As Australia prepares to roll out aged care reforms under the new Aged Care Act 2024 and Support at Home programme from 1 November 2025, key pressure points are coming into focus. Waiting lists for care, cost burdens for older people, regional equity of service, the pace of reform—each of these will test whether the reforms succeed or falter.
This article examines where waiting lists currently stand, how cost contributions will change, what equity concerns are emerging, what recent developments show, and what to watch to ensure reforms don’t leave vulnerable older people behind.
The Situation: Waiting Lists & Delays
- A Senate inquiry released in October 2025 has warned that over 200,000 older Australians are on waiting lists: for initial assessment, or for home care package allocation. The inquiry called the backlog “a calculated denial of services” with potentially fatal consequences. Many wait for essentials such as help bathing, feeding, medication or transport.
- The in-home care portion of the Support at Home rollout began with 20,000 packages in October 2025, but many in the sector say that this number is far short of what is needed to reduce the backlog or meet demand.
- Some reforms due to start on 1 July 2025 were delayed until November 2025 in response to warnings from providers about lack of readiness. The delay was intended to give more time for systems, providers and people to prepare.
Cost Changes: Who Pays More, Who Pays Less
- Under the new Support at Home program, fee and contribution arrangements are changing. From 1 November 2025, older people receiving in-home services will have co-contributions based on income and assets, not just pension status. Full or part pensioners and self-funded retirees will be assessed differently.
- A lifetime cap of $130,000 applies to co-contributions across Support at Home and residential aged care, so that older people do not continue to accumulate non-clinical contribution costs indefinitely. Once someone reaches that cap (or after four years in an aged care home in some cases), non-clinical contributions stop.
- Some service types (non-clinical care: assistance with mobility, lifestyle, cleaning etc.) will require co-payments for those who can afford them. Clinical care remains government-funded.
Equity and Regional Disparities
- Regional and remote areas often face shortages of providers, higher costs in delivering services, lower digital infrastructure, and fewer allied health professionals. These factors may mean older people in these areas receive fewer or lower quality services or face higher out-of-pocket costs.
- First Nations people have specific concerns. The aged care quality bulletins have introduced new resources for First Nations providers, and materials to help providers understand obligations, but some worry that underlying access, cultural safety, and recognition will lag unless specific attention is given.
- Older people with low digital literacy or without reliable internet may struggle with new digital tools or online portals required under expansion of digital systems.
Recent Developments & Warning Signs
- The sector welcome sentiment following the June 2025 announcement delaying some reforms until November to give providers more preparation time. Many providers had warned the July start date was “impossible” under existing readiness and systems.
- The Aged Care Quality and Safety Commission published its Bulletin #75 in March 2025, including guidance tools for providers, case studies, and tailored resources aimed at real-world practice under strengthened Quality Standards. This shows effort being made to prepare the sector in practice.
- Also in September 2025, publication of final exposure drafts for Financial and Prudential Standards under the legislation signals that governance, financial stability and provider sustainability are being addressed. Providers will face minimum liquidity standards and clearer definitions.
What to Watch: How To Tell If Cost and Equity Are Managed Well
- Whether waiting lists begin to decrease in the months following rollout; whether people waiting for services are receiving core supports (such as basic hygiene, medication) during the queue.
- Impact of contribution changes: are older people with modest means forced to choose between essential daily support and other spending?
- How many people reach or are close to the lifetime cap for non-clinical co-contributions; whether the cap is sufficient.
- Whether new separate pricing caps are enforced, such that providers cannot exceed what is allowable, especially in home-based services.
- Whether transparency around provider fees and what each component of cost covers increases (e.g. daily fees, hotel-like services, non-clinical care) so people can make informed decisions.
- Geographic variation: comparing metropolitan vs rural/remote areas in speed of access, types of providers, cost burdens.
- Monitoring of First Nations cultural safety and access—whether resources published actually reach local providers, whether service models are adapted, whether community voices are reflected in practice.
Recommendations to Address These Pressure Points
- Prioritise support for those in greatest need: older people who have minimal supports and are waiting longest should be first in line for packages or service upgrades.
- Consider partial subsidies or hardship relief for non-clinical contributions for low-wealth older people so cost changes don’t lead to service avoidance.
- Strengthen regional service delivery through incentives, mobile/distributed allied health services, telecare or hybrid models to ensure rural/remote areas are not left behind.
- Support providers early with funding, guidance, clear operational rules, so they can adapt in advance of changes.
- Ensure robust public communication about what costs will be, how contributions are calculated, rights under the new act. Older people and their families need clarity.
- Monitor outcomes transparently: publishing data on waiting times, cost burdens, regional variation, usage; seeking feedback from older people/families.
- Protect quality standards: even while cost and access are addressed, ensure care isn’t diluted—regular audits, compliance, accountability.
Aged care reforms in 2025 are ambitious: changing how care is funded, delivered, regulated, priced and accessed. The cost, waiting lists and equity dimensions are central to whether reform succeeds. For many older Australians, these changes will shape not just comfort, but dignity, safety and possibility of ageing in place.
What happens over the coming months—how quickly waiting lists fall, how fairly costs are shared, how consistently providers deliver—will show whether the reform meets its promise or if the gaps in the current system simply shift rather than close.
