Chapter 9Concluding comments
9.1This inquiry has been vitally important in uncovering the true scale of delays faced by older Australians in receiving appropriate at home care services. These delays are not only significant in terms of their length, but the devastating, irreversible and sometimes fatal impact they have on the health and wellbeing of older Australians. Delays also have devastating, intergenerational consequences for family and friends undertaking caring responsibilities which are taxing both physically, mentally and financially.
9.2Older people have spent their lifetimes contributing to our communities, and they should be able to expect that, when they need care, they can get it at the time that they need it. It is unacceptable that people are dying while waiting for assistance. Older people and their families deserve better.
9.3This inquiry has also examined concerning evidence received in relation to the operation of the Aged Care Act 2024 (new Aged Care Act). It is clear that while the new Aged Care Act represents a once in a generation reform of the aged care system, there are areas which must be urgently reviewed and amended to ensure that it truly delivers person-centred, rights-based care.
Progress Report
9.4As noted in this report, the Inspector-General of Aged Care released the 2025 Progress Report into the Implementation of the Recommendations of the Royal Commission into Aged Care Quality and Safety on 4 September 2025 (Progress Report), during the course of this inquiry.
9.5This report should serve as a warning to the Australian Government that the new Aged Care Act may not only fail to implement the recommendations of the Royal Commission into Aged Care Quality and Safety (Aged Care Royal Commission) but may serve to entrench the failings of the previous systems.
9.6It is vital that the Australian Government consider the Inspector-General of Aged Care’s warning that ‘the required sector ‘transformation’ ha[s] not been achieved. Much of the reform agenda has been made up of disparate and sometimes disconnected changes that target specific issues rather than delivering systemic change.’
9.7Further:
The Act will incontrovertibly implement flagship changes. But when considered in light of the whole model of care envisaged by the Royal Commission, it appears a large number of the recommendations implemented by the Act are not necessarily the ones tantamount to really shifting the system. Many of the recommendations that would truly bring the objectives of the new Act to life remain outstanding. And the implementation of others appears to be more peripheral or completed in a rush. This has the potential to give rise to unintended consequences that threaten to undermine the Royal Commission’s broader intention to improve access to quality care and potentially push people who would prefer to age at home prematurely into residential aged care, against the government’s own stated ambition for people to age in place.
9.8The Progress Report also contains a range of concerns in relation to the co-payment model, and the level of support provided to older Australians with a disability which are explored below.
9.9The committee is of the view that the Australian Government must enact urgent changes to the new aged care system in order to implement the recommendations of the Aged Care Royal Commission.
Release of Home Care Packages
9.10The committee welcomes the Australian Government’s announcement on 3 September 2025 that 20,000 Home Care Packages (HCPs) would be immediately released. It was clear from evidence received in both written submissions and at the committee’s hearing on 29 August 2025 that these packages should not have been deferred from their originally planned release date of 1 July 2025.
9.11The committee accepts that the Australian Government and the aged care sector were not ready for the commencement of the new Aged Care Act on 1 July 2025 but the decision to both delay commencement, and the release of promised – and much needed – aged care packages has contributed to the suffering of older people in desperate need of appropriate at-home care services.
9.12Service providers made it clear that they have the capacity to service additional packages, and it is more than evident that the community requires additional packages. The only barrier that existed was the government’s refusal to release them.
9.13Without the important evidence received over the course of this inquiry, and the work of senators in examining the Aged Care and Other Legislation Amendment Bill 2025 and Aged Care (Accommodation Payment Security) Levy Amendment Bill 2025 (the Aged Care Bills), these packages would not have been released by the Australian Government.
9.14The committee is concerned that the Department of Health, Disability and Ageing (the department) gave evidence that ‘packages continued to be released’ between 1 July 2025 and 1 November 2025 when these are in fact, packages being reassigned as older Australians exit the home care program either through death or entering residential aged care. This disingenuous approach to addressing the crisis that is the current waiting list significantly reduces public trust in government.
