“The reformed Support at Home program has proved in practice to be neither particularly supportive nor effective care for elderly Australians,” writes columnist ROBERT McMAHON.

Sir Humphrey Appleby, the ever-wily fictional permanent secretary in the BBC Yes Minister series, was wont to quip the best way to deal with a problem was to name it in the title of the report inquiring into it.

And so, the federal government has recently re-badged its reformed Home Care program as Support at Home.

Yet, as the current Senate inquiry into the reformed Support at Home program has heard, it has proved in practice to be neither particularly supportive nor effective care for elderly Australians.

Home care aims to keep the elderly out of residential care (what we used to call nursing homes) and hospitals. Depending on assessed need, services can include nursing, physio, help to shower and dress, transport and assistance to go shopping or to cook.

To be fair, the old Home Care program was not without its faults. Following criticism by the Royal Commission into Aged Care, the Albanese government abolished Home Care and replaced it with Support at Home, starting in November 2025.

Former Home Care recipients were grandfathered into Support at Home, while new entrants required to pay higher co-payments. This shouldn’t surprise because the government said one of the objectives was to make the scheme “more sustainable” – government language for saving money.

So is it any wonder Support at Home has started to show cracks little more than five months after it began. 

Over the last few months, I have joined various Facebook groups where Support at Home recipients share their experiences. They are almost, without exception, negative.

Recipients complain of their funded hours being drastically reduced and to now having to pay up to $120 or $130 an hour for the same care that used to cost $60 to $80 an hour under Home Care. Alarmingly, some recipients report their budgets having been so eroded they have had to ration their care.

ACT independent senator David Pocock has been alert to the problems of the scheme for months and a member of the Senate committee inquiring into the new program.

He recently told me his constituents reported being forced to “make some really tough decisions… by getting in a carer every second day, skipping a shower or showering without help and risking a fall”.

The other way the government achieved “sustainability” was by imposing co-payments on recipients.

Those on fixed incomes, many as aged pensioners, are now expected to make a contribution of around $5-$20 an hour. Sounds fair enough? But if they receive care for just one hour a day, this would cost something in the range of $35 to $140. Every week. For an aged pensioner on an already very limited income.

The story is even more stark for those with superannuation or savings. Their co-payments can be in the order of 50 per cent to 80 per cent. 

So a self-funded retiree accessing an hour of care daily can be up for something in the order of $60 to $96 an hour. Or a staggering $420 to $670 a week. Just to keep living in their own home with help showering or going shopping for food.

Pushing the burden on to older Australians

On these figures, it’s little wonder recipients in the Facebook groups I observe are not only cutting back their allocated hours, they are giving up their packages all-together because they simply can’t afford the new co-payments the government has imposed. 

As Senator Pocock put it, the new system is “pushing the burden on to older Australians, their families and the state and territory healthcare systems”.

This rationing may well make the scheme more “sustainable” for the government, but is likely to give rise to what policy academics call a “perverse incentive”; a fancy term for unintended outcomes. Or, as we might call it, an own goal. That’s because the very point of home care is to keep older people in their own homes and out of nursing homes and hospitals where they tend to linger as what’s bluntly called “bed blockers”. 

In fairness to the government, it appears to have listened to the dire feedback and recently announced changes, starting from October: classifying help with showering and dressing as “clinical care”, thereby avoiding co-payments.

How this will play out in practice, and whether both pensioners and superannuants are eligible for this revised definition, is also unclear. 

Either way, we can only hope that the changes announced by Health Minister Mark Butler will make the scheme “sustainable” – not only for the government’s coffers, but also for the people it is intended to support in their final years. 

Dr Robert McMahon PSM is a Visiting Fellow at the Australian National University, Adjunct Professor at the University of Canberra, and former Assistant Secretary of the Department of the Prime Minister and Cabinet.