The new Support at Home Program for older people is introducing a ‘free market’ transactional aged care system. It’s a retrograde step, Sarah Russell reports.
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, which the Albanese Government just introduced on November 1. Unlike Hawke’s HACC program (which later became the Commonwealth Home Support Program), the Support at Home Program is a transactional aged care system in which users pay a share based on the services received and the participant’s financial situation.
Even basic services such as showering require pensioners to make a financial contribution.
Is this further evidence that the current federal Labor government is the least Labor-like government in the history of Labor governments?
Aged care reform promises
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 who was not in Cabinet (changed after the 2025 election).
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 the 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.
Star ratings and private hand-outs
After the Minister for Aged Care and Sport got some runs on the board, the 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 $1.5B 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.
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 the 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 that 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.
Pay or skip your shower
Some beancounter 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 take a shower. I can only imagine what Hawke would say seeing his beloved Labor Party travel this far down the neoliberal rabbit hole.
Aged care “free market” where a home care package deal masks a crisis
Dr Sarah Russell is a public health researcher. She is the Principal Researcher at Research Matters and Chair of Progressives of the Peninsula. She was formerly the Director, Aged Care Matters.