victorians want to remain at home, and they should be supported to do so. Ageing in place strengthens social ties, keeps people engaged, and delivers better value for government investment.
COTA Victoria and Seniors Rights Victoria welcome the new Aged Care Act as a positive step toward addressing the needs of older and ageing Victorians. This reform aims to provide more flexible, transparent, and person-centred support, helping older people live with dignity in the place of their choice, usually their own home.
Launching on 1 November, Support at Home is a cornerstone of these reforms. It is designed to help older Victorians remain at home for longer.
But with rollout just months away, major questions remain about how services will work in practice, including how they’ll be delivered, what they’ll cost, and how people in hardship will be supported. Uncertainty is already causing anxiety among older people and their families, as we are hearing through our Care Finder program and engagement work.
Concerns as raised by our supporters
Here are the questions and concerns being voiced to us by interested parties.
Co-contributions for low-income older people
A key concern is that co-contributions under Support at Home may discourage low-income older people from accessing approved care. Unlike the current Home Care Package program, most full pensioners will now have to pay.
Although a fee reduction supplement is proposed, the Hardship Application process via Services Australia is complex and slow, and many vulnerable older people may struggle to access it.
Reduced flexibility puts older people at risk
We are also concerned about a significant reduction in flexibility under the new model. Currently, Home Care Package providers and recipients can work together to adapt support as needs change. Under Support at Home, new entrants’ services will be tied to their support plan and notice of decision developed at the time of assessment.
If someone’s needs shift, and the services they require are not on their notice of decision, they may face delays waiting for a support plan review or reassessment. Delays in reassessment are already a well-known issue in the system.
This rigidity puts older people at risk. Unmet needs can lead to avoidable hospitalisations or premature entry into residential aged care, the very outcomes the reform is trying to prevent.
How these concerns could be addressed
Before rollout, older people and families need clear, accessible information about costs, eligibility, and available supports. After rollout, the system must be closely monitored so that problems are quickly identified and fixed.
Aged care reform is a chance to deliver a more responsive, person-centred system. But without urgent action to address these concerns, too many older Victorians risk being left behind.
Scenarios to consider
With concerns raised by our supporters in mind, we present the following scenarios to highlight the issues older people will face. It is our desire that these scenarios be considered and addressed as part of these important aged care reforms.
Click each scenario to expand it and learn more.
Alina
Open/close Alina’s scenario
Profile
- 82 years old
- Full age pensioner
- Lives alone in public housing
- Has arthritis and mild cognitive decline
Status
She was recently assessed and approved for a Home Care Package but, given the expected wait times, is likely to be assigned a classification under Support at Home. She continues to rely on CHSP-funded services. Under CHSP her provider has the capacity to not charge co-contributions.
Under the new system
With the introduction of Support at Home, she will be required to make co-contributions towards Independence and Every Day Living services:
- 5% for personal care
- 17.5% for everyday living supports (cleaning, meals, etc.)
Despite a modest amount of service provision, this equates to around $40 per week, which she cannot spare after expenses including food, medication, rent and utilities. She reduces or cancels cleaning and meal support to avoid falling into debt. She is unclear about what hardship supports are available and does not receive support from the provider – she makes the decision to cease or reduce services that require a co-contribution.
Potential outcome
Within months, the reduced support leads to a fall at home. She is hospitalized and discharged into permanent care despite having wanted to age in place.
Alternatively: She is made aware of the Fee Reduction Supplement and the need to make a Hardship Application via Services Australia. She is supported to do so by her aged care provider. However, while the hardship application is undergoing review, the provider stops charging fees (a requirement) until a decision is made. Services Australia has 28 days to decide once the application is received.
If there is information missing or further evidence required, the 28 days KPI starts again from the receipt of this information. Depending on the accuracy of the application this can be a drawn-out experience. Her fees are eventually reduced (not reduced to zero), but not enough to mitigate the hardship burden this puts upon Alina. She is also now required to pay a debt for the non-discounted service fees accumulated during the application assessment period.
Key questions
- Could this process risk service providers cherry-picking clients based on their ability to pay co-contributions. Increased risk of providers not being able to recoup money owing? This is currently a challenge under HCPs.
- Could an application put further financial pressure on the participant given that fees are not waived during the assessment process?
Rowan
Open/close Rowan’s scenario
Profile
- 77 years old
- Legally blind
- Lives alone in a public housing unit
Status
He is not yet in receipt of a Home Care Package, but he was assessed and approved for one six months ago. He remains on the national queue. He was provided with CHSP approvals for domestic assistance and social support individual (accompanied grocery shopping) but funded providers in his area have no capacity.
Under the new system
He will eventually transition to Support at Home. My Aged Care are advising of an expected wait time of 6-9 months. He wants to better understand what his co-payment requirements will be. He is aware that hardship exemptions exist, and that he can undertake a pre-entry hardship application, but he struggles to navigate the forms due to his low vision and lack of support.
Potential outcome
He continues without any services for months. Meanwhile, his health declines, and he loses confidence managing independently. Rowan’s case highlights how people are adversely impacted by restrictive hardship application processes – the 17-page physical form, that requires 3-months of evidence, makes it impossible for him to fill this out independently.
Key questions
- What support is available for those who do not have a trusted person to help them fill out this form? What safeguards are in place to mitigate the risk this creates for financial abuse? Do providers have capacity and safeguarding measures in place to take on a potential responsibility to support people in completing this application?
- Are there going to be any provisions to make these forms simpler?
Chris
Open/close Chris’s scenario
Profile
- 69 years old
- Diagnosed with early-stage dementia
- Family lives interstate
Status
They are a CHSP recipient but have undergone a reassessment due to increasing support needs and have been approved for an HCP/Support at Home classification. Their expected waiting period will be 9-12 month thus their assignment of funding will be under the Support at Home program.
Under the new system
The Single Assessment team approve a Level 4 Classification and outline a list of approved services on their Notice of Decision:
- 12 months post her assessment they are assigned their Level 4 Classification, and they choose a provider
- Their needs have changed in that time and the services on their Notice of Decision don’t replicate all their current needs.
- Although the provider has adequate funding to meet their current needs, they need to seek a Support Plan Review from the Single Assessment Service as so they can add this service to their Notice of Decision allowing them to provide the required service.
- The wait time for a Support Plan Review is 6 weeks
Potential outcome
While they wait for support plan review, they go without required care, and their condition worsens. Eventually, emergency services are called after a neighbor finds them disoriented and they are admitted to hospital. Despite the provider having capacity and available funding, the delay in accessing the Single Assessment service is putting them at risk.
Key questions
- Should providers be given limited discretionary authority to adjust or expand services within the allocated budget, without requiring a formal reassessment for every change?
- How can the system better recognize and accommodate the fact that older people’s needs can change significantly during the waiting period (9–12 months)?
If you would like to assist our advocacy and have a story you would like to share about how the rollout of Support at Home or further aged care reforms will impact you, we invite you to do so by completing the below form.