ABSTRACT
Objectives
This paper reviews Australia’s aged care Home Care Package program to assess the ability of its replacement, the Support at Home program, to deliver on its stated principles of independence, autonomy, empowerment and freedom of choice for older people. The program is reviewed from the perspective of older people who wanted maximum independence and control over their support packages.
Methods
The findings from a qualitative study of the Home Care Package program in 2023–2024 involving 30 participants are used as a lens to review the Support at Home program. The two programs are sufficiently similar that findings based on the earlier program are relevant to the latter one. Semi-structured online interviews were conducted with older people who self-managed, their family representatives, support workers, service providers and aged care professionals. A combination of inductive and deductive analytical methods was used.
Results
Older people wanted programs that promoted their autonomy and allowed them to select support workers and negotiate services. However, structural barriers limited opportunities. Insufficient funding, workforce shortages and restrictive regulations were constraining factors. Restrictive regulations limited service providers from giving older people the agency they wanted over their lives.
Conclusions
The Support at Home program’s legislation and guidelines are constraining the independence, autonomy and empowerment of older people who want greater agency over their lives. Reforms are needed to address an absence of rights, funding shortfalls, workforce shortages, and policy and regulatory inflexibility. Although inadequate funding and workforce shortages are structural constraints difficult to overcome, a renewed focus on the rights of older people is feasible and necessary. A more flexible and client-focused approach will help the program give older people what they want.