Hidden Costs of Being a Family Carer in Australia

Australia is in the middle of the most significant aged care reform in decades, and families are caught in the middle. The Aged Care Act 2024, which commenced on 1 November 2025, has introduced a rights-based framework that raises the bar for what older Australians can legally expect from providers.^[1] The Support at Home program has replaced the former Home Care Package system. The Single Assessment System has replaced the old ACAT process. And from 1 November 2025, Medicare bulk-billing incentives were extended to all Medicare-eligible patients, with a new voluntary Bulk Billing Practice Incentive Program rewarding practices that bulk bill every patient.^[2]

These are real improvements. But none of them change a quieter, older equation: when formal care falls short, families step in. And right now, formal care is falling short more often than the policy documents acknowledge.

A 2025 comprehensive analysis of Australia’s aged care system found that funding remains insufficient to meet escalating demand, that workforce shortages continue to hinder service quality, and that the capital needs of the sector over the next decade exceed AUD 55 billion.^[6] That gap does not disappear because the legislation changes. It gets filled, mostly by unpaid family carers.

The Invisible Workforce Holding Aged Care Together

Australia’s aged care system runs, in part, on invisible labour. Family carers, predominantly women, perform daily personal care, medication management, transport, emotional support and care coordination that would otherwise fall to paid workers who, in many instances, are simply not available.^[6]

The preference among older Australians for home-based care over residential facilities is well documented.^[6] This preference is not irrational. Concerns about safety and quality in residential facilities have been consistent and persistent, and the Royal Commission into Aged Care Quality and Safety made that reality impossible to ignore. The shift toward “ageing in place” is now embedded in both policy and consumer behaviour.

But here is the operational tension: policy has oriented itself toward home care expansion at precisely the moment when the home care workforce is stretched thin. Workforce shortages, difficulty adopting new technologies, and funding instability have created a system where the rhetoric of “ageing in place” collides daily with the reality of limited Support at Home budgets, long waiting periods, and patchy service coverage, particularly in regional and rural areas.^[6] The people who fill that gap are the family carers. And the cost is rarely counted.

What the Costs Actually Look Like

The hidden cost of family caring has several layers, and understanding each of them matters for carers trying to plan, for GPs trying to support patients, and for allied health professionals trying to understand what families are managing between appointments.

Lost Income and Career Interruption

Many carers reduce their working hours or leave paid employment entirely to manage care responsibilities. The compounding effect over years on superannuation, career progression and lifetime earnings is substantial and largely unrecognised in policy settings.

Out-of-Pocket Expenditure

Even within the Support at Home program, co-contributions apply to non-clinical services. Personal care currently attracts a contribution, though this is scheduled to change from 1 October 2026, when personal care is due to move into the fully funded clinical care category (families should confirm the current status of that change before treating it as settled). Transport, social support and other independence services also attract contributions, and these count toward a lifetime non-clinical contribution cap. For new entrants to the system, that cap is $135,318.69. For participants transitioning from the former Home Care Package system under no-worse-off arrangements, the cap is $84,571.66. These are not trivial figures for families managing a household budget alongside caring responsibilities.

There has been some cost-of-living relief on medicines, at least. From 1 January 2026, the general PBS co-payment dropped to $25 per script, down from $31.60, while the concessional co-payment remains frozen at $7.70.^[7] For families managing several regular medications for an older person, that adds up across a year.

Clinical Care Is Different

It is worth stating clearly for families who may not know this. Under Support at Home, clinical care carries zero participant co-contribution. Nursing, physiotherapy, occupational therapy, podiatry and speech pathology are classified as clinical care and are fully government funded, regardless of income or assets. Families who are currently paying out of pocket for allied health visits for a loved one on Support at Home should raise this directly with their provider or contact My Aged Care on 1800 200 422.

Physical and Mental Health Toll on Carers

Carer burnout is not a metaphor. It is a measurable health outcome. Carers who do not receive adequate respite or support face elevated rates of depression, anxiety and physical health deterioration. Yet access to GP and allied health support for the carer, as distinct from the person they care for, often falls through the cracks of a system focused entirely on the care recipient.

System Gaps That Make Caring Harder Than It Needs to Be

Several specific system features, or failures, consistently increase the burden on family carers right now.

