Possibilities, problems and perspective
Womenjeka. In the language of the Kulin nations this means 'coming together for purpose'.
Marvel Stadium is situated on the traditional lands of the Wurundjeri Woi-Wurrung and Boon Wurrung/Bunurong peoples of the eastern Kulin Nation. I pay my deep respect to their Eders past and present. I am deeply grateful to be on their Country, and I am deeply grateful to all Aboriginal and Torres Strait Islander people here today.
In the very spot where this stadium stands, long before colonisation, this was a special ‘murnong’ root collecting place for women. Murnong root (also known as ‘yam daisy root’) was a staple food for people of the Kulin Nation. And when hooved animals arrived, they trampled and killed a lot of the murrnong root, which were carefully cropped across country by the people.
For Aboriginal and Torres Strait Islander people, age brought knowledge, standing and responsibility. Ageing – and dying – were understood as part of life, held within community, not displaced into other places and other spaces.
We have so much to learn from cultures where elders are not hidden away; they are present, central, and authoritative.
And that’s just what we are meant to be achieving in this brave new world of reform, under an Act that promises dignity, compassion, kindness: relevance.
My role, as Inspector‑General of Aged Care, is to hold the government to account in delivering this very compass for aged care.
For those of you who are not familiar with my role, it is to hold the Commonwealth to account for how aged care is designed, funded, administered and regulated, and to say, publicly and independently, whether the system that exists in practice matches the promises that have been made in law.
It is not to regulate providers. It is not to run programs. And it is not to defend government decisions.
And right now, the place where that gap I oversee is most visible – and most consequential – is in Support at Home. And I am also going to steal this platform to talk about what is happening to CHSP. Because the two are deeply interrelated in the outcomes they are designed to achieve for older people.
I woke up this morning with a “woot woot” when I heard the Government’s announcement that older people will no longer be asked to co-contribute for essential personal care under Support at Home – specifically showering, dressing and continence support. The decision responds to evidence that co-payments have been hitting the poorest older Australians hardest, with many pensioners already reducing or withdrawing from care and reporting distressing trade-offs between basic daily needs.
I want to congratulate you as a sector, and the many older people, and advocates whose sustained advocacy for this change, well precedes my own appointment.
You might find it surprising, but I think this decision is a good fiscal decision, as well as a human rights victory – and you will see why in a moment.
Let me start with the possibility – because it matters to say this out loud.
Possibility
The ambition behind Support at Home is not wrong.
A system that supports people earlier, that helps people remain independent, that keeps people connected to community, and that prevents unnecessary escalation into residential care: that is exactly where a rights‑based aged care system should be heading.
And CHSP, in particular, has long been one of the most important – and most under‑recognised – parts of that story.
It is the primary prevention end of the aged care system. It slows decline. It supports function. It keeps people engaged and connected.
And, critically, it does all of that at a fraction of the cost of tertiary care.
So the possibility here is enormous.
If we get Support at Home and CHSP right, we are not just delivering better lives for older people - we are reshaping the trajectory of the entire aged care system.
But that brings me to the problems.
Problems
The issues being raised with my office about Support at Home are consistent, widespread, and deeply concerning.
But pervasively, and perversely, I am hearing they are actively undermining the objectives of dignity, agency, independence, connectedness, and ageing in place.
First, the current settings are disincentivising uptake of home care – and, most importantly, for those who can afford it least
These are largely pensioners or part pensioners. Three out of every 4 people on Support at Home are pensioners. Seventy-five percent.
What does that mean? Older people and families are delaying, reducing, or withdrawing from care because of cost. I am hearing stories of this every day: from older people themselves, providers, advocates and carers.
Co‑payments, as they are currently landing, are not neutral design features. They are shaping behaviour.
They are disincentivising the use of Support at Home.
The true implementation of grandfathering is a huge issue too, because the ‘no worse off principle' is not playing out in practice.
And the irony of the approach in practice: someone needed a $50 pair of crutches, which they could not afford. Crutches fall under mobility aids under the Home Mods scheme. They were told it would cost $1,800 via the government funding and there would be 3 months wait for an occupational therapist (OT) assessment. What do you think the consequences of this are for the person? And for the much-needed OTs whom we have to spread across the system?
And when people disengage from support at home, they don’t disappear from the system, they come back with their only option being residential care, hospital – or, worse – they have died.
Second, the system is relying on hardship protections that many people simply cannot navigate.
There is an assumption embedded in current design that vulnerable people will be protected because hardship processes exist.
But the existence of a safeguard on paper does not mean it works in practice.
It is unrealistic to expect people with cognitive decline, limited family support, language barriers, digital exclusion, or deep distrust of government systems to successfully navigate complex administrative processes.
It’s a 17-page PDF. And many people are just opting out.
That is not a safety net.
Third, uncertainty is destabilising providers, particularly at the CHSP end of the system
I hear small, community‑based providers – especially CHSP providers – say they can no longer plan, no longer carry risk, and no longer be confident post July next year that they will continue to operate or be viable under the merger with Support at Home.
