Backflips are a sign something’s broken

Fixing something you broke in the first place isn’t a thing to be celebrated. You should be apologising for the wasted time, money, and distress.

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Nothing grinds my gears more than a government backflip being dressed up as a win, especially when that backflip is fixing a problem it created in the first place.

And right now, aged care reform is becoming a case study in exactly that.

This week, of course, we’ve seen a giant backflip by the Department of Health, Disability and Ageing.

After almost six months of charging old age pensioners between $5 and $50 for help in taking a shower, the DoHDA has finally listened to the cacophony of outrage and changed its mind.

The system won’t change until October, however, leaving Support at Home participants with another five months of forking out cash in order to take a shower safely and with dignity, or for those with less funds at their disposal, going without in order to pay for other things, like food or medication.

Why October? Ian Yates, former inspector-general of aged care, told me he believed the delay in the backflip was largely about the lack of administrative capacity at the DoHDA.

In short, the department still hasn’t got the basics right – and now it’s trying to change course mid-stream.

This reform is being built backwards, and the backflips are evidence of that.

Mr Yates told the SaH conference some fascinating truths about the history of the Support at Home program – more details here – but in summary, the original design was much closer to what you could genuinely call a “rights-based” aged care system, but the departments of treasury, finance and the PM&C nixed it and landed us with what we’ve got now.

Now, finally, senior Australians and their advocates are starting to be heard.

Aged care minister Sam Rae was selling this week’s backflip like it was a natural evolution of this “once-in-a-generation” reform, and that our senior Aussies deserve the dignity and respect of a free shower and a bag of incontinence pads.

He didn’t seem to feel that way back in November when he introduced the co-payments in the first place.

His answer to that, of course, was that government had simply followed the advice of experts when designing the Support at Home program.

Those experts also included an army of lived experience advocates and experienced sector workers who were shouting very loudly indeed – for months before 1 November 2025 – about what an appalling idea it was to make showers, dressing, and continence care at luxury rather than an essential part of care.

Those experts didn’t get listened to. But at least they didn’t get thrown under a bus this week.

Next cab off the rank

If the shower co-payment debacle was a design failure hiding in plain sight, the next one is already here – the integrated assessment tool.

Spend two days in a room full of home care providers and you don’t hear abstract policy concerns. You hear frustration, disbelief, and, increasingly, anger.

Assessments, as one session at this week’s Support at Home conference made clear, are now “one of the most contested issues in the sector”, and for good reason.

At the sharp end, providers are seeing something very different from the tidy policy logic coming out of Canberra.

Adrian Morgan, general manager of FlexiCare, and a contributor to HSD in the past, put it bluntly. Since November, his organisation has seen a “surprisingly large number” of clients rejected for higher-level packages – a dramatic shift from the previous system, where “essentially none” were knocked back.

What changed?

“The algorithm was being used,” Mr Morgan said. But more importantly, “the clinically qualified assessors could not override a questionable outcome”.

That one line should send a chill down the spine of anyone who thinks aged care assessments are, or should be, about clinical judgement.

Because what providers are describing is not just a new tool. It’s a system where human expertise has been deliberately sidelined in favour of what one speaker described as a “rigid, opaque, secretive, not fully tested algorithm”.

And the consequences are already showing up.

Requests for assistive technology and home modifications are being approved, Mr Morgan acknowledged, but with funding levels that bear no resemblance to what’s actually needed.

Why? Because the tool isn’t asking what the person needs, or what it costs. It’s classifying them into a tier based on function and spitting out a number.

“Nowhere is the assessor asked to consider what does the person actually need, and how much would that cost,” said Mr Morgan.

This is how you end up with people approved for a wheelchair ramp they can’t afford to build, or a piece of equipment they can’t actually buy.

And if you think that sounds like a system ripe for challenge, think again.

Technically, participants can seek a review. In practice, they have to write a physical letter, within 28 days, explaining why a decision is wrong, without being able to see how that decision was made in the first place.

“You cannot see the goalposts,” Mr Morgan said.

Unsurprisingly, the official figures show only 0.5% of decisions are being challenged.

The department presents that as evidence the system is working. Providers see something else entirely.

“I don’t think it’s a fair measure of how many people are unhappy,” Mr Morgan told the conference, pointing to the barriers older people face in navigating what is, for many, an unfamiliar and intimidating process.

And even when people do get through the system, the problems don’t stop.

Under the new arrangements, participants initially receive only 60% of their allocated funding. If that allocation is already too low – because the IAT got it wrong – the gap between need and support becomes even wider.

“By definition, the person will not get the support they need,” said Mr Morgan.

This is the bit that should sound familiar, because it’s exactly how the shower co-payment fiasco unfolded.

It was a policy designed in abstraction. There were plenty of warnings from the sector well before 1 November – in fact, well before the original implementation date of 1 July 2025.

There were real-world consequences, followed by more public pressure, and finally, a backflip.

Even within the same conference session on Wednesday, there was a sense of inevitability about what comes next in terms of the IAT.

“I was incredibly pleased this morning with the news about the change to the way personal care is being managed,” Mr Morgan said.

“It gave me a little bit of hope that maybe the next cab off the rank will be the IAT.”

We can only hope, Adrian. We can only hope.

The problem is not the government’s willingness, or reluctance to backflip. The problem is the fact that these policies keep needing to be backflipped in the first place.

Advocates need to keep their foot on the pedal, because it works. Not quickly enough, but eventually is better than never.

Bring it on.