From October people will no longer have to pay to receive help with showering, dressing and support in managing continence, in changes to home care packages to be announced by Health Minister Mark Butler on Wednesday.

Under the aged care reform program brought in by the Albanese government, clinical care is free but showering and similar personal help fell into the category of services for which the person is charged a co-payment.

From the start, it was pointed out by stakeholders that showering is essential and should belong in the free category.

The government says in a statement, “The changes respond directly to feedback from older Australians, their families, advocates and providers, who have made it clear that these personal care services are essential for people’s independence and ability to stay at home”.

When he was asked on The Conversation podcast last year why showering wasn’t being entirely funded as a necessity, Aged Care Minister Sam Rae said: “We’ll be monitoring this very closely.

"We want to make sure that every single older person gets the care that they need and that they deserve. So there are very modest co-contributions associated with some services, such as showering, that we are asking people who have the means to contribute to, to do so.”

In the statement announcing the changes, Rae says:“Showering, dressing, continence care – these aren’t optional extras. They’re the basics of ageing with dignity, and no older Australian should miss out because of cost.

"Older Australians, their families and providers told us these services needed to be protected. We’ve listened, and we’re acting.

"As our population ages, we’ll keep doing the work to make sure the system is strong enough, and fair enough, to meet the moment.”

Butler will announce the cost of the aged care changes on Wednesday, when he appears at the National Press Club to outline the government’s overhaul of the National Disability Insurance Scheme.

The NDIS changes are to cut the scheme’s unsustainable growth in cost and number of entrants. Currently the cost is growing at 10% annually, even after earlier reforms to rein it in. The government wants to cut this to 5% annually.

On Tuesday Treasurer Jim Chalmers met his state counterparts in a virtual conference for preliminary talks about managing the scheme. The states need to take extra responsibilities for disability services as the Commonwealth pulls back, but they have proved difficult to persuade.

Queensland has not signed up to the “Thriving Kids” program that followed earlier reforms to shift some of the burden for disability services to the states.

The states said after Tuesday’s discussion that they had been given little detail of the coming round of changes.

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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.

Tracy Comans, Professor, School of Public Health, The University of Queensland; The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Every welfare program negotiates a fundamental tension: between fiscal responsibility and consistency on one hand, and care for real people with complex needs and situations on the other.

Over the past decade or so, one Australian program after another has tried to absolve itself of that tension by handing off part of its decision-making to a computer.

Robodebt automated welfare debt recovery, with devastating results.

The National Disability Insurance Scheme (NDIS) is moving towards computer-guided planning tools to generate budgets after participants’ support needs are assessed. Many worry this amounts to a form of “robo-planning”.

Since November, the new Support at Home program has used a rules-based algorithm called the Integrated Assessment Tool to decide how much home-care funding older Australians receive.

Each of these systems promises to replace fallible human judgement with something more consistent, efficient and fair.

Now, the Commonwealth Ombudsman is investigating complaints about the aged care assessment tool.

This is just the latest moment to ask: what do we lose when we automate decisions that really should be difficult and made case by case?

What’s the controversial aged care algorithm?

The Integrated Assessment Tool is a structured digital assessment used during a home interview with an older person seeking government-subsidised care. Assessors enter information about mobility, cognition, daily living and the person’s broader circumstances.

The tool converts these inputs into scores. It then applies rules to sort the person into one of eight funding classifications.

Assessors are barred from overriding the tool’s classification except in a small set of pre-defined circumstances.

Despite requests for the technical specifications, and for the identity of the team that designed the classification logic, details have not been released.

Is this really the new Robodebt?

Some commentators have drawn parallels between the Integrated Assessment Tool and Robodebt, but the comparison doesn’t quite work.

Robodebt was implemented at arm’s length from both welfare recipients and compliance officers. Debt notices were sent without human involvement in individual cases.

However, the Integrated Assessment Tool still involves an assessor sitting down to interview an older person in their home.

