Need care at home? We look at where to find it and what it costs

It’s most people’s preference to age gracefully in their own home and that’s certainly something to aim for.

If it’s just a few basic things you need help with, then family, friends and the local community can often be the first port of call. While getting assistance from your nearest and dearest is the cheapest option, it can’t always be relied on, especially over the long term.

So, what are the alternatives? It could be time to explore government-subsidised in-home care.

Home care packages – what are they?

A home care package is a coordinated package of services delivered using a budget allocated to an individual, which is tailored to meet a person’s more complex care needs.

Services may include help with personal care such as showering, support services for cleaning and even equipment where necessary, such as walkers for mobility.

Four package levels

The packages are offered at four different levels to help meet different levels of need, which are determined by the outcome of an aged care assessment (ACAT).

The packages are provided by a range of not-for-profit and commercial organisations using money allocated to an individual by the government.

The chosen provider hosts the package and for a fee (which comes out of the package) will manage it for you. The provider works with you to select the services and carers based on what you need to stay in your own home.

A monthly budget prepared by the provider allows you to see how much funding is available and where it’s being spent. This can help determine how to tailor the services to meet your own needs.

Package budgets

The annual budgets for packages are indexed. The current amounts (including the government subsidy and client contribution) are:

• Level 1 package, for basic needs: $14,760 per year
• Level 2: $23,031 per year
• Level 3: $45,062 per year
• Level 4: $66,094 per year

As well as paying for the selected services, the budget must cover the client contribution (where applicable) and administration and case management fees, which could be as high as 35%.

Depending on the case management and admin fees and the hourly rate charged by the provider, the number of hours generally works out at about:

• 2 hours per week for a level 1 package
• 3–6 hours per week for a level 2 package
• 7–10 hours per week for a level 3 package
• 10–14 hours per week for a level 4 package

Not surprisingly, the higher-level packages are the ones in highest demand and generally offer the best value for money. However, there are some other factors to consider when applying for a home care package.

Package delivery isn’t entirely free

The aged care system operates as a user pays system, where if you can afford to pay something towards your Home Care Package you will be asked to. The government will pay the rest.

An income assessment will determine your contribution beyond a basic daily fee.

There are three income-tested thresholds.

• A single full pensioner with assessable income below the income threshold of $33,027 (indexed) a year is not required to pay any income-tested fee.
• A single part pensioner with income above $33,027 a year and below $63,559 a year would be expected to pay $18.30 a day towards their care as an income-tested fee, capped at $6661 a year.
• Anyone with income above the $63,559 a year threshold would be expected to pay $36.60 a day as an income-tested fee, capped at $13,323 a year.

In addition to the income-tested fee there is a basic daily fee that everyone is expected to pay, which ranges from $11.43 a day for a Level 1 package to $12.75 a day for a Level 4 package.

The other cost of a Home Care Package comes from the provider who will charge an administration fee and a care management fee. Care and package management charges are capped at 20% and 15% of the package level respectively

Each Home Care Package service provider charges a different amount for their services and care management. How much they charge depends on the services you need, and the prices they have set.

For example, a self-funded retiree on a Level 2 package might be asked to pay $22,732 ($13,323 means-tested fee + $4,409 daily fees + $5,000 provider fee for administration and cash management) a year towards their budget of $23,031 a year. This means they are effectively receiving no financial benefit from the package.

Depending on the help you are getting it may be cheaper to pay privately. For example, if the only help you need is a weekly cleaner and the occasional gardener then the cost of paying privately may be more like $7,000 a year.

It’s a different story and much more cost effective if a self-funded retiree gets a Level 4 package with an annual budget of $66,096and is getting higher levels of help such as dressing and showering. They might pay fees of about $28,006 (including income tested fee, basic fee and provider fees) and receive about 15 hours of care a week.

Services range from cleaning to social support, transport, shopping, personal care, medication supervision and meal preparation. Packages can also be used to buy equipment such as walkers, wheelchairs, recliner chairs – anything that helps you remain living in your own home independently.

Funding can take time

High demand for a government-subsidised home care package means it’s now common for anyone with approval for one to wait 6–12 months before receiving any funding.

According to the latest Home Care Packages Report (March 2024) there are about 284,400 older Australians using home packages, with about 59,751people waiting for one at their approved level.

This raises the question of what to do about getting help in the interim. And even if you do get a package, what if it isn’t sufficient to deliver the level of care you need to remain at home?

