Australia’s Support at Home program was designed to modernise in-home aged care, simplify funding, and help older Australians live independently for longer. On paper, the reform promises flexibility, transparency and better outcomes.

On the ground, however, a growing number of older Australians, carers and healthcare professionals are reporting the opposite: rising costs, reduced access to care, confusion, and a widening gap between assessed need and what funding can realistically deliver. Across community forums, advocacy groups and professional networks, a consistent message is emerging — the system is consuming funding faster than care can be delivered, leaving many people worse off than under the previous arrangements.

Eroding Budgets and Escalating Costs

One of the most significant concerns is the rapid erosion of individual budgets under the new pricing model.

Consumers report dramatic increases in service costs, including:

• Physiotherapy and occupational therapy rising from around $130 per hour to $180–$200 per hour
• Personal care increasing from approximately $70 per hour to $110–$120 per hour

Under the previous Home Care Packages system, allied health services were commonly charged as a base hourly rate plus travel. Under Support at Home, providers must now use a single “direct care” price, intended to incorporate wages, travel, leave, superannuation, compliance and administration.

While the policy intent may be sound, the change has not been adequately explained to consumers. Many older Australians simply see their budgets shrinking at double the previous rate, without a clear understanding of what has changed or why.

The result has been widespread confusion, anger and mistrust, with many consumers believing providers are “charging double” or exploiting the new system — regardless of whether that perception is fair or accurate.

Allied Health: Technically Funded, Practically Unaffordable

Allied health services — including physiotherapy and occupational therapy — do not attract a consumer co-contribution under Support at Home. In theory, this should protect access to services that are essential for mobility, safety and independence.

In practice, allied health is being cut from care plans at an alarming rate.

Because of higher hourly rates and shrinking budgets, many consumers are forced to prioritise:

• basic personal care
• essential domestic support

and drop what are often seen as “optional” services — despite their preventative value.

Healthcare professionals warn this has serious consequences:

• increased falls and injuries
• accelerated functional decline
• avoidable hospital admissions
• earlier entry into residential aged care

This represents a false economy. Preventative allied health delivered at home is significantly cheaper than hospital care or residential placement, yet current funding realities are pushing consumers away from prevention and toward crisis.

Self-Management Under Support at Home: Why Many Consumers Feel It’s an Illusion, Not Freedom

In the midst of rising costs, dwindling package balances and confusion over pricing, a groundswell of aged care consumers online — especially on chat forums and Facebook pages — is talking about “self-managing” their Support at Home budgets or leaving the government program altogether to pay for services privately.

However, the reality of self-management under the new Support at Home program is fundamentally different from what many expect.

1. You Still Need a Registered Aged Care Provider

Under Support at Home, self-management does not mean you deal directly with government funding, as it does under some disability schemes such as the NDIS. Instead, even if you choose to self-manage your services, your Support at Home funds must still be held and overseen by a registered aged care provider who:

• holds your budget
• processes invoices on your behalf
• ensures compliance with the Aged Care Act 2024 and Aged Care Rules 2025
• oversees quality and safety requirements

You cannot simply pay workers directly or independently submit invoices — the provider remains the legal conduit for all services and spending.

2. Administrative Oversight Still Applies

Even in a “self-managed” arrangement, providers retain critical responsibilities, including:

• verifying services are appropriate and aligned with your approved support plan
• ensuring third-party workers meet screening and compliance standards
• issuing statements and tracking your budget
• managing payments from your Support at Home funds

Providers can charge a capped administrative overhead (currently 10% of the invoice for third-party services), even if you have greater control over sourcing support.

In practice, this means most of the traditional “management” tasks remain with the provider — just under a different label — and this inevitably erodes part of your funding whether you self-manage or not.

3. Consumers Feel Misled and Cornered

Many older Australians expected self-management would allow them to:

✔ negotiate lower service rates
✔ hire trusted local workers or family carers
✔ avoid large provider overheads
✔ keep more of their budget for direct care

Instead, the reality they encounter is that self-management does not provide true financial autonomy — the costs of compliance, administration and oversight still apply, and can consume significant portions of budget. This has fuelled resentment, especially when combined with:

• package balances being clawed back due to delayed statements or administrative errors
• rapidly rising hourly costs for allied health and personal care, consuming budget faster than before
• confusion over why costs have escalated and what’s driving these changes

Consumers are reporting that they still “have to pay a provider even if they manage everything themselves,” and feel the system offers less control, not more.

The Likely Consequences: False Savings, Real Harm

The widespread withdrawal of allied health support has serious and foreseeable consequences:

1. Increased Falls and Hospitalisations

Physiotherapy and occupational therapy play a crucial role in:

• fall prevention
• strength and balance maintenance
• safe mobility
• home safety assessments

Without regular allied health input, older people face a higher risk of falls, fractures and emergency hospital admissions — outcomes that are far more costly to the health system than preventative care delivered at home.

2. Accelerated Functional Decline

Allied health supports older people to:

• maintain independence
• use mobility aids safely
• adapt to changes in health conditions

Removing these services often leads to rapid functional deterioration, increasing reliance on personal care and informal carers — or triggering earlier entry into residential aged care.

3. Higher Long-Term Costs to Government

Cutting allied health may look like a short-term budget saving, but it creates long-term cost blowouts through:

• avoidable hospital stays
• increased demand for higher-level care
• premature placement into residential aged care

This directly contradicts the stated goal of Support at Home: keeping people well, independent, and living at home for longer.

4. Increased Carer Burnout

When allied health is removed, the burden shifts to family carers, many of whom are already stretched emotionally, physically and financially. This leads to:

• burnout
• reduced workforce participation
• poorer health outcomes for carers themselves

The emotional distress expressed by carers in community discussions highlights how unsustainable this situation already is.

A Growing Gap Between Policy Intent and Lived Experience

Support at Home was designed to:

• improve access
• promote independence
• prioritise prevention
• provide clarity and choice

Yet many consumers are experiencing:

• reduced access to care
• rapid budget depletion
• loss of preventative services
• confusion rather than clarity
• fewer real choices

Healthcare professionals are increasingly concerned that the gap between assessed need and deliverable care is widening — and that those with the most complex needs, the least financial flexibility, and the least capacity to advocate are being hit hardest.

A System Undermining Its Own Objectives

The irony is stark:

• allied health is technically protected from co-contributions
• yet it is being functionally priced out of reach
• consumers are cutting preventative care to survive day-to-day needs

The result is a system that rewards crisis response over prevention, reactive care over proactive support, and administrative compliance over human outcomes.

For many consumers, the message feels painfully clear:

“You can stay at home — but only until the money runs out.”

Unless pricing transparency improves, funding adequacy is addressed, and preventative services are genuinely protected in practice — not just policy — the Support at Home program risks driving worse outcomes for older Australians while costing the system more in the long run.