9.15The committee also notes that while it welcomes the early release of these packages, the committee is also of the view that 20,000 new HCPs is inadequate in meaningfully reducing the vast waiting list of over 200,000 older Australians currently waiting for either an assessment of their needs, or an HCP. Even the full release of 83,000 promised packages is unlikely to be sufficient.
9.16The committee is concerned that without addressing the foundational issue of existing waiting lists, the new Aged Care Act is unlikely to deliver the promise of rights-based aged care.
9.17The committee recommends that the Australian Government release all 83,000 packages promised prior to the 2025 federal election, before 30 June 2026.
Recommendation 2
9.18The committee recommends that the Australian Government make provision for additional Support at Home packages as a matter of urgency, to meet the needs of the over 200,000 older Australians who are either waiting for a package or waiting for an assessment for a package as identified by the Department of Health, Disability and Ageing.
Rationing of care
9.19While the committee strongly supports the urgent release of additional packages, rationing care through packages is fundamentally at odds with a rights-based aged care system as recommended by the Royal Commission into Aged Care Quality and Safety (the Aged Care Royal Commission).
9.20The Aged Care Royal Commission stated that all older people in Australia should be entitled to funded care. It explicitly warned against ‘rationing’ care, where only a limited pool of government money is set aside for aged care and once spent, people either miss out or have to wait to get access to care.
9.21The Aged Care Royal Commission instead called for a demand-driven system underpinned by a universal entitlement to provide guaranteed access to aged care based on assessed need. This was echoed by witnesses during this inquiry, and the Inspector-General of Aged Care’s 2025 Progress Report - Implementation of the Recommendations of the Royal Commission into Aged Care Quality and Safety.
9.22The calculated denial of service through waiting lists, and the rationing of care through the periodic release of packages, leads to significant and life altering consequences for older Australians. These consequences can be fatal.
9.23The new Aged Care Act purports to be implementing once-in-a-generation reform but fails to meet the foundational recommendation of the Aged Care Royal Commission – universal entitlement to care.
9.24The committee recommends that the Australian Government work towards ending the rationing of care packages in a timeframe that is consistent with the sector’s capacity to deliver the additional packages.
Commonwealth Home Support Programme
9.25The Commonwealth Home Support Programme (CHSP) provides vital at home care and support for many thousands of older Australians who do not yet need a Home Care Package.
9.26Due to the extensive waiting times for HCPs and residential aged care places, the CHSP is unfortunately being utilised as a default level one care package. This is leading to adverse outcomes including for the care recipients, state and territory health care systems, and care providers.
9.27A little care is not a substitute for appropriate care. It is not enough that older people are receiving some care under the CHSP when they should be receiving what they require on an HCP or in a residential setting. Aged care workers delivering CHSP services should not be forced to deliver out-of-scope care. Service delivery providers should not be forced to close their books and decline new care recipients because their funding has been exhausted providing alternative care for older Australians who should be served by other funding arrangements.
9.28The committee is aware that the CHSP will transition to the SAH Program no earlier than 1 July 2027, and that between 2025 and 2027, it will continue to operate as a grant funded program. The committee is however concerned that little detail has been provided regarding this transition to the SAH.
9.29Noting the CHSPs vitally important work in helping older Australians live independently at home, the committee is of the view that certainty is required for all stakeholders.
9.30The committee recommends the Senate refer to the Community Affairs References Committee the following matter for inquiry and report by the first sitting week of August 2026:
the timeline for the transition of the Community Home Support Programme to the Support at Home Program after 1 July 2027; and
the expected impact of this transition including on waiting periods for assessment and receipt of care; the lifetime cap of $15,000 on home modifications; and the End-of-Life Pathway time limits.
