Why retirees prefer private care over new aged care reforms

The federal government's new Support at Home reforms came into effect in November, aiming to simplify aged care and help older Australians remain at home longer. But early signs suggest the changes may be driving more families toward private care instead.

Ivan had always been fiercely independent, even as dementia made daily life harder. His daughter Belinda wanted support that kept him connected, safe and at home - not stuck on a waiting list.

So, the family chose a private provider, bypassing government-subsidised care entirely.

"This choice let them focus on what mattered most: nursing care at home and companionship," says Ruba Fattouh, director of Just Better Care Ryde Parramatta.

They're not alone. Despite the government launching its new Support at Home program in November, a reform designed to simplify the system, many families are paying out of pocket instead.

Just Better Care's Melbourne and Hobart offices say private clients have jumped 87% in the past year.

What older Australians value in aged care

Just Better Care's national survey asked Australians approaching retirement to rank what matters most to them, and the top answers explain why private providers are seeing increased demand.

Staying at home topped the list, with nearly three quarters of respondents ranking it as their number one priority.

Quality of care came second, while low cost and affordability ranked third - showing that for many families, independence and quality matter more than price.

Other factors rounding out the top ten included provider reputation, flexibility, choice and control.

Interestingly, one in four older Australians still view private care as "mainly for the wealthy."

Yet what the survey shows is that families are increasingly weighing cost against control and quality, especially as the new Support at Home system beds in.

What Support at Home actually changes

Support at Home replaces Home Care Packages and Short-Term Restorative Care, with the Commonwealth Home Support Program transitioning by 2027.

The changes came in with Parliamentary bi-partisan support following recommendations from the Royal Commission into Aged Care Quality and Safety in 2021.

Older Australians are assessed through My Aged Care and allocated to one of eight funding classifications, with three short-term pathways covering things like home modifications and end-of-life support.

On paper, it's meant to be simpler.

"They place a stronger emphasis on early intervention to help older people stay independent for longer, and they aim to make pricing more standardised and transparent," says Callum McMillan, general manager at Just Better Care Mornington Group and Hobart.

He says clearer service categories and new safety safeguards are designed to improve quality and make it easier to know what's included.

But in practice, families are finding the system harder to navigate, and sometimes more expensive.

Pay-per-shower? The new co-payment pain points

Under Support at Home, all non-clinical services attract co-contributions of up to 80% per hour unless someone receives a hardship exemption.

The percentage is based on the type of service received. Participants will make:

• no contribution for clinical support services (such as nursing and physiotherapy)
• moderate contributions for independence services (such as personal care and assistive technology)
• the highest contributions for everyday living services (such as domestic assistance and gardening).

Critics say the details are controversial.

"Some bean counter in Canberra decided showering is a non-clinical service," aged care advocate Sarah Russell wrote in Michael West Media. That means older people who need help showering must now contribute towards it.

"Pensioners, for example, will be required to contribute 5% the cost," Russell said. "If an older person cannot afford the co-payment for a shower, they may need to skip it. Had the bean counter considered that not showering could very quickly become a clinical issue?"

For families already juggling rising living costs, even small co-payments add up.

Friction in the Support at Home rollout

Support at Home is still in its early rollout phase, but providers and advocates say cracks are already showing.

On his Support at Home Substack, aged care analyst Jeremy Curtis warned that mid-sized providers "who thought they were ready... aren't," with transition issues hitting "operational reality" long before policy catches up.

"The next few weeks will set the tone for the next few years," Curtis wrote.

"Providers who act early - tightening scheduling, fixing claims leakage, aligning finance and workforce, and resetting consumer experience - will not just stabilise under Support at Home, they'll outperform."

For families, the transition has created uncertainty. McMillan says the push for standardisation, while well-intentioned, risks eroding flexibility.

The Just Better Care survey found 52.3% of women and nearly 40% of men rank flexible support that adapts to changing needs as a top priority.

McMillan says digital barriers are also proving a real hurdle. Some older Australians struggle with online portals, passwords or My Aged Care terminology.

"Terms such as 'Support at Home', 'Home Care Packages' and 'Commonwealth Home Support Programme' often blend together," McMillan says.

Then there's trust. Aged care advocate Jim Moraitis says confusion is breeding suspicion:

"Trust towards aged care is in the toilet. And honestly... can you blame people?
When clarity is missing and information is patchy, it's human nature to assume the worst," Moraitis says.

The problem is this: aged care in Australia has become faceless in the eyes of consumers. People don't see the real humans behind the service - just 'the provider.'"

The survey found having consistent carers that they can get to know was a top priority for 40% of older Australians.

"If the sector doesn't tackle this head-on, not as a marketing exercise but as a responsibility, we risk eroding trust even further."

How does private aged care compare?

McMillan says the biggest drawback of private care is cost.

"Without subsidies, the expense sits entirely with the individual or their family, making it a significant out-of-pocket commitment. It isn't affordable for everyone, and many older Australians rely on subsidised care because of cost constraints."

But he says the benefits, especially during a major system overhaul, are driving families toward private providers:

• Immediate access: "Families can start services straight away without waiting for government approvals."
• Tailored support: "Care plans can be customised to someone's preferences, schedule and changing needs."
•  Simpler process: "No income assessments, no government forms, no complex budget rules."
• No caps: "Unlike subsidised packages with fixed allocations, private care lets people access exactly what they need, when they need it."
•  Rapid adjustments: "If someone's needs change, private providers can scale support immediately, whereas subsidised programs require reassessments and wait times, potentially risking their current state worsening while they wait."

What this means for families

For families weighing their next steps, the decision between subsidised and private care comes down to two things: values and money.

For some, the choice isn't about dollars but preserving independence and quality of life, even if that means paying more.

For others, cost decides everything, leaving them to navigate the teething problems of a new system still finding its feet.

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