The closer parallel is with NDIS assessment reforms. These appear to be moving in the same direction with scoring tools that convert disability into numerical metrics, and opaque algorithms with weighting that has not been made public.

The health department insists the Integrated Assessment Tool for aged care is not artificial intelligence (AI). It says it is a rules-based classification algorithm, not a machine-learning model. But whether a system involves AI or not is beside the point.

Deeper issues sit underneath the technology.

There are deeper issues

The key ethical problems in algorithmic decision-making relate to opacity, discretion and accountability. In other words, problems relate to whether the people affected can see how the system works, whether the professionals using it can exercise judgement, and whether anyone can be held to answer for its decisions.

A standardised tool does deliver consistency: everyone is processed the same way. But consistency is not fairness, especially when the standard is hidden and applied to people whose needs do not fit standard categories.

US public policy researcher Michael Lipsky made the case in his classic 1980 study Street-Level Bureaucracy – discretion is a defining feature in frontline public service work.

Teachers, social workers, nurses and aged-care assessors exercise judgement precisely because rules are always incomplete, resources are constrained, and every client is unique. Strip discretion out of these encounters, and the assessment can no longer respond to what it finds, only to what the tool allows.

The appeal of the algorithm is partly a belief that machine thinking is less biased than human thinking. One review calls this the “perceived mechanistic objectivity” of computer-generated analytics. In other words, people defer to algorithmic outputs because they appear neutral, and may even override human judgement.

This is partly what aged-care assessors mean when they describe feeling “handcuffed” by the new system. The algorithm’s apparent objectivity makes their professional judgement look like bias, even when they know better how to respond to the person in front of them.

This appearance of objectivity also does political work some have called “agency laundering” – distancing oneself from morally consequential decisions by attributing them to an algorithm. Responsibility is diffused, and it becomes hard to say exactly who decided that a particular older person should receive less support this year than last.

None of this is abstract

By late March this year, some 800 people had formally requested reviews of their Support at Home assessments.

Media reports describe older people being reassessed under the new system at lower funding levels than they received previously, even where their needs had increased.

Minister for Aged Care Sam Rae has defended the reforms by pointing out that A$4 billion was incorrectly allocated under the previous system.

This may well be true. But fixing allocation errors is not the same as building a system that older Australians can understand, question and contest where necessary.

What happens next?

The Commonwealth Ombudsman has rightly said it cannot comment on the substance of its investigation while the investigation is underway.

So the government should pause using the classification algorithm until the investigation concludes.

Failing that, the minimum owed to older Australians and the public is transparency: publish the algorithm itself and its classification logic, reveal who designed it and how, and open all of it to scrutiny by sector experts, advocates and the people it affects.

Eligibility criteria and funding rules are public documents. A scoring system that determines whether someone can safely stay in their own home should be held to at least the same standard.

Laura Davy, Senior Lecturer, Crawford School of Public Policy, Australian National University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Politically, it’s a very bad time to be a baby boomer.

It is not just that intergenerational equity has become, rightly, a priority for Labor.

It’s also that this government, which always has an ear cocked to public opinion, is fully aware of the resentment towards boomers from many people aged 25–45 who see themselves paying for their elders while often unable to afford the housing that was more readily available to a “lucky” generation.

When on Wednesday Health Minister Mark Butler announced the government would scrap the top-up private health insurance subsidy for those over 65, brought in by John Howard, he cast the decision in generational equity terms.

The extra subsidy “means two households on the same income receive different levels of government support, based only on their age,” Butler said. “That’s not fair between generations.”

Removal of this (income-tested) benefit will save the government $3 billion over the forward estimates. With an ageing population putting an increasing burden on the budget, the government is repurposing this money into aged care, including paying the full cost of showering for those on home care packages. (So, the government might argue, there are swings and roundabouts for boomers.)

Treasurer Jim Chalmers will make intergenerational equity a major thread woven through his May 12 budget.

