Aged Care Reforms

From 1 November 2025, a once in a generation reform will transform the way aged care is delivered in Australia, putting older people at the very centre of care.

Whether you are a health professional, an older Australian, family member or carer or a neighbour, Healthy North Coast is committed to helping people get the most out of life through aged care. 

View information and resources to support Health Professionals

Information for residential aged care homes, residents, and families

Information for health professionals supporting older Australians.

From 1 November, 2025 the New Aged Care Act will transform aged care in Australia.

This page is designed for health professionals working with older Australians, including GPs, nurses, allied health practitioners, pharmacist and aged care professionals. You will find practical guidance and resources to help you support older patients to access the services they need.

Why is the Aged Care Act changing?

The new Aged Care Act responds to the Royal Commission’s call for stronger protections, higher standards and greater accountability across the aged care system. It introduces a people-first approach that puts older Australians, their rights, needs and dignity, at the centre of care.

Overview of changes:

  • Older people are recognised as rights holders, supported by a new statement of rights ensuring more choice, independence and control over their care,
  • Strengthened Quality Standards, including for clinical care.
  • Patients can have their My Health Record linked to their My Aged Care client record supporting co-ordinated care between the aged care and primary care teams.
  • New funding pathways, and subsidised aged care services available, all of which are more flexibly available to those eligible.

Government Subsidised Services available

Commonwealth Home Support (CHSP)

CHSP provides subsidised entry-level home support for older people who need domestic assistance, personal care and social support to keep living independently. Be mindful that not all services CHSP offer are available in all areas.

Check availability in your area.

Support at Home Program – On-going Pathway

Replacing the current Home Care Packages, the Support at Home On-going Pathway offers 8 levels of funding to support people as their needs change over time.

Services included in Support at Home are:

  • Clinical supports – such as nursing care, occupational therapy and physiotherapy.
  • Independence – such as help with showering, taking medications, transport or respite.
  • Everyday living – such as cleaning, gardening, shopping or meal preparation.

Support at Home – Short Term Pathway

Services included in the Support at Home Short Term Pathway include: 

  • Short-term Restorative Care – Offers 12 weeks of support for those requiring early intervention or post discharge support.
  • Assistive Tech & Home Modifications – Offers between $500 – $15k to help older people remain independent at home.
  • *NEW End of Life Pathway – A new pathway to help those  with a confirmed life expectancy of 3 months or less to access up to $25k to receive care and die at home. A GP or Nurse Practitioner referral is required. Learn more about the End-of-Life Pathway

View the full list of services.

Eligibility and referrals

Who is eligible to receive Aged Care Services?

  • People aged 65+ or
  • 50 + for Aboriginal or Torres Strait Islander peoples or
  • 50+ if homeless or at risk of homelessness

What should I look for?

If you notice a decline in your patient’s cognition, mobility or a change in their circumstances they may be eligible for services. Refer to the eligibility checker.

How can I make a referral for my patient?

There are a few ways to support your patient in being assessed or re-assessed for aged care services.

  • Self-Referral – A person, family member or carer can contact My Aged Care directly, by phone, online or in person at Services NSW centres. See how to apply – assessment for full details.
  • E-Referral – GPs can make an online referral through their patients’ online record if they are using HealthLink. Find out more about E-Referral.
  • My Aged Care referral page for Health Professionals. Here you can provide patients details and attach relevant documents to support your referral. View referral page.

My patient has no family support and faces barriers in navigating the process, who can help?

Carefinders is a free service supporting those who face barriers to accessing aged care and with no family to help. They meet patients face to face and are there every step of the way. Referrals can be made on their behalf, or they can refer themselves.

Find out more about Carefinders and who to contact in your region.

My patient already receives services, but needs more help?

Recommend the patient speaks to their provider for a re-assessment or follow the assessment process to refer for a re-assessment.

Role of a Health Professional in Support at Home

For older people considering access to government-funded aged care services

Suggest and/or support referrals to access an aged care assessment if an older person may require funded aged care services

For Support at Home participants

Respond to request from providers for case conferencing to develop or review a participant's care plan.

For participants accessing the Assistive Technology and Home Modifications scheme

Complete prescriptions for assistive technology or home modifications that align with a participants assessed needs.

For participants accessing the Restorative Care Pathway

Participate in the multidisciplinary team for the Restorative Care Pathway and contribute to goal planning.

For older people who may access the End-of-Life Pathway

Support referrals to the End-of-Lfe Pathway for those eligible for the pathway A score of 40 or less on the Australian-modified Karnofsky Performance Status (AKPS) score (mobility/frailty indicator).

Resources

Aged Care Reform Webinar

Explore the upcoming aged care reform agenda, including key changes commencing on 1 November. It is tailored for primary care organisations and providers, highlighting what they need to know when supporting older patients and participants through this transition.

Podcast: From Invisibility to Empowerment, Healthy Ageing with Jo Winwood

In this episode of Medicubes, hosts Riwka, Kim, and Chris are joined by Jo Winwood, Associate Director of Healthy Living and Ageing at Healthy North Coast. Discussing aged care in Australia, recent reforms driven by the Royal Commission, and the practical implications for general practice teams and their elderly patients. Listen now

Health Professionals

Resources for your patients

End of Life Pathway

I want to understand more about new End of Life Pathway, and how I can support a patient?

The new Aged Care Act supports older people who wish to spend their final months at home, with their loved ones through the End-of-Life pathway, offered under the Support at Home short-term services. For those diagnosed with three months or less to live, up to $25,000 toward in-home aged care services will be available, helping them remain at home if they choose.

Who is eligible?

The patient must be eligible for My Aged Care, although not necessarily registered, or already receiving services. A priority My Aged Care assessment will be conducted.

What is the role of the GP or Nurse Practitioner?

The End-of-Life Pathway form must be completed by a GP, non-GP specialist or nurse practitioner to receive a priority assessment and be considered eligible.

The GP/Nurse Practitioner or specialist must:

Referral checklist

Confirm Eligibility

  • Patient meets general entry criteria for accessing funded aged care services (aged 65 or over, or aged 50 or over for an Aboriginal or Torres Strait Islander person or a person who is homeless or at risk of homelessness).
  • Patient has a life expectancy of 3 months or less, confirmed by a GP, non-GP specialist, or nurse practitioner
  • Patient has an Australian-modified Karnofsky Performance Status (AKPS) score of 40 or less

Complete the End-of-Life Pathway Form

  • Fill out the End-of-Life Pathway form
  • Include the AKPS score and relevant clinical details
  • Sign the form

Submit the form based on whether the patient is currently receiving aged care services

  • As a minimum for all patients, provide the completed form to the patient or their carer/representative, AND/OR
  • Lodge the completed form through the GP e-referral for patients who are NOT currently receiving aged care services, OR
  • Encourage patients who ARE currently receiving aged care services to take the form to their provider


The GP or Nurse Practitioner will continue to play a role in case conferencing and supporting holistic delivery of care.
For further information and resources relating to the End-of-Life Pathway please refer to the helpful links below.