Support at Home promises a simpler, more flexible home care system. But Care Connect believes one of the biggest questions remains unanswered: how will providers deliver the level of clinical nursing currently available through the Commonwealth Home Support Programme?
The Commonwealth Home Support Programme (CHSP) is often described as the entry point to Australia’s aged care system. Care Connect Chief Executive Officer Lynda Chalmers
believes that description no longer reflects the reality providers see every day. Nearly nine months after the introduction of Support at Home, she argues the sector has focused heavily on packages, budgets and co-contributions – but not enough on how higher intensity clinical care will be delivered in people’s homes. “The level of funding will not fund the costs associated with clinical services under Support
at Home,” Lynda said.
“It will for your once-a-week or once-a-month clinical care, but not the level of clinical services that happen under CHSP.” More than an entry-level program CHSP is often characterised as a low-level program providing domestic assistance before people progress to more comprehensive home care. Lynda believes that overlooks how the program is already being used.
Care Connect supports clients receiving intensive nursing through CHSP, including medication management several times a day, catheter care, wound management and other
clinical services that allow people to remain safely at home. Nursing is used by fewer CHSP recipients than services such as domestic assistance, allied health and transport, yet accounts for the second-highest Government expenditure. See below
Top 5 home support services ranked by total expenditure, 2023-24. Credit: GEN Aged Care Data
For many clients, CHSP has become a highly flexible clinical program rather than simply an entry-level service. One example continues to surprise people. “A person on CHSP might only need to contribute around $40 a month to receive all of the nursing services they need,” Lynda said. “That could include someone who requires insulin administration three times a day.”
Under Support at Home, clinical services remain fully Government funded, but they must be delivered within a person’s quarterly budget. When budgets meet reality The challenge, Lynda said, is not the introduction of clinical funding but the way it is structured.
“If you’ve come out of hospital and you have higher clinical needs in that particular moment that might then dissipate as you improve, you can still only get the clinical support, along
with your other supports, within that quarterly budget,” Lynda said. Unlike the former Home Care Package program, where providers could accumulate unspent funds over time, Support at Home relies on quarterly budgets with limited rollover. Lynda believes that makes it harder to respond when a client’s clinical needs suddenly increase. “There’s not enough flexibility in that program for us to deliver in the way that we would want to be able to deliver for our clients,” she said. She believes even clients receiving the highest Support at Home classification could face challenges if they require intensive nursing over an extended period.
Home care becomes home health
The debate also highlights a wider shift taking place across the sector. Enkindle Consulting Founder Jennene Buckley said CHSP had evolved well beyond the ‘entry-level’ program often described by the Government.
Jennene Buckley
“There is nothing ‘basic’ about the CHSP program,” Jennene said. “It can and does care for people who are much more acute and high risk than Support at Home.” She said CHSP’s ability to accept people directly from hospital before a formal aged care assessment had given it a critical role across both the health and aged care systems. That flexibility allows providers to deliver intensive short-term nursing and personal care to people whose needs might otherwise go unmet. As home care becomes increasingly clinical, Jennene believes providers will need even stronger nursing capability. “The Government doesn’t understand the diversity and the complexity of CHSP,” she said. “It is the safety net of the aged care system.”
An unfinished reform
Neither Lynda nor Jennene questions the aim behind Support at Home. Their concern is whether the funding model has fully caught up with the increasingly clinical nature of home care.
“It’s really the operational side that hasn’t landed in all of those nuances in how we need to deliver that,” Lynda said. For providers, home care has already grown well beyond basic support services. The next challenge is ensuring the funding model grows at the same pace