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TRANSCRIPT
"The system being introduced on the 1st of November is the biggest reform to aged care in a generation. It is a very substantial package of reforms."
That was Health Minister Mark Butler, speaking in September of 2025 about the government's new system that essentially means more older Australians will have to contribute financially to the aged care services they require.
Older Persons Advocacy Network [[OPAN]] policy director Samantha Edmonds says the first step in the process is assessing someone for what they might need.
"After their assessment they get given a list of services that they can purchase from that package."
For those who are allocated personal care services, the reforms mean that who pays what is clearly defined - and it's not all on the government.
Nelson Ma is from the University of Technology Sydney Ageing Research Collaborative team.
"The government will continue to pay the clinical [[nursing]] component. But all the other components - here we're talking about all the non-direct care components... so laundry, catering, cleaning costs, as well as part of the accommodation costs, depending on the means of the resident - those types of things will start to be covered to a greater degree by the recipient of the care."
But that funding decision sparked immediate concern from advocates.
Ageing Australia Chief Executive Tom Symondson was among those to argue the most vulnerable older Australians who were already under strain from cost of living pressures would be worse off.
"We did not want to see older people sacrificing showering - basic hygiene and dignity - because they could not afford it. And we've seen too many older people doing just that: sacrificing showers, having fewer showers per week."
Now the government has reversed its decision.
Federal Health Minister Mark Butler has confirmed in a major speech to the National Press Club that the government will now cover the cost of showering supports - by scrapping subsidies for private health insurance for older Australians.
"I understand this won't be a welcome decision for many. But it is the right thing to do to re-establish intergenerational equity in the rebate system. And also to free up funding that we need to provide more care and more dignity to older Australians."
Tom Symondson says it was the right move.
"It's unfortunate that it's not happening until October - but it's still a really good outcome that will benefit hundreds of thousands of older Australians right now, and millions over the coming years."
But other major issues remain.
The waiting lists for aged care assessments remain considerably long.
Then once the assessment is complete, the most recent Productivity Commission report** on government services says older Australians are waiting an average of nine months to get access to home support services anyway, which includes showering, meal preparation and cleaning.
And according to Samantha Edmonds, that means the condition of the person might worsen and push them out of home based aged care altogether.
She says the algorithm used in the assessment process doesn't necessarily always get it right.
"What we've been informed and what we're seeing through our cases is that when people seek a reassessment they're actually then assessed as needing less, even though they need more in terms of services. And that some priorities don't seem right either, like people that should be a high priority are getting a medium priority."
There is also the issue of what is known as bed block, where long waiting lists leave people stuck in hospital.
Chief Operating Officer of Uniting Care NSW-ACT, Patrick Reid, has previously spoken aboutthi is a too-frequent phenomenon.
"We know that there are a number of hospitals around the country which are experiencing delayed discharge, where people are languishing in hospitals for long periods of time and do not have access to either residential aged care or to return home."
Part of the reason for these delays is sheer demand.
There are just over 234,000 [[234,893]] people on the waiting list for home based aged care - which includes an estimated 103,000 [[103,527]] older Australians just waiting to be assessed.
The government says it has been doing everything it can to address demand, and fund services that older Australians need.
Mark Butler says the new funding model for home based aged care is proving to be better than the old approach.
"We've also been closely monitoring the rollout of the new Support at Home program that started last year. This program is undeniably delivering improvements to the system. It's delivering more packages, better quality packages, and it's reducing wait times."
Meanwhile, Mr Symondson says it will continue to advocate for improvements to the home based aged care process.
"We will be pushing to make sure that the government continues to review whether there are other things that older people are not doing that might be in their interests because they can't afford them. So we'll be continuing to look at whether there are other things they can take charges away from, to make sure that older people get the best outcomes."
