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Support at Home? First they came for the young people, now they come for the old

The Aged Care Royal Commission was blunt about some aged care providers rorting home care packages.

In their final report, the royal commissioners noted that a Level 4 home care package – then worth around $52,000 a year – offered on average less than nine hours a week support for older people.

Meanwhile, older people who managed their own home care package could buy more than double the support – around 20 hours a week.

And now we find out that the Albanese Labor government is enabling aged care providers to take an even bigger cut of the aged care budget, this time via those who self-manage Support at Home.

Self-management has always been a well-kept secret. Most older people opt for an aged care provider to manage their support workers and suppliers. They simply don’t know there is an option to manage their home care themselves.

Although the new Support at Home program allows older people to self-manage, the rules have changed significantly. So too have payment processes.

In the past, invoices from support workers and suppliers were submitted to the self-managed provider. The provider paid these invoices from the client’s home care package.

The new Support at Home – Self Management Fact Sheet explains that self-management can involve “paying invoices for services and being reimbursed”. As a result, some providers require older people to pay their support workers and suppliers from their own pocket. They are later reimbursed.

This policy assumes people have the cash available to pay for their home care services.

Provider-managed and self-managed care are two fundamentally different approaches to home care. Provider-managed puts the aged care provider in the drivers’ seat. In contrast, self-management is based on shared decision making between the older person their support workers and the self-managed provider.

In my 2021 research Consumer views of self-managed home care packages older people described “choice, control and costs” as their main reasons for switching from provider-managed to self-management. They also appreciated being treated as adults.

With self-management, older people were not only able to choose who worked in their home, when they came and what they did but also able to negotiate directly with their support workers about how much they were paid.

The financial benefits of self-management will be much less with the Support at Home program. From 1 July 2026, older people will no longer be able to negotiate lower rates with support workers or services outside the government approved pricing schedule. In addition,  those who self-manage will be charged an overhead for the third-party service.

This overhead fee has been capped at 10 per cent – with clients encouraged to “negotiate” this fee based on how much work the provider is required to do before paying an invoice (e.g. ensuring the third party supplier meets workforce requirements). Not surprisingly, some providers simply charge their clients a 10 per cent “processing” or “loading” fee on each invoice, irrespective of how much work they did.

Another significant change is the requirement of a co-contribution. With the new system, providers resemble debt collectors – responsible for collecting the government’s co-contribution.

To ensure providers are not out of pocket for this co-contribution, some require their self-managed clients to pay for their support services out of their own pocket and then submit proof of amount they have paid. They are then reimbursed the full amount they have paid less the amount of the co-contribution.

Some providers have changed the payment process for all clients, both those who have been grandfathered (on home care packages) and new clients (on Support at Home).

Take for example an 88 year old pensioner who has a Level 4 home care package. He lives in a remote location with no local aged care provider. His only option is to self-manage. He employs local support workers and suppliers who are all registered with a provider.

Previously, invoices from the registered nurse, support workers and suppliers were submitted to the provider. These invoices were then paid in full from his home care package. The provider charged a monthly administration fee.

Since the recent introduction of Support at Home program on 1 November, his provider has changed the payment process – to ensure the provider collects the co-contribution.

Although this man’s home care package has been grandfathered (i.e. he does not pay a co-contribution), his provider recently asked him to pay his monthly support services from his own pocket. The provider would then reimburse these costs.

Just to be clear, a pensioner is asked to pay around $5,000 per month for his support services, money he does not have.  As a result, he has a home care package he can no longer afford to access.

Fortunately, his registered nurse acted as an advocate. The provider agreed to continue to pay the monthly invoices. However, there will undoubtedly be other older people living in remote areas who have an assessed need for support but will be unable to afford to access it.

The Support at Home program has made self-management a much less attractive option. As a result, providers, not older people, are back in control. Ka-ching.

First published in Michael West Media 16 November 2025

Pay per shower: fully-funded aged care turns market-driven aged support

Forty years ago, the Hawke Government introduced a significant aged care initiative that was in line with traditional Labor values. The Home and Community Care (HACC) program provided government-subsidised home and community-based support services. These services – such as meals on wheels, community transport and nursing care – enabled older people to live independently in their own homes.

