Introduction by Croakey: Aged care advocates have welcomed the Federal Government’s decision to retain the Commonwealth Home Support Program (CHSP) separate from the Support at Home Program.
The Government announced today it would extend the CHSP to 30 June 2029, saying this would give 830,000 older Australians certainty about the services they use every day and support providers to continue critical aged care services.
It said CHSP should remain a standalone program, rather than being rolled into Support at Home as had been planned, and that consultation will begin on a long term future for the program so it is sustainable and better integrated with Support at Home.
Professor Kathy Eagar AM, Co-Convenor of the CHSP Alliance, expressed delight at the decision, saying the Alliance had advocated strongly for CHSP, arguing that it should form the basis of a primary care tier to the aged care system.
Meanwhile, this week’s Four Corners program on the Support at Home program has prompted aged care policy analyst Charles Maskell-Knight to call for Prime Ministerial intervention.
The PM should tell the Treasurer to make additional funds available for Support at Home because it will save money, and he also needs to tell Minister for Health and Ageing Mark Butler and Minister for Aged Care and Seniors Sam Rae to redesign the assessment process from the ground up, says Maskell-Knight.
“Depriving people of care at home that costs tens of thousands of dollars a year and forcing them into residential care that costs hundreds of thousands of dollars a year is stupid – yet that is what the Government is doing,” he writes below.
Charles Maskell-Knight writes:
The ABC’s Four Corners program on 17 August – The Waiting Game – was a damning expose of the process for assessing eligibility for Support at Home aged care services and the waiting times for care after assessment.
Aged Care Minister Sam Rae responded to the concerns raised by mouthing his usual talking points that waiting lists were falling and the Integrated Assessment Tool (IAT) was improving fairness.
When asked why he didn’t think there was a problem with the IAT, Rae said: “I want to see the very best outcomes for older Australians.
“And so investing in constant improvement is a critical way to make sure that the $50 billion of precious taxpayer money that we will be expending each financial year over the coming financial years is invested to the very best that it can be to get the very best outcomes for older Australians.”
At this point the Government should consider replacing Rae with a ChatGPT interface – the answers it will produce may not be any better, but it would save well over $100,000 in Ministerial salary (after paying for the software).
The day after the Four Corners program aired, the Senate adopted a motion from Greens Senator Penny Allman-Payne that the Senate:
- notes that the IAT is untested, structurally flawed and systematically under-assessing the care needs of older Australians, especially those living with mental health conditions, cognitive issues and frailty; and
- calls on the Government to:
– take immediate action to abolish the IAT,
– replace the IAT with a tested assessment system that is designed with clinical experts,
– ensure this new assessment system has guaranteeing the rights of older people as its first priority, and
– restore the role of clinical professionals in the assessment process and reinstate the ability for human override.
Motions of this sort unfortunately have no direct impact – the Government is under no obligation to acknowledge the motion, far less act on it.
Sector responses
Nonetheless, the Australian Physiotherapy Association (APA) thanked the Senate “for its strong recognition that algorithms cannot replace clinical decision making by qualified healthcare professionals”.
APA President Dr Rik Dawson said “comprehensive clinical assessment by a clinical assessor, not an algorithm, is the only mechanism that will accurately determine the level of care older people need to remain independent at home”.
Dawson said “the Government must work closely with expert clinicians as a matter of urgency to ensure improved needs-based access to care for older Australians” and develop a system including:
- timely access to physiotherapy to maintain strength and mobility, prevent falls, reduce hospitalisation and early entry into residential aged care
- genuine clinical oversight of assessment and funding decisions
- clear pathways to escalate cases where an outcome does not match identified need
- faster access to approved funding and services
- timely access to assistive technology and home modifications
- clear identification of the needs of those near end of life
- funding classifications that reflect the actual cost of delivering the care people have been assessed as requiring.
The Australian and New Zealand Society for Geriatric Medicine (ANZSGM) said “the experiences and expert analysis presented in the Four Corners program reinforce concerns ANZSGM has raised for some time: aged care assessment must properly recognise frailty, cognitive impairment, multimorbidity and the complex and changing needs of older people”.
The ANZSGM was particularly concerned that the Four Corners analysis “suggests that frailty, cognition and other health conditions enter the classification process at a point where their influence may be limited, while significant clinical and social observations recorded by assessors do not directly determine the classification outcome”.