The politics says housing unaffordability remains red hot among voters. It is now accepted the capital gains discount will be hit; also, negative gearing is likely to be altered.

Other sweeteners in the tax or housing areas are possible – if they come they would have, at least in part, an intergenerational equity lens.

The government is under pressure not to splurge in the budget, not least because the Reserve Bank will be watching closely. But Butler’s announcement of a “reset” of the National Disability Insurance Scheme has given Chalmers some funds to play with.

The estimated savings from the NDIS overhaul are huge: $22 billion over a four-year budget period.

The government is absolutely right to tackle the NDIS’s multiple problems. Despite initial curbs in Labor’s first term, when Bill Shorten was its minister, the expenditure trajectory was still unsustainable.

But achieving the projected savings will be a herculean endeavour. The states will drag their feet and drive hard bargains. Much detail hasn’t been worked out, and discussions with stakeholders will be difficult. Stories of people thrown off the scheme by the cuts will abound. The program’s new rate of cost growth will be only 2% annually in the next four years – a big cut in real terms.

But much of the pain will be delayed until long after this budget. And getting the NDIS announcement out now means Chalmers’ budget night can concentrate on the good news.

Early signs are the opposition will back the thrust of the changes (while noting that when the Morrison government tried to make some reforms, they were demonised by the then Labor opposition).

As the government puts together its budget – with the prime minister saying “resilience” will be at its centre – the context is dominated by the Middle East conflict and the alarming prospects for fuel supplies if the situation is not resolved soon.

The government is now confronted with a campaign, that has considerable community support, for a new tax to be imposed on gas exports, as companies stand to benefit from the higher prices brought by the international crisis.

This week the battle over the tax was ventilated in often heated hearings at a Senate inquiry, chaired by the Greens, which will report before the budget.

One of those arguing for a new tax is Ken Henry, formerly head of treasury, who chaired the far-reaching tax inquiry commissioned by the Rudd government (which recommended a mining super profits tax).

In his submission to the Senate inquiry, Henry dwelt on generational equity. Canvassing how the proceeds of a gas tax could be used, he said, “Consideration might be given to three dimensions: public debt management, nature repair, and boosting productivity.

"All three dimensions are highly significant for the living standards of future generations and thus offer the opportunity to address sources of intergenerational inequity.

"Revenue raised from a windfall gains tax could be invested in a sovereign wealth fund for the benefit of future generations.”

While that thinking would fit naturally with the inclination of Chalmers, other considerations are pushing against the government going down this path.

These include warnings about the potential disincentive for investment coming from the companies, which have an advertising campaign running, and from countries that take our gas.

In his recent “fuel diplomacy” trips to Singapore, Brunei and Malaysia, Anthony Albanese’s mantra was that Australia is a dependable supplier of LNG.

His messaging has flagged that he is disinclined to the tax. In a podcast this week with The Daily Aus, Albanese rejected the suggestion the companies were paying little tax.

“Some of the facts haven’t been out there,” Albanese said. “The truth is that the gas taxes in the last financial year […] were around about $22 billion. So, I’ve seen there are reports suggesting that there’s more on beer tax than gas. It’s just not true.” Pressed for detail, he pointed out the Petroleum Resource Rent Tax was not the only relevant tax – the gas producers also paid company tax.

Albanese said he understood people would like to see more taxes paid. “In budgets, we look at the full suite of measures. What I am saying very clearly though is that we honour contracts and we honour those arrangements with countries.”

Resources Minister Madeleine King is cautious with her words but is obviously against a new tax.

Perhaps more important is what Western Australian Premier Roger Cook said this week, when he opposed a new gas tax. “I don’t think it’d be good for Western Australia and I’ve made those views clear to the prime minister,” he said. Cook’s views hold a lot of sway with Albanese.

Japanese Prime Minister Sanae Takaichi will visit Australia in early May, just before the budget. She is likely to get reassurance there will be no new gas tax.

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.