And that matters profoundly.
Because in many geographically isolated communities, in many culturally and linguistically diverse communities, and in many Aboriginal and Torres Strait Islander communities, they are the only service.
When those services become unviable, there is no market correction. There is simply absence.
And the consequences are borne by older people first – and not long after, by hospitals or residential care, often a long way from home,
What does all this mean for our system that mandates dignity, independence and ageing in place – not as an aspiration – but in law?
Quite simply, it’s thwarted. And I will argue in a moment it is thwarted both from a human rights perspective and an economic perspective
At this point, I need to step back and talk about why this is happening.
Large‑scale reform like this only works when we do something very deliberate. That is, when we define the outcomes we want, and then we design incentives, funding and administration to deliver those outcomes.
That is theory‑of‑change work.
We didn’t do it.
Instead, we have ended up with disconnected, isolated reform mechanisms; reforms that look coherent in isolation, but clash in practice.
And the result is perverse outcomes.
We are:
- discouraging people from taking up home care, while saying we want ageing in place
- destabilising the primary prevention end of the system, while saying we want to slow demand and ‘can’t build enough beds’
- and creating uncertainty for providers who are doing exactly the work the system most needs.
I want to be honest with you. Human rights will always be my greatest motivation, and I will keep advocating – publicly and persistently – for the problems that need to be addressed.
But I am also a realist.
I do not believe government will now stop, rewind, and do the theory‑of‑change work properly, much as I would like them to.
So rather I want to hit the issue from the way I am hearing them misconceive the problem we are solving for: “The problem is that we have a largely static aged care budget, demand is growing as our population ages, and the tax base that funds it is under pressure".
Over time, that observation hardens into a kind of fatalism; the idea that the budget will never be enough, and that this is, ultimately, an unsolvable problem.
But I think that framing is part of what is holding us back.
Perspective
The new Aged Care Act invites – in fact, it requires – us to ask a different budgetary question altogether.
Not simply: how do we stretch a finite budget to meet ever growing demand?
But rather: how do we use that $40 billion to prevent frailty, cognitive and physical decline, and support people to age in place, so that fewer people need the most expensive, tertiary services, and they need them later?
This is not about asking for more money. It’s about making that $40 billion go much further.
When we reconceive the system this way based on this question, something important happens: more people get access to support earlier, at lower intensity; decline is slowed; pressure on residential entry eases; and the system is no longer forced to respond primarily at the point of crisis.
Fewer people need beds, sooner, and the budget works harder, for longer, for more people
The question is not how much we spend — it is how we spend it, and what outcomes that spending buys.
Australia has one of the longest average stays in residential aged care in the OECD.
That should give us pause for thought. Because residential care is the most expensive setting in the system.
If people are entering earlier than they need to, and if they are staying longer than is necessary, then the budget is being consumed at the wrong end of the system.
This is where Support at Home and CHSP matter, fiscally.
The aged care budget works harder every time home support is accessed early, every time functional decline is slowed, every time crisis is avoided, and every time entry into residential care is delayed.
Not later. Now.
And this is the point I want to make as strongly as I can: Delivering on rights, dignity and agency is not just morally right; it delivers the best bang for the aged care buck.
A system that supports independence rather than dependency, intervenes early rather than late, invests in connection rather than crisis: serves more people, with shorter wait times,
and fewer emergency escalations.
That is not sentiment. That is public policy logic.
So here is my call to action, and it is a different one from the usual.
It’s not about joining voices to demand a bigger budget.
It’s about joining voices to demand smarter use of the $40 billion we already spend. Because we are also competing in our advocacy in one of the most volatile periods we could face in our lifetime.
To say, collectively and clearly:
- Support at Home and CHSP are not “nice to have” programs - they are core fiscal infrastructure
- destabilising prevention costs more than it saves
- a system that waits for crisis is both cruel and inefficient.
You – as providers, community organisations, Aboriginal‑controlled services, and advocates – see the dividends of home support every day.
From the outcomes of your own work, you see how integral your work is to:
- people staying independent longer
- carers burning out later, or not at all
- crises avoided
- hospital presentations reduced
- dignity preserved.
Those are not soft outcomes.
They are the difference between a budget that collapses under demand, and one that stretches further, serves more people, and holds.
If we want government to listen, this is the argument we must make together: Getting Support at Home and CHSP right is not a cost pressure. It is the most credible strategy Australia has to keep that $40 billion working as hard as it can, sustainably.
The promise of the new aged care framework is dignity, agency and rights.
The opportunity before us is to show – unequivocally – that those things are not in tension with fiscal responsibility. They are the pathway to it.
Thank you for the work you do. Thank you for telling the truth about what you are seeing. And thank you for standing with me in insisting that how we spend this money matters – profoundly – to the lives of older people, and to the future of the system itself.