Margaret Duckett is scared for her friends.
The 77-year-old pensioner is the recipient of a home care package – which allows her to get support with cleaning, gardening, transport, physiotherapy and podiatry – and some personal care, so she can continue living independently at her home in Sydney’s Riverview.
When changes to the Aged Care Act are rolled out across the country in November, she will be grandfathered in and the costs of her support won’t change. But her friends who have not yet been assessed for home care packages will be forced to pay much more for basic care.
Under the new act, home care package recipients, including those on the full pension, will be required to make co-payments for nonclinical services including – controversially – showering, dressing, continence support and wound care, as well as other things such as assistance with cooking, cleaning and gardening.
“Too many pensioners go without food to visit a doctor already,” she says. But under the changes, she fears people will be forced to make even starker choices. Choices such as whether to pay for groceries or pay for help to take a shower.
She is not alone in holding these concerns.
Senators David Pocock and Penny Allman-Payne, who will launch a Senate inquiry this week into the Aged Care Act, say they are concerned the changes to the home care packages will either push people into residential care sooner or mean that they end up in hospital.
“People are going to refrain from getting some aspects of care,” Allman-Payne says. “And that’s definitely going to contribute to bed block in hospitals and more people being pushed into residential aged care.”
‘Everybody deserves to have a shower’
At the heart of the changes to the new home care package provisions is the co-payments system. It means that care, which used to just come out of someone’s allotted home care package, will also require a co-payment from the individual.
The government will cover the full cost of clinical care such as visits to doctors and specialists. But for “independence support” – which includes help with showering, medications, dressing and wound care – people will have to pay between 5% of the cost for full pensioners to up to 50% for a self-funded retiree.
For everyday living support – which includes gardening and cleaning – the out-of-pocket costs will range from 17.5% for full pensioners through to 80% for self-funded retirees.
The middle category and, in particular, the inclusion of showering as an “independence support” rather than a “clinical” measure, has advocates particularly outraged.
“Everybody deserves to have a shower a day or every second day. If they are wanting help with a shower, it means that they can’t do it for themselves,” says Amina Schipp, an aged care advocate. “So if they have to give up a shower because it means they’ll be able to afford dinner, that’s what they’ll do, but that’ll lead to other issues – UTIs and infections and whatever else.”
If the new co-payment system applied to her, Duckett says she would have to reduce or cancel the fortnightly cleaning support that she gets, which is not a clinical need, but could lead to real health issues.
“I often have ulcers and wounds and things. It’s a dangerous situation clinically, but [cleaning] is still categorised as a life choice.”
Penny Allman-Payne, a Greens senator, says that when announcing the legislation, the government “made a big deal” of reassuring older people that they “didn’t need to worry because the government would foot 100% of the cost of clinical care.
“And yet, the bulk of the care that an old person needs is actually not clinical care,” she says. “It’s help with showering, it’s help with taking medication, it’s help with mobility, feeding, all of those things and those things are not being fully covered by the government.
“And that’s where … for some older people, those costs are going to be significantly increased and we are certainly hearing from people … saying, if I was in the same situation, we would have to forego some of this care.”
‘We’re not rolling in money’
The new Aged Care Act passed parliament in November 2024, aimed at responding to a range of recommendations from the royal commission into aged care quality and safety.
Announcing the new act in September 2024, Anthony Albanese said it was “the greatest improvement in aged care in 30 years” and aimed to “support the growing number of older Australians choosing to retain their independence and remain in their homes as they age” as well as improve residential care and introduce laws to allow for stronger penalties against those who breach standards in aged care provision.
The government says the new package will allow them to support another 300,000 people and has defended the co-payment system, saying that current arrangements aren’t sufficient to keep up with the rapidly growing demands on the aged care sector.
Sam Rae, the minister for aged care and seniors, told Guardian Australia: “The Labor government’s reforms will support more older Australians to live and receive high-quality care in a safe and familiar environment, close to family and community.
“The new Aged Care Act’s needs-based funding model will ensure that older people at a financial disadvantage will receive extra support to get the care they need.”
Some aspects of the act have drawn praise from aged care groups, such as the Older Persons Action Network (OPAN), which has said while it doesn’t agree with everything in the new package, it’s “significantly better than the one we have”. It says the new package “delivers faster services to the community, gives older people more choice and control over their aged care [and] provides stronger protections”.
A co-payment system for aged care is not a bad idea in principle, says the independent senator David Pocock, “as long as … it’s properly means tested and as long as it actually delivers on what was agreed, the government’s stated aims that these reforms will keep people at home for as long as possible.
“I think this is one of the challenges … of aged care reforms is recognising that we do have an ageing population and how do we ensure that people who need support have the support they need to age with dignity, whilst not overburdening younger generations with the cost of paying for that.”
But he says there is a lot of uncertainty about how the new system will work “and I think [there are] some very valid questions being raised about some of the services that will attract a co-payment”.
The government has promised that those who were already approved for a home care package by 12 September 2024 would be no worse off under the new system, but have conceded that 30% of pensioners and 75% of part-pensioners approved for a home care package after this date are going to pay more for their care as a result of the changes.
Duckett says the entire idea of the co-payment system is predicated on the myth that older people have money to burn, which is untrue, particularly for those on pensions like her.
“The evidence is so very, very clear that co-payments differentially impact on the poor and disadvantaged,” she says, citing the statistic that nearly 60% of people over 65 receive the age pension. “We’re not rolling in money … The budget is tight.
“When you’re on an income of less than $30,000 a year, living in Sydney, there’s not much money left over to go and play with … Now if you’re going to have to start paying co-payments as well, at even a small level, it will have an impact.”
‘Fifteen thousand gets you bugger all’
Paul Absalom, 78, had polio when he was a child and for most of his life has lived with “one leg that’s pretty useless and the other one that’s nearly useless”.
But about seven years ago, injuries from falling stopped him walking and he gets around on a scooter.
Absalom says he lucked out: his Alice Springs home is – without him having to do much work to it – quite accessible for him. But it did require Absalom to renovate the bathroom nine years ago, removing the bathtub, retiling the room and getting an accessible shower.
All up it cost Absalom about $20,000, which he paid for himself; it was not part of a home care arrangement.
However, if someone in Absalom’s position were in need of a similar renovation under the new Aged Care Act, it appears they would not be able to get it. Home modifications are now capped at $15,000 for someone’s entire lifetime, with an additional $15,000 available for assistive technology like wheelchairs.
“Fifteen thousand gets you bugger all, basically,” said Absalom.
On top of the lifetime cap, under the old system, people could opt to save money from their home care package and then put the accrued funds towards a more expensive item such as a new shower, a stair lift, or ramps in and out of the house. The item still had to be approved by an occupational therapist as being necessary and falling within the guidelines of appropriate spending, but was a way for people to pay for expensive modifications – particularly as people over 65 are not eligible for NDIS.
Under the new scheme, only $1,000, or 10% of someone’s home care package budget, can be carried over each quarter – which leaves all new recipients of a home care package “at a real disadvantage”.
This is yet another area where Absalom and other advocates fear changes to the act will push people from being able to live at home independently into residential care, because of a lack of the support they would have had under the old system.
“The government’s made a lot of noise about wanting to keep people in their own homes … But without the possibility of being able to make those home mods, it gets very difficult,” he says.
“It’s nearly saying, that if you can’t afford to do them, you’ll have to go into residential care.”