Release of accurate information
9.31Of particular disappointment to the committee is the way in which the Australian Government would not provide the committee with more recent data regarding the National Priority System (NPS) waiting list. It is astonishing that despite repeated questioning the Australian Government refused to release this data until it was forced to do so.
9.32The committee is of the view that the Australian Government should have released such data, with appropriate caveats regarding the possible need for adjustment after analysis, in order to properly inform the inquiry, and debate on the Aged Care Bills.
9.33The Australian Government’s reluctance to acknowledge that the aged care waiting list emergency is more severe now than in March 2025 is disappointing.
9.34It is also clear to the committee that public trust is being eroded by a lack of available information and insufficient communication with older people regarding waiting lists, including the waiting list to receive an assessment. The committee was concerned to hear that older Australians are disengaging due to the belief that they will never receive the care they require, and that a lack of appropriate communication is leading to confusion and distress.
9.35The Australian Government must do more to provide accurate information about waiting times, and must improve communication with older people who are waiting for assessment and care.
9.36The committee recommends the Department of Health, Disability and Ageing publish real-time information on both the waiting period for assessment and receipt of a home care service package; and review communication strategies to ensure that older people remain engaged with seeking assistance.
Single Assessment System
9.37The committee welcomes the efficiency that a Single Assessment System (SAS) provides but is concerned that there are implementation issues undermining its objective.
9.38It is unacceptable that assessments are increasingly being conducted by telephone when it is clear that such assessments are distressing and confusing to vulnerable older Australians, and appear more likely to miss important clinical information which can only be obtained through an in-person assessment. Assessments should therefore be conducted in person by default and only by telephone by exception.
9.39Telephone assessments are also inappropriate for some members of culturally and linguistically diverse communities and some First Nations Elders and old people. The committee emphasises the need for culturally safe and appropriate care and service delivery throughout the process. Assessments should be delivered in a manner that encompasses considerations such as language barriers, the need for familial and community support, and access and familiarity with technology.
9.40It is also clear to the committee that there are deficits in the workforce capacity to adequately provide assessments in a timely manner. This is particularly the case in rural, regional and remote communities.
9.41The need for clinicians to conduct assessments is also evident, particularly in relation to clients with disabilities and/or complex and chronic conditions. It is not appropriate for assessors to be conducting assessments of such vulnerable older Australians without the appropriate level of expertise, as this is likely to result in people not receiving the care they require.
9.42The committee also notes the evidence received in relation to the impacts of care recipients requiring reassessment when their care needs change. The volume of reassessments generated through the natural progression of ageing is compounded by reassessments being required for care recipients who have suffered significant declines in health as a result of being forced to wait too long for care. It is clear that care recipients are likely to experience lengthy delays in seeking reassessment, and that alternative arrangements such as service providers making adjustments to care plans when required are likely to deliver more timely and appropriate changes.
9.43The committee is of the view that the Single Assessment System as it is currently operating is leading to failures in older Australians accessing appropriate and timely care at home.
9.44The committee urges the Inspector-General of Aged Care to consider conducting an urgent review into the operation of the Single Assessment System.
Co-payments
9.45Under the SAH Program, all care recipients who were approved for a package on or after 13 September 2024, including full pensioners, will contribute financially to the cost of their care.
9.46Pensioners, part-pensioners and self-funded retirees will pay between 5 and 50 per cent of the service provider's fee for ‘independence’ tasks, like personal care. It is important to emphasise that this category includes tasks such as showering and assistance with medication.
9.47The indicative price list for such services released by the department states that the national median price for ‘personal care’ which includes showering is likely to be $100 per hour. As such, some care recipients will be forced to pay $50 for a shower.
9.48For services described as ‘everyday living’, such as help with cleaning, cooking and laundry, recipients will pay between 17.5 and 80 per cent of the price charged by the provider. The price list indicates that the median prices for services such as meal preparation and domestic assistance are $97 and $95 respectively.
