The Albanese government has this week announced it will introduce one of the largest reforms to Australia's aged-care sector to date.
Authors
Tracy Comans
Executive Director, National Ageing Research Institute; Professor, Centre for Health Services Research, The University of Queensland
Frances Batchelor
Director Clinical Gerontology & Senior Principal Research Fellow, National Ageing Research Institute, The University of Melbourne
The package includes a A$4.3 billion investment in home care, now called "Support at Home", to come into effect from July 2025. This reflects both the desire of many people to remain living at home as they age, and the government's desire to reduce the costs of residential aged care.
So what changes is the government making to home care packages? And what will these changes mean for ageing Australians?
Reducing waiting times
One of the major complaints about the current home care system is the long waiting times. Estimates suggest there's a 6-to-12-month wait for the higher level 3 and 4 home care packages. For people with the highest needs, this is far too long.
As of March this year, around 45,000 people were waiting for any level of home care. An additional 14,000 were already receiving a package, but on a lower level of home care than they were entitled to.
With additional funding, the new system will support more participants. It aims to shorten wait times to an average of three months from July 2027.
Changes to services
The new system will replace the current four levels of home care packages with eight classifications of funding for services. When participants are assessed, they will be assigned the most suitable category. There's currently very limited information on what these classifications are, but the idea is they will provide more targeted services.
A number of short-term supports will also be available. These include assistive technology (such as mobility aids) and home modifications. Some people will be able to access 12 weeks of restorative care - a more intensive program designed to build function after injury or illness - as well as palliative care support.
The way different types of services are subsidised is also changing. Previously, the same means-tested co-contribution applied regardless of the type of service.
Under the new system, services are categorised into clinical care (for example, physiotherapy or wound care), independence (such as help with bathing or cooking) and everyday living (for example, gardening or home maintenance). The new reforms fully subsidise clinical services regardless of income, whereas independence and everyday living services will attract co-contributions based on means testing.
For example, a self-funded retiree would pay nothing out of pocket for physiotherapy, but would pay 50% for help with showering and 80% towards gardening costs. A full pensioner would also pay nothing for physiotherapy, but pay 5% for help with showering and 17.5% of the cost of gardening.
This is a positive change. Our research has previously highlighted a tendency for people with home care packages to choose everyday living services such as gardening and cleaning and refuse clinical care such as allied health and nursing as these types of services were more expensive.
These changes should make older people more likely to choose allied health and clinical care services, which will help them maintain their function and stay fitter for longer.
Some challenges
For the government's reforms to deliver faster and better support at home, a number of issues need to be addressed.
As people stay at home for longer, we also see that these people are frailer and have more health conditions than in the past. This requires a different and more highly skilled home care workforce.
The current home care workforce consists largely of personal care and domestic support workers alongside a much smaller skilled workforce of registered nurses and allied health professionals.
But with the changing profile of people receiving care at home, there will need to be a greater focus on maintaining functional capacity. This might mean more allied health input will be required, such as from physiotherapists and occupational therapists.
It's difficult to source an appropriately skilled workforce across the sector, and almost impossible in rural and remote areas. Alternative models, such as training personal care workers to act as allied health assistants, and effectively using technology such as telehealth, will be necessary to meet demand without compromising on quality of care.
One example of the need for upskilling in specific areas relates to caring for people with dementia. The majority of people who are living with dementia at home receive care from family carers, supported by home care workers. It's vital that these care workers have adequate knowledge and skills specific to dementia.
However, research has shown the home care workforce may lack the knowledge and skills to provide best-practice care for people living with dementia. Specialised dementia training for home care workers is effective in improving knowledge, attitudes and sense of competence in providing care. It should be rolled out across the sector.
What about unpaid care at home?
Unpaid carers, such as family members, provide significant amounts of care for older people. The value of this unpaid care is estimated to be in the billions. As older people stay at home for longer, this is set to increase even further.
However, carers with high care burdens are particularly vulnerable to poor physical and mental health. Without adequate support, we may find extra caring pressures lead to a breakdown in caring relationships and an increase in other health-care costs for both the carer and care recipient.
So we need to ensure carers have adequate financial, psychological and practical support. But the currently available detail on the reforms doesn't indicate this has been adequately addressed.
With careful implementation and ongoing evaluation, these reforms have the potential to significantly enhance the home care system. However, their success will depend on addressing workforce challenges, ensuring adequate support for unpaid carers, and maintaining a focus on the holistic needs of older Australians.
More information about Support at Home is available online.
Tracy Comans receives funding from the National Health and Medical Research Council and the Medical Research Future Fund and holds consultancies with the Australian government Department of Health and Aged Care.
Frances Batchelor has received funding for research from the Royal Commission into Aged Care Quality and Safety, Department of Health and Aged Care, Medical Research Future Fund. Funders have had no input into this opinion piece.
