In Part 1 – The Monthly Physio Myth, we challenged a pattern that has quietly become embedded in home care: low-frequency, indefinite physiotherapy referrals that feel safe, predictable—and ultimately deliver limited functional change. The question now is not whether that model is suboptimal, it’s “What Do We Replace It With”.

The policy shift is clear—our referral habits aren’t

Under the Australian Government’s Support at Home reforms, restorative care is no longer a niche concept—it is central to the system design.

The My Aged Care Restorative Care Pathway explicitly promotes:

• Short-term, goal-oriented interventions
• Higher intensity input over defined periods (up to ~12–16 weeks)
• A focus on improving function and independence—not maintaining decline

And yet, in practice, many referrals still look like this:

• “Monthly physio review”
• “Fortnightly for maintenance”
• “Weekly ongoing”

These are not restorative models. They are risk management models.

The problem with low-frequency, long-duration care

Low-frequency physiotherapy sounds cost-effective—but it often creates a hidden inefficiency, it spreads funding thinly over time without generating meaningful functional change.

The result:

• Limited strength, balance, or mobility gains
• Ongoing dependence on personal care
• Increasing long-term package pressure

In a system already experiencing rising core care costs crowding out restoration, this is a compounding problem.

What actually works: intensity + intent

Restorative care flips the model:

• Higher frequency (e.g. 2x/week)
• Short duration (8–12 weeks)
• Clear functional goals (mobility, transfers, falls risk, ADLs)

This aligns with evidence-based rehabilitation principles—and the design of the Support at Home system itself, which enables time-limited, goal-focused allied health interventions.

Cost comparison: Traditional vs Restorative Models

Assumption:

• Physiotherapy rate = $190/hour (in-home)
• 52-week year

1. Traditional “maintenance” referral patterns

Model	Frequency	Annual Sessions	Annual Cost
Weekly	1x/week	52	$9,880
Fortnightly	1x/2 weeks	26	$4,940
Monthly	1x/month	12	$2,280

What do these models deliver?

• Weekly: high cost, often low progression
• Fortnightly: moderate spend, minimal intensity
• Monthly: low cost, negligible functional change

2. Restorative model (front-loaded intensity)

Option A: 8-week intensive block

• 2x/week for 8 weeks = 16 sessions
• Then fortnightly (22 sessions remaining year)

Phase	Sessions	Cost
Intensive (8 weeks)	16	$3,040
Fortnightly remainder (22 sessions)	22	$4,180
Total Annual Cost	38 sessions	$7,220

Option B: 12-week intensive block

• 2x/week for 12 weeks = 24 sessions
• Then fortnightly (20 sessions remaining year)

Phase	Sessions	Cost
Intensive (12 weeks)	24	$4,560
Fortnightly remainder	20	$3,800
Total Annual Cost	44 sessions	$8,360

What stands out?

1. Restorative models are not necessarily more expensive
   • A 12-week intensive + monthly model ($6,270) sits between fortnightly and weekly spend
2. You’re buying outcomes—not visits
   • Higher upfront cost → measurable functional gains
   • Lower downstream reliance on care hours
3. Frequency drives adaptation
   • Strength, balance, and motor learning require repetition
   • Monthly input cannot achieve this

Expanding the model: the untapped value of centre-based programs

One of the most underutilised levers in Support at Home is community-based exercise programs. At an average cost of $80 per 60-minute session, these programs fundamentally change the value equation:

For less than half the cost of a single in-home visit, clients can often access group-based, equipment-supported, higher-frequency exercise.

This creates a powerful opportunity:

• Increase frequency (2–3x/week)
• Maintain clinical oversight
• Dramatically improve cost efficiency

Cost comparison: Centre-based vs In-home models

Assumptions:

• In-home physiotherapy: $190/session
• Centre-based program: $80/session
• 52-week year

How this compares to in-home physiotherapy

Model	Annual Sessions	Annual Cost	Key Value
In-home weekly	52	$9,880	High cost, moderate impact
In-home fortnightly	26	$4,940	Lower cost, low intensity
In-home monthly	12	$2,280	Minimal functional change
In-home restorative (12-week intensive + monthly)	33	$6,270	Moderate cost, higher impact
Centre-based (3x/week → 1x/week)	76	$6,080	High intensity + low cost
Centre-based (2x/week ongoing)	104	$8,320	Maximum frequency, strong outcomes

The real value equation (what case managers should consider)

Instead of asking:

“How often can we afford physio?”

We should ask:

“What level of intensity is required to change this client’s trajectory?”

Because the biggest cost in home care isn’t physiotherapy.

It’s unrecovered function.

Why this matters more now than ever

When you compare models side by side, the insight becomes clear:

• Low-frequency, in-home models preserve budget—but not function
• High-intensity restorative models change function—but require upfront investment
• Centre-based programs unlock intensity at a lower cost point

This is the critical shift:

Value is no longer about cost per session. It’s about functional gain per dollar.

A client attending a centre-based program at $80/session, 2–3x per week may receive:

• 2–3 times the clinical dosage
• For the same—or lower—annual cost than traditional in-home models

That’s not just efficiency.

That’s a completely different outcome trajectory.

A new referral model for case managers

Here’s a practical framework that reflects both restorative principles and smarter use of delivery models:

1. Trigger-based referral

Refer to physiotherapy when:

• Post-hospital or illness decline
• Falls or near misses
• Reduced mobility or transfers
• Increasing care hours

2. Prescribe intensity upfront (and choose the right setting)

Default to:

• 2x/week for 8–12 weeks (in-home or centre-based depending on client need)

But critically, also ask:

• Can this client safely attend a centre-based program?
• Would they benefit from 3x/week intensity instead of 1x/week at home?

Guiding principle:

• Use in-home physiotherapy for assessment, early rehab, and complexity
• Use centre-based programs to scale intensity and progression

3. Build step-down pathways (not static care plans)

Avoid locking clients into a single model.

Instead, transition intentionally:

• Intensive (in-home or centre-based)
  → Centre-based high frequency (2–3x/week)
  → Weekly / fortnightly maintenance
  → Discharge or self-management

This ensures:

• Funding is targeted when it has the most impact
• Services don’t become passive, ongoing cost centres

4. Measure outcomes (not activity)

Track what actually matters:

• Gait speed
• Sit-to-stand performance
• Falls risk reduction
• Reduction in care hours
• Independence in ADLs

Because:

If function isn’t improving, the model—not the client—needs to change.

The strategic shift

This isn’t just a clinical change—it’s a financial one. Short-term, higher-intensity investment—particularly when blended with lower-cost, high-frequency centre-based programs—can:

• Reduce long-term care hours
• Delay or avoid package upgrades
• Improve client outcomes and satisfaction
• Stretch package value significantly further

And importantly, it aligns with where the system is heading:

• Goal-based funding
• Clinical justification
• Functional outcomes over service volume

Final thought

The “monthly physio” model isn’t wrong because it costs too much. It’s wrong because it doesn’t do enough.

Centre-based programs and restorative models show us what’s possible when we rethink intensity, setting, and purpose.

If we want to truly deliver value under Support at Home, the shift is simple:

From spreading care thinly over time → to concentrating it where it creates change.

And increasingly:

From defaulting to in-home care → to combining it with models that make intensity affordable.