Is this thing even on? What is it going to take to get Mark Butler, Sam Rae and the federal government to acknowledge the badly designed elephant in the aged care room?
Now that the National Health Reform Agreement is finally nailed down, perhaps Mark Butler, Sam Rae, the prime minister and the DoHDA bureaucrats can turn their minds to the steaming pile of regret and expense that is the Support at Home Program.
There are two inquiries on the books.
The first is the Senate Standing Committee on Community Affairs inquiry into the Transition of the Commonwealth Home Support Program to the Support at Home Program. Public hearings begin next Friday, 6 February, and the report is due on 15 April.
The second is the same committee’s inquiry into the Support at Home Program itself. Submissions close on 31 July – there are five so far – and the committee doesn’t report until 24 November.
Yesterday, submissions to the Senate Community Affairs References Committee on The Transition of the CHSP to the SAH program closed, and a quick analysis tells me people are not happy.
At the time of writing – about 4pm yesterday – there were 31 submissions to the inquiry.
I’ve read every one of them, readers, so you don’t have to.
With the exception of one or two which offered broad support, not one of those submissions comes without a set of deep concerns and in many cases, urgent recommendations for getting things right before they get worse.
Myself and others have written before about the inherent problem in the way people are assessed for inclusion in Support at Home services – you can read them here, here, here, here, here, here, here, here, and here.
To summarise, the Department of Health, Disability and Ageing used external consultants – KPMG, PwC – to help design an Integrated Assessment Tool that would use an algorithm in a black box to turn a human assessor’s observations into a clinical needs assessment to determine which level of care package the client needed.
The same consultants were then employed to review the tool. And then the same consultants were used to test the tool on, it turns out, 22,000 living guineapigs known as Australia’s senior citizens.
Then the DoHDA banned its human assessors from over-riding the algorithm’s decisions, even when they were blatantly wrong.
Nothing has changed on that front since November 2025 when it first came to our attention.
In fact, according to a services provider I spoke to this week, prior to the introduction of the IAT their clients’ assessments were being accepted almost 100% of the time.
Now, 38% of their assessments are being rejected. “Something very weird is going on,” said my friendly provider.
As an aged care advocate said to me earlier this week, perhaps the IAT is working exactly the way the DoHDA wants it to – downgrading those with previously assessed high levels of need and therefore achieving the all-important cost savings.
Too cynical? Maybe.
Add to that the persistence of the DoHDA’s insistence on only paying 60% of the value of each home care package, with no real timeline on when the balance is going to handed over – there are rumours of 17 weeks being bandied about – and you can see why people are getting cynical.
The fact remains that the politicians and bureaucrats remain stubbornly unable or unwilling to concede that there are problems with their big, shiny new elephant.
Related
Transition from CHSP to SAH
Oh boy.
Look, let’s be clear. The Commonwealth Home Support Program is one of the most successful parts of the aged care system and has been for four decades.
It provides vital early intervention home support services to people who just need a little help to stay in their home.
As the Commonwealth’s own Inspector-General for Aged Care said in her inquiry submission:
“The CHSP is currently the Australian government’s primary vehicle for preventing acute ageing, supporting older people’s preferences to age in place and keeping people out of higher cost and more intensive tertiary aged care and hospitals.”
In 2024–25, the CHSP supported approximately 838,964 people.
How do you reckon the current Support at Home system is going to cope when those hordes want to be assessed and allocated their package?
Professor Kathy Eagar sums up the problems of the transition very clearly in her excellent submission to the inquiry.
“My view is that the initial decision to close CHSP and fold it into SAH is not the right approach and my central recommendation is that the government abandons this plan and adopts a different approach going forward,” she said.
“The only criticisms [of CHSP was] it is underfunded and neglected by successive governments.
“The first principle of program reform is ‘Only fix what is broken’. Getting rid of a long-established and highly effective program that continues to work very well simply makes no sense.
“There is no possibility that the government will achieve its target to reduce waiting times for SAH unless the government maintains and develops the CHSP.”
And as we know, thanks to the Productivity Commission yesterday, those waiting times have blown out, yet again.
Professor Eagar suggests improving CHSP by funding it properly, rather than trying to fold it into a Support at Home program that is already badly designed and struggling to cope.
But you wouldn’t know any of that if you just listen to Mark, Sam and Albo.
Who knows? Perhaps the two inquiries will provide the proof they can’t ignore, although waiting till April and, god help us, November, seems less than ideal – assuming the reports are even made public.
The only other hope for those desperate for improvements is the Australian National Audit Office’s report into the effectiveness of the CHSP, which will be released in March.
The ANAO has a lot to say about aged care this year, with audits also expected of the residential aged care star rating system, and support of residential aged care provider viability.
“We owe Australian families a system that works on the day they need it – and every day after,” said Mr Rae the day after the new Aged Care Act kicked off.
Yeah mate, we do. But first you have to admit that things are not working the way they should and get on with swallowing your pride, and fixing it.
I’m off to watch Chitty Chitty Bang Bang, multiple episodes of Bluey, and puppy videos on YouTube in a bid to dispel the cynicism. Have a good weekend.