9.49The committee is gravely concerned that vulnerable older people will forgo necessary care because they cannot afford to make these co-payments or are uncertain about what the cost may be. Older people’s dignity, and health and safety are likely to be endangered as a result.
9.50A co-payment model based on the premise that the more assistance you require, the more you pay fails to recognise that many older people have no way to mitigate such increases in costs, except to decline necessary care. As submitters described it, the model creates a tax on frailty.
9.51There is an urgent need to amend the co-payment model that new entrants to the SAH Program will be subject to, before vulnerable older Australians suffer life changing negative consequences as a result.
9.52The committee also notes that the introduction of co-payments is inconsistent with the Aged Care Royal Commission’s vision of a rights-based, person-centred system which provides a universal entitlement to high-quality care. Similarly the Inspector-General of Aged Care’s 2025 Progress Report - Implementation of the Recommendations of the Royal Commission into Aged Care Quality and Safety noted, ‘the anticipated impacts of co-payments…are inconsistent with the Act’s Statement of Principles which codifies the Australian Government’s commitment to supporting people to stay at home if they choose.’
9.53The committee recommends the Senate refer, to the Community Affairs References Committee, for inquiry and report by 15 April 2026, the expected impact of the Support at Home Program model on:
older Australians’ dignity, health, safety and access to care; and
the residential aged care system, and hospitals.
No-worse-off principle
9.54As noted above, care recipients either already receiving an HCP, waiting in the National Priority System, or assessed as eligible for an HCP on or before 12 September 2024 will make the same financial contributions or lower, than they would under existing HCP arrangements. That is, they will not be subject to the same co-payment model as new entrants to the SAH Program because of the application of the no-worse-off principle.
9.55However the committee is concerned that a range of older Australians who met or will meet these criteria between 13 September 2024 and 31 October 2025 will not be, or are not, aware that they will be subject to the SAH Program co-payment model.
9.56The Australian Government’s lack of clarity in its communication regarding the rollout of the SAH Program, its subsequent deferral, and the cut-off dates for eligibility for the no-worse-off principle is creating confusion in the community.
9.57Those older Australians who assume they are subject to the no-worse-off principle widely touted by the Australian Government, and who may have made financial decision as a result, should not be punished for a lack of clarity in communication on the part of the Australian Government.
Ageing and additional care needs
9.58The committee is concerned insufficient provisions have been made for older Australians with a disability, or chronic or complex condition to receive appropriate at home care.
9.59The committee is of the view that the Australian Government cannot continue to ignore the recommendations of the Royal Commission, the National Disability Insurance Scheme (NDIS) Review, and the Inspector-General of Aged Care that additional provisions must be made for older Australians with a disability.
9.60It is unacceptable that older people with a disability will experience a disparity in services and support between the NDIS and the aged care system. Further progress should have been made to align the two and it is disappointing that the Australian Government has not taken the opportunity that the new Aged Care Act presents, to do so.
9.61The committee recommends that the Australian Government should consider the adequacy of daily living supports delivered through the at-home aged care system for older Australians living with a disability, in comparison with those delivered through the National Disability Insurance Scheme.
Assistive Technology and Home Modifications
9.62The committee is concerned that the Assistive Technology and Home Modifications (AT-HM) scheme is insufficient.
9.63It is clear to the committee that the $15,000 lifetime cap on home modifications will lead to older Australians, either living in dangerous or inappropriate housing due to being unable to afford required home modifications, or they will be forced into hospitals and residential aged care.
9.64The committee is also concerned about the evidence it received regarding the products and equipment that care recipients can access through the AT-HM scheme. It would appear to the committee that there is a need for an urgent review to ensure that this scheme appropriately provides funding for necessary assistive technology.
Recommendation 9
9.65The committee recommends that the Department of Health, Disability and Ageing, in consultation with allied health professionals, undertake an urgent review of the list of inclusions for the AT-HM scheme.