Compare that with the Support at Home Program the Albanese Government just introduced on November 1. Unlike Hawke’s HACC program (that later became the Commonwealth Home Support Program), the Support at Home Program is based on a free market transactional aged care system. Even basic services such as showering requires pensioners to make a financial contribution.

Is this further evidence that the current federal Labor government the least Labor government in the history of Labor governments?

Let’s take a look at the evidence.

In the 2022 federal election campaign, Albanese had campaigned on delivering aged care reform. However soon after Labor was elected came a series of red flags. The first was Albanese’s decision to keep the aged care and sports portfolios under the same minister – a minister that was not in Cabinet.

Another red flag appeared when Labor tabled the Aged Care and Other Legislation Amendment (Royal Commission Response) Act 2022. This was the exact same bill the Liberal party had tabled in 2021.

When I noticed that schedule nine had been included in Labor’s bill, I thought it must have been a mistake. This granted providers and their staff immunity for using restrictive practices such as chemical restraints (drugging residents). The aged care royal commissioners had not recommended that, so why had the Labor government included this schedule in the bill?

After raising my concerns about schedule nine with then minister for aged care, Anika Wells, I received a response from the Department of Health. This response had similar wording to the response I had received a year earlier from the previous Coalition minister.

During their first term, the Labor government claimed it was “reforming the Australian aged care system through several key initiatives”. Mandating a registered nurse on site 24-hours per day in all aged care homes was an important initiative. So too the pay increase for personal care workers.

After the Minister for Aged Care and Sport got some runs on the board, Labor government introduced a star rating system that initially rated 91% of aged care homes as providing an “acceptable” quality of care. After hearing appalling accounts of widespread neglect and abuse in aged care homes during the royal commission, this star rating system appeared to be more spin than substance.

The Labor government then did what even the Coalition chose not to do, and the Aged Care Royal Commission warned against. It handed out nearly $1.5 billion to private operators to conduct aged care assessments under the Single Assessment System.

This was another stop along the aged care free market train. Now our taxes are given to large private companies to undertake the private assessments and private companies to deliver the services. A privatisation slam dunk.

Not surprisingly, privatising regional aged care assessments has resulted in poorly trained people undertaking these assessments. In some cases, aged care assessments are undertaken over the phone or internet. How is it possible to accurately assess an older person’s needs without meeting them in person and observing them in their home?

Perhaps the most mind-boggling initiative was when the Labor government convened yet another task-force in 2023. This task-force recommended older people contribute to their care costs based on their ability to pay. Co-payments are contrary to the recommendations of the royal commission, which had called for guaranteed access to aged care based on assessed need.

Co-contributions are based on whether the services are clinical or not. Clinical services – nursing care, wound management, physiotherapy, and medication assistance – will be fully funded by the Support at Home Program. However, non-clinical services – domestic and gardening help, and lifestyle activities – require a co-contribution.

Some bean counter in Canberra decided showering is a non-clinical service. As a result, older people who require assistance with showering must pay for this service. Pensioners, for example, will be required to contribute 5 per cent of the cost. If an older person cannot afford the co-payment for a shower, they may need to skip it. Had the bean counter considered that not showering could very quickly become a clinical issue?

Ageing Australia chief executive officer, Tom Symondson, spoke without any evidence when he said: “My strong feeling“(my italics) is that pensioners will “not seek support with showering because of the five per cent charge.”

My strong feeling is one of shock. Shock that a Labor government would introduce a program that charges pensioners for a support worker to help them to take a shower. I can only imagine what Hawke would say seeing his beloved Labor Party travel this far down the neo-liberal rabbit hole.

First published in Michael West Media on 3 November 2025

MP News

Big money, big conflicts. Aged care assessment privatised by stealth

The Coalition government abandoned plans to privatise aged care assessments in 2021 following an outcry from key stakeholders, amid warnings of risks to the health of older Australians and conflicts of interest.

Three years later, the Albanese Labor government has stealthily done what the Coalition government recognised as a step too far. Labor has largely privatised the aged care assessments under the guise of a Single Assessment System.

What’s worse, aged care assessments are being conducted by organisations that also deliver aged care support, a clear conflict of interest. Catholic Healthcare, for example, operates 42 residential aged care homes and provides home care services to about 4,000 older Australians. It was awarded nearly $136 million to undertake aged care assessments until 2029.

