In the ever-evolving landscape of healthcare policy, change is inevitable. But when new eligibility criteria risk excluding some of our most vulnerable citizens, it’s worth pausing to ask: Are we getting it right?

The updated eligibility criteria for the Support at Home Restorative Care Pathway aim to prioritize those who can actively participate in short-term reablement or recovery-based services. On paper, this focus on short-term, goal-oriented intervention makes sense — the pathway is designed to restore function, promote independence, and reduce longer-term dependence on services.

However, a growing concern among healthcare professionals and advocates is that this new approach may inadvertently marginalize individuals suffering from depression, chronic mental health conditions, or other illnesses that affect motivation, energy, and engagement.

The Problem with “Engagement-Based” Eligibility

The updated pathway places an emphasis on individuals’ ability to engage with the restorative process. But what happens to those who want to get better, but currently lack the energy, motivation, or mental clarity to do so?

Depression, for example, is not just a mental illness — it’s a condition that deeply affects one’s physical health, cognitive functioning, and motivation. Asking someone in the depths of depression to set and pursue functional goals can be like asking someone with a broken leg to run a marathon. Their inability to participate actively is often a symptom of the condition itself, not a sign that they wouldn’t benefit from support.

Yet under the new criteria, such individuals may be seen as “unsuitable” for the pathway — not because they don’t need care, but because they are temporarily unable to meet the participation requirements.

Who Gets Left Behind?

Those most at risk of being excluded under the new framework often include:

• Older adults with undiagnosed or poorly managed depression.
• Individuals with cognitive impairment or early dementia who appear disengaged.
• People recovering from long hospital stays or traumatic events who are experiencing temporary motivational lows.
• Those from culturally or linguistically diverse backgrounds where motivational cues or expressions of distress may not be easily recognized.

This raises a serious question: Are we creating a system that supports only the easiest cases?

Restorative Doesn’t Mean Rigid

Restorative care should be flexible and person-centered — not one-size-fits-all. The pathway must account for fluctuating conditions, mental health barriers, and the nuanced needs of those who may not initially present as “motivated,” but who can still make meaningful gains with the right support.

Embedding Trauma-Informed and Inclusive Practice in Line with Aged Care Principles

To meet the expectations set out in the Aged Care Act and uphold the Aged Care Quality Standards, eligibility assessments for programs like the Support at Home Restorative Care Pathway must go beyond a narrow focus on immediate engagement. Instead, they should embrace a person-centred, trauma-informed, and culturally appropriate approach that recognises the diverse experiences and needs of older people.

Standard 1 of the Aged Care Quality Standards emphasizes that people receiving care must be treated with dignity and respect, and supported to make choices about their care, even when those choices are not easily articulated due to mental health or cognitive challenges. Standard 2 further supports this by calling for ongoing partnerships in care planning, which should accommodate each individual’s unique situation, including emotional readiness or psychological barriers to engagement.

Frontline workers and assessors need to be equipped to distinguish between true refusal and symptom-related disengagement — particularly when working with individuals affected by depression, trauma, or cultural differences in communication. What may appear as “non-participation” could in fact be a clinical indicator of unmet mental health needs or a sign that more time is needed to establish trust.

Rather than excluding individuals who appear disengaged, a more inclusive approach would ask:

“What supports would help this person to engage meaningfully in restorative care?”

This may include:

• A timely and comprehensive mental health assessment;
• Motivational interviewing techniques that explore readiness and barriers to change;
• Language support or cultural mediation to ensure the person fully understands and feels safe with the process;
• Simply allowing more time to build rapport and psychological safety.

By aligning eligibility assessments with the legislated principles of dignity, inclusion, and respect, we ensure that restorative care is accessible not just to those who are ready to engage immediately, but also to those who need support to get there.

After all, truly person-centred care doesn’t start with exclusion — it starts with understanding.

Moving Forward

The intent behind the Support at Home Restorative Care Pathway is commendable. But for it to truly support everyone who needs it, we must ensure that those with mental health challenges or cognitive impairments are not overlooked or left behind.

Policies must reflect the complexity of human experience — and that includes recognizing that healing and recovery don’t always begin with motivation. Sometimes, they begin with being seen, heard, and supported — even when we’re struggling to show up.