Home mods cap will force people to resi care

The proposed $15,000 lifetime cap on home modifications under the new Support at Home program will force older people into residential care prematurely, create financial stress and increase hospitalisations from preventable falls, says the home modifications peak.

Home Modifications Australia (MOD.A) – which is the national peak and industry body representing home modification providers for the aged and people with disabilities – is calling for a more flexible approach to funding under Support at Home.

The new in-home care program – due to kick off on 1 July 2025 – includes three funding tiers for the new home modifications scheme, the Support at Home program handbook shows.

This includes a 12-month funding cap of $500 in the lowest tier followed by $2,000 (medium) and $15,000 (high). “Access to high tier home modifications will be capped at $15,000 per lifetime (plus any additional supplements),” according to the handbook.

Support at Home is meant to support older people to live at home for longer but the proposed $15,000 lifetime cap would severely hinder that goal, said Steve Pretzel, director of MOD.A.

“It will impact older people by forcing them to leave their homes and move into residential care prematurely. It will result in them rejecting important recommendations in order to preserve the capped funding – just in case. And it will create financial stress for many,” Mr Pretzel told Australian Ageing Agenda.

“It will also increase the risk to carers if they are contending with a home that has not been properly adapted, will increase the amount of (and cost of) personal care a person will need if they are unable to carry out some of the activities of daily living independently, and it will increase the hospital load from preventable falls.”

After the handbook was published, MOD.A designed and commissioned an online survey to get an indicative sense of the price range of different types of more complex home modifications and perceptions of those involved in prescribing and delivering home modifications about the impacts such a cap might have on older people.

The survey received 60 responses, mostly from occupational therapists who prescribe home modifications for providers of home mods or Home Care Packages and found that 64 per cent of projects came in under $2,000. However over 10 per cent – 1,800 projects –exceeded $15,000.

Home modifications vary widely

The range of home modifications is as broad as the individuals who need them and the homes they live in, said Mr Pretzel.

“Some people only need minor supports such as something to hang onto while they shower or a threshold ramp to help them avoid tripping over a sliding door frame. Other people need more extensive modifications such as a ramp or extended steps so they can get into and out of their home or garden safely, a level access bathroom to reduce the risk of falling – the bathroom is statistically the most dangerous room in the house – or doors widened to accommodate a wheelchair or walker.

There are two common threads among home modification recipients, said Pretzel, which can be summarised as a strong desire to remain at home and be independent.

“Firstly, they all want to stay living in their own homes. Often they have been living in the one place for decades. It’s familiar, comfortable and filled with treasured memories. They often have friendships and supportive neighbours. It’s home,” he said.

“The second common thread is their desire for the dignity of independence. They would much rather have a bathroom modified so that they can safely shower themselves than have someone coming in to help them into and out of a bath or over a shower hob.”

3 key issues with cap, says MOD.A

The proposed $15,000 cap is problematic in several ways, Mr Pretzel told AAA.

“Firstly it will preclude some of the higher cost but most important modifications such as level access bathrooms and major ramps. 

“Secondly, by being a lifetime cap it is likely that older people will reject recommendations for immediate, even lower cost, modifications to preserve that funding in case they need it for something major later on. Sadly, a fall because they rejected the recommendation for even a simple grab rail could put them into residential care – or hospital – and result in them missing out on staying in their home,” he said.

“Thirdly, a fixed amount of home modifications fails to recognise that people’s needs change as they get older and that homes need to be adapted progressively to align with declining stability and physical acuity. 

“It seems ridiculous to force an older person into residential care earlier than necessary – at a cost to the taxpayer of approximately $88,000 per annum per person – when an additional, say, $30,000 in home modifications could see them living independently in their own home for several more years or more.”

8 recommendations to improve policy

Despite the current proposal, Mr Preztel said MOD.A was optimistic that between now and the introduction of Support at Home in July a more flexible approach to funding home modifications could be worked out. 

The peak has put forward eight specific recommendations:

1. Resolve the tension between capped and needs-based funding
2. Recognise the economic benefits of avoided health care and premature entry to residential care
3. Review the need for and quantum of any home modifications funding cap
4. Devise a more palatable Home Equity Access Scheme
5. Access to funding beyond the designated home modifications limit
6. Remove prescription, coordination and wrap-around services costs from the home modifications funding limit
7. Ensure independent assessors are appropriately skilled in identifying home modifications indicators
8. Ensure any funding limits are response to changing cost influences.

“The program handbook itself contains reference to the funding tiers being subject to finalisation and MOD.A is engaged in ongoing dialogue with the department,” Mr Pretzel told AAA.

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