The Royal Commission expressly warned against this being allowed: it recommended that all assessments be undertaken by an assessor who was not involved in providing aged care, so that a person’s level of funding would be determined independently. 

Nearly $1.5 billion has been handed out to private operators under the Single Assessment System to conduct aged care assessments, according to contract details released last December by the Department of Health and Aged Care.  

A Single Assessment System was a recommendation of the Royal Commission into Aged Care Quality and Safety, which the Coalition accepted. 

However, its plans to privatise aged care assessments was met with fierce resistance from stakeholders, including state and territory health ministers, the Australian Medical Association and the Australian and New Zealand Society for Geriatric Medicine. 

The AMA, for example, warned that privatisation “would risk the health of older Australians and open the system up to conflicts of interest”.

Despite these warnings, the federal Labor government has now proceeded down the privatisation path. In early 2024, there was an open tender process for organisations with the capacity and capability to deliver aged care assessments for the Single Assessment System. Since December 2024, the private sector (both for-profit and not-for-profit) has been undertaking aged care assessments. State and territory governments continue to deliver hospital-based assessments. 

Since December, concerns have been growing about the quality of assessments under this privatised system.

I was recently asked to advocate for Susan* following an aged care assessment undertaken by APM – a private company that was awarded $226 million to undertake assessments. Susan lives alone on the Mornington Peninsula with no family on hand to offer support.

In July 2024, Susan’s GP requested a comprehensive assessment via My Aged Care. In December 2024, Susan mistakenly received a regional assessment. According to those working in the sector, this is a common mistake.

Comprehensive assessments need to be undertaken by staff who are clinically qualified. These assessors not only ask questions but also probe the answers. They know that older people with cognitive failure can present very well, so it is critical to dig deeper. 

Regional assessments, on the other hand, do not require staff with a tertiary degree. According to a number of senior staff in aged care, new assessors working for some private companies may only receive eight hours of online training to conduct regional assessments. These aged care staff are also concerned that some assessments are conducted over the phone if the assessor does not have time to do a face-to-face interview. 

Susan’s regional assessment was riddled with errors, some quite serious. These errors have been highlighted in pink. (insert pic)

When I raised concerns about the inaccuracies in Susan’s assessment with the Minister for Aged Care, I received the following response from the Department of Health and Ageing: “I would like to assure you that the Australian Government is committed to creating a better experience for older people in Australia seeking aged care services. 

“The department has developed a new Single Assessment System, to simplify and improve the experience of older individuals undergoing aged care assessments. As part of this system, one workforce will be empowered and trained to conduct the necessary assessments across both home and residential care. This important reform is an opportunity to improve the delivery of aged care assessments, including assessment wait times.”

In the past, our taxes funded councils to undertake regional assessments and provide aged care services under the Commonwealth Home Support Program. Council services were in the main excellent and much appreciated by recipients. Older residents and their families appreciated having a highly trained and fairly remunerated Council employee provide aged care services. They also knew they were not being ripped off by a private provider that prioritised profits over care.

However, councils have exited aged care in droves because of changes in the way the Federal Government funds aged care. According to the Australian Services Union, just 26 of Victoria’s 79 councils currently provide aged care home services. 

So now our taxes are given to large private companies to undertake the private assessments and then private companies to deliver the services. 

In some cases, the company that undertakes the assessment is the same company that delivers the home care. What could possibly go wrong?

* Not her real name

With Elizabeth Minter

First published in Michael West Media on 1 March 2025

Who cares … Arcare? Aged care providers still charging for services never provided, regulator hiding

Some aged care providers are a law unto themselves. Although Australian Consumer Law makes it illegal for a business to accept payment for products and services that are not supplied, some aged care businesses wilfully break the law. Residents in these aged care homes are charged for services they do not use.

Residents may be charged for services such as an internet connection, irrespective of whether they use the internet. Teetotallers may also be charged for wine with dinner. Rather than protect residents from this financial abuse, the Minister for Aged Care and the national regulator of aged care services continue to turn a blind eye.