Finding other help

You may be offered a package at a lower level than you are approved for, or support through another government-subsidised scheme, the Commonwealth Home Support Program (CHSP).

Here services are delivered at a highly subsidised rate on an ad-hoc basis by a range of providers. While it can be cheaper to use this option, it doesn’t always have the security of a home care package and generally covers basic services such as cleaning.

For many people, the year-long wait for a package or finding sufficient help means using their own income and assets to pay privately for the care they need, which can be very expensive. Estimates from one nursing agency show full-time care at home can cost about $250,000 a year, although the overall figure may vary depending on whether the care workers are enrolled nurses or care support and whether they’re required 24/7.

Private care rates vary

Rates for private care through a reputable provider vary from between $65 and $90 per hour, and more in the evenings and on weekends. Care that requires a registered nurse is more expensive. A growing alternative is to recruit carers directly, such as through online platforms like mable.com.au or careseekers.com.au. 

Those needing care can choose and self-schedule workers based on their needs and preferences, including the timing of home visits. You may also be able to negotiate the rate of pay, which generally starts well below those charged by an approved provider or agency.

While employing someone directly may work out cheaper than going to a provider, it can also be more work for the family. This is especially so where rosters or replacing a worker who calls in sick come into play.

If help is needed and you can afford it, then the surest way of remaining in your own home is to pay privately for the services you need until the package is allocated.

It will be a bit like a bonus when the package eventually does come through and you get more hours that you don’t have to pay for.

How do I arrange a Home Care Package?

If you decide that a Home Care Package is the way to go, then the eligibility to apply is: you must be over 65 years of age, still living in your own home and need some support to remain living independently.

You need to satisfy some eligibility criteria in terms of the support needed and, as funding is means-tested, you will need to do your sums to make sure the package you are offered is value for money.

Applying for a Home Care Package

A phone call to My Aged Care (1800 200 422) is the first step to checking your eligibility. They will ask a few questions about you, your health and your support.

If you are eligible for an aged care assessment team (ACAT) assessment, a health professional will arrange a time to come to your home. This generally takes about 90 minutes and covers questions about your lifestyle, any support you have or may need, health issues, your home, your family and your memory.

The assessor will develop a support plan to help you stay independent at home and recommend approval for a Home Care Package – choosing a level they think is appropriate.

Your name is then placed on a national waitlist, which is prioritised according to your care needs. The current wait is about 6–12 months for a Level 2 package and 12–18 months for a Level 4 package.

Commonwealth Home Support Program

If you only require some basic services to remain at home, or you are waiting for a Home Care Package to come through, you should be eligible for subsidised services through CHSP.

Currently an assessor from the Regional Assessment Service will visit you (or phone) to discuss your care needs.

They allocate referral codes specific to the services required which are then given to approved providers in your area who have capacity to deliver the services.

The most common uses of CHSP funding are for cleaners (the cost might be $10–15 an hour) or transport to and from appointments or social events ($15 round trip).

Receiving a Home Care Package

Getting a letter in the mail to say your Home Care Package has been assigned can be a bittersweet moment.

On the one hand it can feel a bit like a lotto win (not that I’ve ever won). On the other, it may not be quite what you expected.

It may have been 12–18 months since you got the letter saying you had been approved for a Home Care Package and three months since being told it is on its way.

The lucky recipients get the package level they were assessed for all those months ago. The not so lucky are offered a lower-level package than the one for which they were approved.

Taking up the package

Just because you are offered a package doesn’t mean you have to take it. It often comes down to the package level, what the income-tested fee might be, and what type of help you need now and in the future. You have 28 days to accept the package and find a provider (or ask for an extension).

Often it pays to look at the long term and take up a lower-level package if that’s what is on offer, use it as much as possible, then ask (through My Aged Care) to be reassessed for a higher package.

Then, if your care needs escalate, you are in the system, and all set up to accept more help quickly.

The ACAT assessor will generally want to see that you are accessing some help or using a lower-level package to get some services before they approve a higher level.

If you do turn down a package that has been allocated, you don’t lose the ability to ask for it later, but you will be placed back in the national queue where the allocation is based on time in the queue and care needs.

If you do decide to take up a Home Care Package, then it’s up to you to choose an accredited provider who will administer the package. The same provider may or may not deliver the services you need. Some providers just administer Home Care Packages and broker service providers while others do the lot.

Cost is one factor in choosing a provider, along with whether they can provide the services you need, when you need them and with carers or other staff that you like.

You can find a provider on the government’s My Aged Care website.