The guiding principle for aged care reform must be: can older people get the care they need, when they need it, in the place they most want to be: their own home.
The ambition behind Support at Home is the right one. Australians are living longer, often with multiple chronic conditions, and overwhelmingly want to remain in their homes and communities for as long as possible. From a consumer perspective, that means maintaining independence, dignity and connection. From a public policy perspective, it means reducing reliance on hospitals and delaying or avoiding entry into residential aged care where appropriate.
But there is a risk that every major reform faces: becoming more focused on managing the system than serving the people the system exists for. Too often, success is measured by whether processes have been implemented rather than whether care has been delivered. Policy without empathy is just bureaucracy.
For older people, delays are not administrative inconveniences. Every week waiting for an assessment, a piece of equipment, a home modification, or an approval, is a week when someone’s quality of life gets worse: mobility may decline, confidence may be lost and health may deteriorate. The consequences can be significant – for the older person and the broader community - including avoidable hospital admissions, increased care needs, and personal, social and system costs.
This is particularly true for people whose circumstances are changing rapidly. Whether someone is recovering after illness, experiencing increasing frailty or approaching the end of life, timely access to support matters. In these situations, care delayed can quickly become care denied.
Just as importantly, the system must remain easy to navigate. Many older Australians already find aged care complex. Adding multiple approvals, reassessments, funding pathways and co-contribution arrangements risks creating barriers for the very people the reforms are intended to help. A system designed to support independence should not require consumers to become experts in bureaucracy before they can access care.
There is also an important equity dimension to the debate. Home care must remain accessible not only to those who can confidently navigate complex systems, advocate for themselves and absorb additional costs, but also to those who are vulnerable, socially isolated or experiencing financial pressure. When people begin declining services because they are confused about costs or worried about affordability, the long-term result is often poorer health outcomes and higher demand on other parts of the health system.
The introduction of interim funding (minimum service offer) has created a false economy in which older people can access their Support at Home package ‘earlier’, but without it meeting their assessed needs. Releasing 60% of a person’s package to them when they have been assessed as needing 100% of that budget and services delays access to care, leads to deterioration, causes consumer frustration, and layers even more complexity and unfunded work into care planning in the context of restrictive care management caps. Interim funding is simply an accounting trick; it is a poor substitute for timely access to the full Support at Home budget someone has already been assessed as needing, and leaves older people with only partial access to the services required to keep them safe, well and independent at home.
The good news is that these challenges are solvable. Silverchain’s submission to the Senate Community Affairs References Committee Inquiry into the Support at Home program identifies several key ways the Support at Home program can be improved. The foundations of reform are strong. What is needed now is a continual focus on implementation and improvement. That means removing unnecessary complexity, improving consumer understanding, shortening wait times and ensuring that care can respond quickly when people's needs change.
Ultimately, the future success of aged care reform will not be determined by how many new processes are introduced; it will be determined by whether older Australians can access the right care, at the right time, in the place they most want to be.
If we keep that simple principle at the centre of decision-making, Australia has the opportunity to build an aged care system that genuinely delivers on its promise.
Read Silverchain’s full submission to the Senate Community Affairs References Committee Inquiry into the Support at Home program (PDF, 625 KB).