Palliative care
9.66The committee welcomes the introduction of the End-of-Life Pathway, a necessary and vitally important program to provide older Australians to stay at home until they die.
9.67The committee is however concerned that if older Australians outlive their 12-week prognosis (16 weeks if funding has not been exhausted), they will be forced to seek assessment for an appropriate home care package.
9.68Palliative care recipients and their families should not have to undertake such a stressful and arduous process while they are at their most vulnerable. In considering this matter, the committee is also acutely aware of the waiting times that currently exist in seeking assessments and receiving home care services.
Provider readiness and impacts of delays on staff
9.69The committee welcomes the clear evidence from aged care providers that they are willing and ready to provide home care services. However, the committee also notes that providers have been unable to provide this care to older people due to delayed release of new HCPs.
9.70The committee finds this misalignment deeply concerning. It reemphasises to the committee that the only barrier to the release of new HCPs was the government’s refusal to act, as providers have maintained their readiness to care for older Australians.
9.71The committee also understands that the inability to provide this necessary and lifesaving home care to older Australians has placed undue pressure and stress on aged care staff.
9.72The committee notes that this stress has been felt acutely by the CHSP workforce, which has stretched to address the increased demand for home care well beyond their scope, expertise and capacity. The committee is of the view that this risks both the safety of older Australians and of staff, which could have been avoided had the government released additional HCPs sooner.
Workforce disruptions
9.73The committee notes that the deferral of the SAH Program commencement negatively impacted providers who had invested in preparation efforts in anticipation of a 1 July 2025 commencement date, only to have to scale these efforts back.
9.74The committee also understands that aged care providers have faced workforce disruptions due to the management of HCPs – with either erratic allocation of packages or a lack of packages impacting matters such as recruitment, training, rostering and staff retention.
9.75It is clear to the committee that greater clarity is required from the government on the release of any new HCPs and the implementation of the SAH Program to ensure that going forward, providers are supported in their workforce planning so that they can deliver care confidently and efficiently to older Australians.
9.76The committee recommends that the Australian Government provides aged care service providers with a schedule for the release of places under the Home Care Packages Program and the Support at Home Program, which includes details on the volume of places, the timing of their release, and their geographical locations.
Broader workforce concerns
9.77The committee notes the broader calls for greater workforce investment and planning to ensure that the sector is prepared for the changes under the new Aged Care Act, as well as for the requirements of Australia’s ageing population in the years to come.
9.78The committee acknowledges that this is particularly pertinent for aged care providers that service regional, rural and remote communities. The committee understands that that workforce challenges in these areas are persistent and that building a sustainable workforce in thin markets is a complex problem.
9.79The committee also notes that these workforce challenges can impact the quality of culturally safe aged care for both First Nations and CALD communities. To ensure that culturally safe care is maintained for these cohorts, the committee encourages the government to continue address workforce scarcity and staff retention in these communities.
9.80The committee also understands that the allied health sector is experiencing difficulties in recruiting, training and retaining staff. The committee encourages the government to work with this sector to ensure that it is appropriately supported to care for older Australians.
Digital readiness
9.81The committee notes that government and provider readiness are interlinked. As such, the committee is alarmed by evidence from inquiry participants that government ICT and IT systems have not yet been finalised ahead of 1November 2025, despite the delay in the commencement of the new Aged Care Act.
9.82In particular, the committee notes that software details and versions are still being finalised, and that testing environments are not currently fit for purpose for providers. This hampers the ability of providers to ensure that their systems are ready and working by 1 November 2025.
9.83The lack of communication and transparency with providers is also of great concern to the committee. It is of the view that these matters must be finalised as soon as practical, so that providers have the certainty they need to make finalise their own ICT preparations.
9.84The committee recommends that the Australian Government finalise its Information and Communication Technology (ICT) systems as a matter of urgency to ensure that providers can be ready to meet the requirements of the Aged Care Act 2024 on 1 November 2025.
Senator Penny Allman-Payne
Chair