According to legislation, additional services can only be charged if the resident “receives direct benefit or has the capacity to take up or make use of the services”. Aged care providers must not only regularly review a resident’s ability to derive a benefit from the additional care or services but also itemise these additional services in a monthly statement.

When Mr and Mrs Jones entered an Arcare residential facility, the contract included an Additional Services fees of $20 per person per day. So what did this buy them? A choice of menu for lunch and dinner; a selection of wine and beer with dinner; weekly hot cooked breakfast; exclusive use of the private dining room; weekly pre dinner drinks; weekly high tea; daily newspaper in communal areas; wireless internet in your private suite; exercise classes; Foxtel, and local small group outings. Other items listed in the agreement, included, a welcome gift on arrival, exclusive use of private dining room and two meals for family and friends on first day. So residents had to pay for their own welcome gift – seriously?

When Mr and Mrs Jones’ daughter questioned paying an extra $140 each per week, Arcare agreed to reduce the fee to $70 per week, on the condition that Foxtel was removed from each room.  Was Arcare charging her parents $10 per day to access Foxtel?

Each month Arcare provided an invoice. This invoice included ‘daily care fees’, ‘means tested fees’ and ‘additional services’. However, these ‘additional services’ were not itemised – so there was no way of knowing which of these ‘additional services’ Mr or Mrs Jones had used. Did they have wine for dinner or attend an exercise class?

When the daughter realised that Mr and Mrs Jones were not using any of the additional services, she asked to have the fee abolished. However, Arcare refused. So, the daughter made a formal complaint to the aged care regulator – Aged Care Quality and Safety Commission (ACQSC).

Eight months after her initial complaint, and after numerous follow up emails, the daughter was advised that ACQSC had not been able to resolve the complaint.

The daughter did not give up. She contacted ACCC, the Commonwealth Ombudsman and the Office of the Australian Information Commissioner and Older Persons Advocacy Network – all to no avail. She then went back to ACQSC. Surely it was their job to ensure aged care providers acted lawfully.

Her persistence paid off. Fourteen months after her initial complaint, ACQSC issued a ‘Notice of Intention to Give Directions (Notice)’ to Arcare. According to this Notice Arcare:

• charged an additional services fee for a bundled package but did not provide an itemised cost for each service;
• had no review process to assess a consumer’s capacity to benefit from the additional services provided; and
• included care and services in a package of services already required to be provided under the Quality of Care Principles 2014 (e.g. a communal newspaper, a choice of meals at lunch and dinner, exercise classes and bus outings).

In response to the Notice, Arcare proposed a range of actions it would take. However, these actions were not sufficient to address the complaint. So ACQSC issued Directions to Arcare. These Directions outlined the actions Arcare was required to undertake (including necessary timeframes) in order to meet its responsibilities under the Aged Care Act 1997. Arcare was required to:

• take action to provide an itemised list (including costs) for each element of its bundled package of additional fees;
• provide accurate information about the availability and access arrangements for the included care and services;
• only charge for additional care and services where care recipients are able to derive a benefit from them;
• cease charging for items that should be provided under the Quality of Care Principles 2014; and
• provide refunds where they have charged additional fees unlawfully.

Arcare challenged the Directions Order in the Federal Court. It soon became clear that ACQSC was no match for Arcare’s lawyers. After a year of legal shenanigans, ACQSC advised the daughter to negotiate directly with Arcare for compensation. However, the daughter was not fighting only for her parents. She was fighting for all Arcare residents who are charged for services they do not use.

Arcare continues to charge additional fees irrespective of whether residents use these services. They also do not provide an itemised list (including costs) for each service (see recent invoice).

Although the aged care regulator is fully aware that Arcare and other aged care providers are not acting in accordance with aged care legislation, ACQSC has washed its hands. ACQSC simply does not have the power to enforce residents’ legal rights. What is the point of the government introducing a new Aged Care Act without a strong regulator with the power to enforce legislation?

In 2018, Regis and Japara were forced to repay residents millions of dollars that had been charged to clients under the guise of an ‘asset refurbishment fee’. The ‘asset refurbishment fee’ that was declared illegal by the Federal Court. It’s well past time for Anika Wells, Minister for Aged Care, to step up and declare it illegal for aged care providers to charge residents for services that they are not receiving in an aged care home.