”The Government should now undertake transparent, independent clinical review and validation of the IAT and its classification methodology, with direct involvement from specialists in geriatric medicine and the health and functional assessment of older people,” the ANZSGM said.
ANZSGM President Professor Sue Kurrle AO said “technology and standardisation can play an important role in aged care, but they must serve the older person”.
“The test of this system is not simply whether assessments are faster or more consistent,” she said. “It is whether we accurately recognise an older person’s needs and connect them with the right care before preventable decline or crisis occurs.”
Longstanding concerns
COTA CEO Patricia Sparrow said the Four Corners report “reflected concerns COTA has consistently raised with the Government about the operation of the new system”.
“Having an algorithm determine a person’s level of care, with limited opportunity for assessors or clinicians to intervene in the outcome, was always likely to create problems.”
Sparrow added “lengthy waits for care remain one of the most significant challenges facing older Australians”.
“It’s crucial that support is available early. Delays can lead to people deteriorating or reaching crisis point before help arrives,” she said.
”We know the Government is working to reduce waiting times, but too many older Australians are still waiting far too long for essential support.
“Until people are consistently receiving the right care at the right time, there is more work to do.”
Older Persons Advocacy Network (OPAN) CEO Craig Gear said the problems highlighted by Four Corners “are the same ones that our advocates have been hearing since day one”.
“Support at Home is well intentioned but it is abundantly clear that the program is not reaching its intent for too many older people.”
In relation to the IAT, Gear said it “may work for some to receive the right levels of support, but we continue to hear from frontline aged care advocates about instances where the outcome does not logically match an older person’s identified care needs… it is crucial that a human element remains when it comes to decision-making”.
”More than 250,000 older people are currently on the wait list for aged care, either for an assessment, allocation of funding or a package at their approved level,” Gear said.
“These are not numbers, they are human beings, who deserve to be treated with dignity and respect. While there have been some gains in allocating more packages there are still a large number of older people who are not getting the support they need or have been assessed for.
“Older people have a right to access a safe, quality aged care system that genuinely realises their rights in practice, not just in legislation.”
Ageing Australia (the aged care providers lobby group) called on the Government “to urgently act to reduce Support at Home wait times, provide packages that better reflect the full cost of older people’s needs, and ensure human oversight is at the core of assessments”.
Ageing Australia CEO Tom Symondson said “currently more than 200,000 people are waiting for a home care package or waiting to be assessed”.
“Fifty thousand more are only receiving a portion of the funding they have been promised,” he said. “We also know that the value of packages does not adequately reflect older peoples’ needs.
“It’s simply not good enough. We need an urgent review of wait lists, wait times, and package values, as well as an urgent release of more packages to clear the backlog.”
Symondson then put his finger on the core issue: “Home care shouldn’t be rationed as it is currently, as the Royal Commission so clearly stated.”
Both the first acting Inspector General of Aged Care (Ian Yates AM) and the inaugural Inspector General (Natalie Siegel-Browne) appeared in the Four Corners program making the same point.
What folly
Depriving people of care at home that costs tens of thousands of dollars a year and forcing them into residential care that costs hundreds of thousands of dollars a year is stupid – yet that is what the Government is doing.
And it is persisting in this course of action despite advice from older people, clinicians, providers, and former independent overseers of the system.
American historian Barbara Tuchman wrote a book about the policy process called The March of Folly, arguing that “a phenomenon noticeable throughout history regardless of place or period is the pursuit by governments of policies contrary to their own interests”.
Anyone wishing to update her work could use the Government’s performance on Support at Home as an example.
If the Government is to avoid this fate, the Prime Minister needs to step in, remove rationing, and tell the Treasurer to make additional funds available for Support at Home because it will save money.
And then he needs to tell the Aged Care Ministers [Mark Butler and Sam Rae] to redesign the assessment process from the ground up with clinical and funding system expertise. 
Author details
Charles Maskell-Knight PSM was a senior public servant in the Commonwealth Department of Health for over 25 years before retiring in 2021. He worked as a senior adviser to the Aged Care Royal Commission in 2019-20. He is a member of Croakey Health Media; we thank and acknowledge him for providing the weekly column The Zap as a probono service to our readers. Follow on X/Twitter at @CharlesAndrewMK, and on Bluesky at: @charlesmk.bsky.social.
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