SaH manual updated, but more info to come

The Department of Health and Aged Care has released an updated version of the Support at Home manual this month.

The primary changes include new definitions and additional information but there have also been changes in the terminology used, such as supported decision making now being referred to as registered supporters and continuity of care now phrased “starting and ceasing services” – in Part B.

Part B also includes further explanation on program assurance, noting that the system governor may publish reports on program assurance activities inclusive of findings, conclusions or recommendations in relation to a registered provider.

Changes in chapter 5 include the removal of the directive to “comply with wellness and reablement reporting requirements” and the switching of “required” to “should” in reference to providers partnering with participants to help them achieve their goals.

This shift from directive language to more suggestive language reduces the assertiveness of the expectation placed on providers, said Lorraine Poulos, managing director of home care consultancy Lorraine Poulos & Associates.

“While the manual continues to embed wellness and reablement as core principles – encouraging providers to support participants’ independence and wellbeing through person-centred approaches – the softer language may lead to variability in how strongly providers prioritise these aspects,” she told Community Care Review.

“Without a clear mandate, some providers may interpret this as a recommendation rather than an obligation, potentially resulting in less consistent application of wellness and reablement strategies across the sector. It will be important for the department to monitor outcomes and reinforce expectations through other regulatory or quality mechanisms if needed.”

Section 5.4 on support for diverse needs has been re-written entirely and now includes a list of individuals who may be more likely to face culturally unsafe or inappropriate care.

Chapter 6 has had further explanation on registering a supporter – including an emphasis on ensuring the older person is still asked to make as many of their own decisions as possible whether they have a registered supporter or not.

Changes were also made to the funding amounts for ongoing and short-term classifications, and a definition for service delivery branch is included in chapter 7 as “the place of business of the registered provider through which funded aged care services are delivered to an individual.” The updated manual also confirmed that both full-hour and part-hour care management claims – in 15-minute increments – are supported.

Chapter 8 of the new manual goes into more depth regarding transitioned Home Care Packages program recipients and HCP unspent funds and has added a diagram to outline how unspent funds can be used for easier comprehension.

Information regarding family members delivering services has been added to chapter 9 and a new process map has been included in chapter 10 to outline engaging a third-party worker for self-management.

Chapter 11 contains added details on outgoing provider obligations – previously referred to as ceasing provider obligations.

Restorative care extended

Notably in Chapter 13, it states an episode of restorative care as providing up to 16 weeks of intensive allied health and/or nursing services aligned to a participant’s assessed needs. This a four-week extension on the duration for the Restorative Care Pathway seen in the first version of the manual.

This is a positive development, said Ms Poulos.

“This additional time allows for a more comprehensive and sustained period of intensive allied health and/or nursing support, which can be crucial for participants aiming to regain or maintain independence,” she told CCR.

“The longer duration aligns with best practice in restorative care, providing participants and providers with greater flexibility to achieve meaningful outcomes within the episode of care.”

Extra information on program linkages can also be found in Chapter 17.

Key details still pending

Overall, Ms Poulos called the updated manual a significant step forward in providing detailed operational guidance for providers transitioning to the new Support at Home framework, covering key areas such as care management, participant budgets, service lists, and provider obligations.

“However, it is important to note that some details are still pending and will be clarified once the aged care rules are finalised. The manual is clear in many respects but leaves certain operational and compliance questions open, which may cause some uncertainty for providers in the interim,” she added.

Areas that Ms Poulos said could benefit from further clarification include:

• service agreements
• program linkages
• financial reporting (monthly statements)
• clinical guidelines.

Ms Poulos pointed out that the manual acknowledges specific service agreement requirements will come from separate guidance, giving the example of how it directs providers to forthcoming department guidance on service agreements – due before 1 July, which she suggests shows some contractual details such as content and formats are not yet fully defined.

She also noted that Chapter 17 – relating to program linkages – contains placeholder text, with the sections on CHSP, transition care and residential care stating ‘more information will be available for 1 July 2025.’

“In other words, how Support at Home integrates with these parallel programs remains to be explained,” Ms Poulos said.

The monthly statement requirements are partly pending, with the manual stating that inclusions for the statement are ‘subject to consultation’ and rule finalisation – something Ms Poulos lists as providers needing clarification on exactly what line items to include once the rules are set.

Lastly, Ms Poulos highlighted the AT‑HM scheme guidelines and restorative care clinical guidelines, which are referenced but not yet published. The department’s website notes these will be available by 1 July 2025, meaning providers must essentially wait for these documents to get full clinical protocols and eligibility criteria.

Ms Poulos also referenced how some routine processes – such as eligibility assessments, asset-tested contributions, no-show policies, and tracking of carry-over funds – are either only briefly mentioned or omitted pending final Rules.

“While the manual provides a strong framework, areas such as exact statement formats, service agreement clauses, and the intersection with other programs still require supplementary guidance,” she told CCR.

“Implementation of Support at Home will be a major shift for providers,” Ms Poulos said. “The manual signals that all existing home care and STRC services transition into this single program, with new classification rules and budget mechanisms. For example, providers must now deduct 10 per cent of each participant’s quarterly budget for care management – pooled in a provider account. This funding model [requires] new accounting systems.

“Providers will need to adapt business practices to manage these pooled care‑management accounts and ensure compliance with the care planning process.”

Workforce implications ‘significant’

Ms Poulos also said the workforce implications as significant, with the manual introducing dedicated care partners for care management – suggesting a flexible staffing approach.

Care partners are described as trained aged care workers but there is no single mandated qualification, and providers may form team-based care management models. Meanwhile care partners are expected to be clinically qualified with university degrees –  for nursing, social work or allied health – to handle complex cases, she said.

“This means providers will need to ensure appropriate training and possibly new hires, for example, allied health or nursing staff, for reablement and complex care,” Ms Poulos added. “The restorative care pathway in particular places a spotlight on allied health interventions and multidisciplinary teams.”

Ms Poulos said providers will need to study the manual carefully and adjust care management and budgeting processes and bolster their workforce capabilities for wellness and reablement. She also encouraged providers to watch for the imminent rules and guidelines referenced in the manual in order to finalise key elements of the new system. 

“The updated manual represents a substantial improvement in guidance for providers, but the effectiveness of some changes – particularly those related to wellness and reablement – will depend on how expectations are reinforced in practice and through future regulatory detail,” Ms Poulos told CCR.

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