The Single Assessment System Transition

The Single Assessment System, which replaced the old ACAT process in December 2024, is designed to streamline access to both home support and Support at Home. In practice, families accessing the system during the transition period have encountered inconsistencies in how assessments are conducted and how results translate into service budgets. The complexity of the transition is real, and families who feel their assessment does not reflect the care needs of their loved one have the right to request a review.

Telehealth With Conditions

Telehealth has been a genuine lifeline for many older Australians and their carers, particularly in rural areas. But from 1 November 2025, Medicare telehealth rebates require either an in-person GP visit within the previous 12 months or enrolment in MyMedicare.^[2] For frail older people who have difficulty attending a clinic, or for carers managing multiple appointments across multiple providers, this requirement adds a layer of complexity. It is important that GPs and care coordinators flag this requirement early so that telehealth access is not interrupted.

Rural Access Remains a Structural Problem

Workforce shortages in aged care nursing and support services remain unresolved,^[6] and even where GP access has improved through bulk-billing reforms, better GP access does not automatically translate into better day-to-day care for an older person living alone in a regional town with a family carer who lives two hours away. The gap between primary care availability and hands-on aged care support is one that families feel most acutely outside the major cities.

Medication Management

The expansion of 60-day prescriptions for stable chronic conditions, rolled out in stages between September 2023 and September 2024 and now covering around 300 PBS medicines, reduces the frequency of pharmacy visits for some patients.^[8] For carers managing complex medication regimes, this is a practical improvement. But it also means longer periods between review, and medication safety in the home requires active monitoring, which often falls to the carer.

Pain Management and the New Standards

Under the Strengthened Aged Care Quality Standards, which commenced 1 November 2025, providers are now legally required to have systematic processes to identify, assess, manage and review pain (Standard 5, Clinical Care).^[9] For family carers supporting someone who receives home-based aged care services, this is significant. If your loved one’s pain is not being systematically assessed, that is now a compliance issue, not just a quality gap. The Aged Care Quality and Safety Commission handles complaints and can order remedies.

What Carers Are Not Claiming and Why That Matters

One of the more persistent problems in the carer support landscape is under-claiming. Carer Gateway (1800 422 737) provides access to respite care, counselling, peer support and practical assistance for carers. Many family carers do not access these services either because they do not know they exist, because the referral pathway involves effort they do not have capacity for, or because the services in their area have waiting times that make them functionally unavailable.

The GP Chronic Condition Management Plan, or GPCCMP, replaced the former GP Management Plan and Team Care Arrangement on 1 July 2025. It provides referrals to up to five allied health sessions per year, with 18-month referral validity and a rebate of around $61.80. The referral is now a standard letter rather than a structured form. For carers who are also managing their own health conditions, ensuring they have an active GPCCMP with their own GP is an often-overlooked step. The person being cared for is not the only one who qualifies for allied health support under Medicare.

The Rights-Based Shift and What It Means for Families

The Aged Care Act 2024 embeds a principle that deserves wider attention: “dignity of risk.” Enshrined in the Act’s Statement of Rights, this principle formally recognises that older people can choose to live with some level of risk, including staying at home despite a falls history, rather than being placed in institutional care purely for safety reasons.^[10] For families, this is a double-edged development.

On one hand, it provides legal grounding for an older person’s preference to remain at home, even when the family is concerned. Providers can no longer simply override that preference on safety grounds without justification, and must instead support the person to understand and manage the risk.^[10] On the other hand, when an older person exercises their right to remain at home with a level of risk, the family carer is often the one managing that risk in practice, without additional support, training or remuneration.

The legislation has strengthened rights and accountability for providers.^[1] The funding gap identified in the 2025 comprehensive analysis has not been resolved.^[6] And peak industry bodies have warned that reforms to speed up access to new medicines for conditions such as dementia, cancer and cardiovascular disease still lacked a funded implementation plan as of the 2026–27 Federal Budget.^[4] The gap between what the law promises and what the system currently delivers is real, and family carers are living in that gap.

