Unfinished business: practical policies for better care at home

by Stephen Duckett, Hal Swerissen

12.12.2021 report

The vast majority of Australians want to be cared for at home in their old age, yet home care is hard to get, confusing, and can be expensive.

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The Federal Government has made significant and welcome commitments to address many of the shortcomings identified by the Royal Commission into Aged Care.

But despite committing more than $2.44 billion of additional funding each year to home care places, the Government’s response leaves unfinished business.

Firstly, the Government has not committed to keeping waiting times for home care to less than a month – and more home care places will be needed as the number of older Australians increases.

Secondly, the extra money the Government is providing will be spent in a poorly regulated and hard-to-navigate system where consumers get a poor deal.

And thirdly, the Government has no plan to boost the number, pay, and conditions of home care staff.

About 46 per cent more staff – or about 58,000 carers – will be needed just to meet the planned increase in home care places. To attract and retain home care workers, they should get better pay and conditions.

A better home care system would cost the taxpayer more. The costs of creating more places could be partly offset by reduced administrative costs and reduced demand for residential care. But the improved regulation and navigation support needed would cost at least $400 million a year more than the Government is promising to spend.

The Government has done a lot in response to the 2021 final report of the Royal Commission, but it needs to do a lot more.

It should take the system to the people, by establishing dozens of regional offices across Australia to develop local, personalised services for people who need aged care and want it delivered to their home.

More money and better design could give Australians more dignity and better care in their old age.


1. Improve stewardship of the home care market

  • The new Aged Care Act should introduce a new approach to regional stewardship to protect the rights of older people and make sure they get the home care services they need.
  • The Federal Government should establish 31 regional offices across Australia, co-located with Primary Health Networks, to act as stewards that plan and develop local aged care services and hold funds, pay providers, and administer service agreements on behalf of individual service users.
  • The Government should expand and strengthen the role of care finders, to act as agents for older people trying to navigate the system.

2. Clear the waiting list for home care

  • The Government should commit to ending waiting lists, and keep waiting times for care at home down to 30 days or fewer when the new home care model is introduced from mid-2023.

3. Expand and develop the home care workforce

  • The Government should explicitly state that it will fund – partially or fully – the flow-on implications of an independently-assessed fair wage for aged care workers.
  • The Government, in consultation with the Aged Care Workforce Industry Council, should develop and implement a workforce plan for aged care as part of the new Aged Care Act.
  • The Government should develop and strengthen leadership, coordination, and service delivery roles, such as ‘advanced personal care workers’ and ‘home care team leaders’, for home and community team-based care for older people with complex needs.
  • The Government should require personal care workers to be registered and to hold suitable minimum qualifications such as a Certificate III in individual support.