As Australia prepares to roll out the Support at Home program in 2025, there’s growing interest in how reablement and restorative care can shape the future of aged care. These models promise to enhance independence, reduce healthcare costs, and delay entry into residential care. But a critical question remains: are we genuinely embracing best-practice care, or are we introducing a centrally managed, cost-controlled system that may not fully meet the needs of older Australians?
What Are Reablement and Restorative Approaches?
Reablement focuses on helping older individuals regain or maintain independence through short-term, goal-directed interventions. Restorative care shares this goal, often involving multidisciplinary support following illness or injury.
These models mark a shift away from traditional, task-focused care toward a more collaborative, strengths-based approach. In theory, this enables older people to live independently for longer — but how well does this theory hold up under scrutiny?
The Evidence: Promising but Patchy
While advocates of reablement highlight its benefits, the evidence base is far from robust:
- A 2023 systematic review found only very low-quality evidence that reablement reduces the likelihood of entering residential aged care. The relative risk ratios at 3 and 12 months were not statistically significant, suggesting the effect may be minimal or inconsistent.
- The Australian Productivity Commission has acknowledged the potential of reablement but cautioned that “more evidence is needed” to understand which programs are most effective and which clients benefit the most.
- A study in BMC Health Services Research (2020) found inconsistent implementation across aged care providers, often due to resource limitations, workforce training gaps, and a lack of integrated infrastructure.
In short, while the principles of reablement are sound, the practical outcomes and return on investment remain uncertain.
The Support at Home Program: Streamlined and Structured — But At What Cost?
Set to replace the Commonwealth Home Support Programme and Home Care Packages, the Support at Home program aims to simplify access to care. It includes:
- Individualised care plans
- Short-term restorative care pathways
- Pricing schedules developed by the Independent Health and Aged Care Pricing Authority (IHACPA)
At first glance, this seems to align with best-practice reablement models. However, concerns are emerging around the centralised control and price-capping mechanisms underpinning the program.
Key Concerns:
- Capped Funding vs. Individual Needs: While price caps aim to ensure value for money, they may limit provider flexibility to tailor care, particularly for clients with complex or fluctuating needs.
- Standardisation vs. Personalisation: A nationally standardised service model may struggle to deliver the nuanced, flexible support required for effective reablement — especially in rural or culturally diverse communities.
- Administrative Burden: Providers warn that the program’s reporting requirements and fixed service lists could shift focus from client outcomes to compliance.
Are We Choosing the Right Model for Older Australians?
The Support at Home model introduces many of the elements associated with reablement and restorative care — but its success will depend on how it’s implemented and supported:
- If backed by strong training, clinical input, and flexible funding, the program could represent a genuine step forward in aged care reform.
- If reduced to a cost-containment strategy, it risks becoming a one-size-fits-all system that prioritises budgetary control over older Australians’ individual goals and preferences.
A Work in Progress
Reablement and restorative care are built on valuable ideas — helping older Australians maintain independence and dignity. However, the current evidence base is not yet strong enough to declare these approaches a universal solution. As the Support at Home program takes shape, stakeholders must ask: Are we building a system that empowers older people — or one that controls costs?
Policymakers, providers, and the public must remain engaged and critical, ensuring that aged care reforms truly deliver what matters most: respectful, personalised, and effective support for our ageing population.
