A free shower is the least older people can expect. But aged care funding misses one key point

This week, we learned older people in home-based aged care will no longer have to pay out-of-pocket for showering, dressing and continence care.

This backflip will provide relief for those currently receiving services under the Support at Home program and the 100,000 or so people on the waiting list for home care.

For people with continence issues, wounds and other issues that make showering essential, this is welcome news and something both advocates and consumers have been calling for.

This announcement comes as the government grapples with the cost of providing health care in various forms, prompting major changes to the National Disability Insurance Scheme, aged care and private health insurance.

In fact, the government plans to pay for increased funding for aged care, including the Support at Home program, by scrapping the additional private health insurance rebate for the over-65s.

One key issue now is how Australia subsidises this type of aged care without shifting excessive costs onto future generations.

Equitable but at what cost?

A key push of the Support at Home program, which started in November 2025, is that people who can afford it should fund more of their own care. The aim of this so-called “vertical equity” is to ensure the system is sustainable.

In theory, this protects funding for those who need it most. In practice, it has raised questions about whether it has undermined access to necessary care.

There’s a list with three types of services requiring the person receiving care to contribute at different levels:

• Clinical support services require no co-contribution, regardless of means. This includes services such as wound care or podiatry.

• Independence (including personal care) requires a contribution of 5–50% of the fee depending on income and assets. This currently includes services such as showering, social support and respite care.

• Everyday living requires the biggest contribution of 17.5–80%. This includes cleaning, home maintenance and gardening.

Let’s see what this means in dollar terms. Currently, if a shower costs about A$100 an hour (not unreasonable given this hourly rate has to include superannuation, travel, workers compensation, for instance), a person on a full aged pension would have to pay $5 per shower and a person at full rates would pay $50.

You can see how this adds up quickly with payments also required for other services, such as cleaning and gardening eating into a fixed age pension. Getting help to shower every day becomes impossible – particularly with higher rates paid at the weekend.

Some people may be able to get friends and neighbours to help with some tasks, such as mowing the lawn or putting out the bins. But showering is intensely personal. It isn’t something you want to have to ask of a friend.

However, the recent announcement means personal care – showering, dressing, continence care – moves from being classified as “independence” which attracted a co-payment to “clinical support”, which requires the participant to pay nothing out-of-pocket.

This ensures a different type of equity, known as “horizontal equity”. In other words, everyone with similar clinical needs can access the same support.

But there’s a flip side. This change means people who could afford to contribute to personal care will no longer need to do so. This increases the share of costs borne by taxpayers.

Why are there different subsidies?

When people start to have difficulty managing their daily activities, they often turn to requesting help doing the cleaning, cooking and gardening rather than working on improving or regaining their capacity to do those tasks.

The idea behind setting varied prices for the different types of services is to shift this pattern.

It’s to encourage people to get the clinical support they need and promote capacity building – via using services with no out-of-pocket costs – so people can continue to manage daily living at home. This may mean bringing in a physiotherapist to help someone move about, and maintain muscle mass and stability, making it easier for them to manage at home.

This logic makes sense early on, where people are capable of reversing or preventing frailty. We want to encourage people to stay active and well. But this isn’t always possible.

Requiring co-payments for support services – such as support to prepare meals or do the laundry under the everyday living category – when capacity can’t be regained can feel like a punitive measure. It’s this part of the funding equation that the latest announcement doesn’t touch on.

How about the future?

Currently, we don’t know if the Support at Home program is delivering its intended effect of increasing access to clinical and capacity building services while charging more for those who can afford it to pay for their care.

But we have a great opportunity to find out. We can compare the types of services people receive under the previous version of the home aged-care scheme before November 2025 (which some people are still on) with the current scheme.

As the Support at Home program matures, we also need to review the level and type of services that attract co-payments. We need to understand if people are forgoing some types of care due to the co-payments and whether other adjustments to the program are needed.

As people progress and need more care, we may need to consider whether co-payments for certain services are still a good idea, or are creating new inequities. As one example, cleaning may need to be provided without a co-payment for people with greater care needs and less ability to pay.

We also need to consider whether wealthier older people should pay more.

A delicate balance

This announcement addresses a clear and important equity concern by removing financial barriers to essential personal care. But it also highlights the delicate balance governments must strike in designing a sustainable aged-care system – one that protects access for those with the greatest needs, while fairly sharing costs across the community.

As Support at Home matures, equity will need to be monitored and government must be prepared to make changes where needed.

Getting that balance right will be crucial to ensuring older Australians can age with dignity, without causing intergenerational inequity by shifting excessive costs onto future generations.