Practical Steps for Carers Right Now

If you are currently providing unpaid care for an older family member, here are the most actionable steps based on the current system:

• Contact My Aged Care on 1800 200 422 to check whether your family member’s current services and assessments reflect the new Support at Home framework and the Single Assessment System. If they were assessed under the old ACAT system some time ago, a reassessment may yield a more appropriate support level.
• Contact Carer Gateway on 1800 422 737 to find out what carer-specific services are available in your area, including respite care, counselling and peer support.
• Ask your GP or care coordinator whether all eligible clinical services (nursing, physiotherapy, occupational therapy, podiatry, speech pathology) are being claimed under the zero co-contribution clinical care provisions of Support at Home. Many families are still paying out of pocket for services that should be fully funded.
• If your family member receives care from a provider and pain management is inconsistent, raise it with the provider and, if unresolved, lodge a complaint with the Aged Care Quality and Safety Commission. Standard 5 of the Strengthened Aged Care Quality Standards now mandates systematic pain assessment and management.
• Ensure that telehealth arrangements for your family member include a recent in-person GP visit or MyMedicare enrolment, so that telehealth access under Medicare is not interrupted.
• Look after your own health too. If you are a carer managing your own chronic condition, ask your GP about a GPCCMP in your own name, and consider mobile allied health if attending a clinic is hard to fit around caring.

Frequently Asked Questions

What is the Carer Gateway and who can access it?

Carer Gateway is a federal government service providing practical support, respite and counselling specifically for unpaid carers. You can access it regardless of whether the person you care for is receiving formal aged care services. Call 1800 422 737 or search for services online.

Does Support at Home cover allied health visits at no cost?

Clinical care under Support at Home, including physiotherapy, occupational therapy, podiatry, nursing and speech pathology, carries zero participant co-contribution. It is fully government funded regardless of income or assets. Personal care services currently attract co-contributions, though this is scheduled to change from 1 October 2026. Confirm current arrangements with your provider or My Aged Care.

What is the lifetime non-clinical contribution cap?

The lifetime non-clinical contribution cap for new entrants to Support at Home is $135,318.69. For those transitioning from the former Home Care Package system under no-worse-off provisions, it is $84,571.66. Services including transport and independence support count toward this cap.

What changed about GP bulk billing from November 2025?

From 1 November 2025, bulk-billing incentives were extended to all Medicare-eligible patients, not just children and concession card holders. Practices that bulk bill every patient can access an additional 12.5 percent loading through the Bulk Billing Practice Incentive Program.^[2] This should improve GP access for older Australians, including those living at home with a carer.

Can my family member stay at home even if the family has safety concerns?

The Aged Care Act 2024 includes the “dignity of risk” principle, which legally recognises an older person’s right to make choices about their own life, including remaining at home with some level of risk.^[10] Providers cannot override this preference without strong justification. If you have safety concerns, the focus should be on putting adequate clinical and support services in place, rather than forcing a move to residential care.

What should I do if the care my family member receives is not meeting the new Standards?

From 1 November 2025, providers are legally required to meet the Strengthened Aged Care Quality Standards, including systematic pain assessment and management. If you believe standards are not being met, you can raise a complaint directly with the Aged Care Quality and Safety Commission, which has the power to order corrective action and refunds for overcharging.

References

1. Australian Government Department of Health, Disability and Ageing. About the New Rights-Based Aged Care Act 2024. Commenced 1 November 2025.
2. Australian Medical Association. Changes to Bulk Billing Incentives in General Practice (effective 1 November 2025). See also Department of Health telehealth eligibility from 1 November 2025.
3. Medicines Australia. Budget Ignores Life-Changing New and Future Medicines. 2026.
4. PMC / National Library of Medicine. Comprehensive Analysis of Australia’s Aged Care System to Inform Reform. 2025.
5. Australian Government. PBS Co-payment ($25 general co-payment from 1 January 2026; $7.70 concessional).
6. Australian Government Department of Health, Disability and Ageing. 60-Day Prescriptions (staged rollout September 2023 to September 2024; around 300 PBS medicines).
7. Aged Care Quality and Safety Commission. Safety of Clinical Care Services, Strengthened Quality Standard 5 (processes to identify and manage pain), effective 1 November 2025.
8. Foundas M et al. Dignity of Risk in Residential Aged Care: A Call to Reframe Understandings of Risk. Medical Journal of Australia, 2025 (dignity of risk under the Aged Care Act 2024 Statement of Rights).