The system explained

The first time I called My Aged Care, I was on hold for forty-six minutes, then got cut off. The second time, I got through to a person who asked me to confirm Mum's Medicare number, which I didn't have on me, and I had to call back. The third time I got through, did the registration, scheduled the assessment, and the woman on the phone said something that helped: "Most people only ever do this once. The system is designed for repeat users, but you're not one. Don't beat yourself up that it's not obvious."

She was right. The Australian aged care system is not obvious. This module is the map.

The gateway: My Aged Care

Everything starts with My Aged Care. It is the federal entry point for all government-subsidised aged care in Australia. Home help. Home care packages. Residential care. Respite. The lot.

You cannot skip this step and go directly to a provider. You can pay for private services without it (a cleaner, a private nurse), but anything subsidised flows through here.

• Phone: 1800 200 422.
• Hours: Monday to Friday, 8am to 8pm. Saturday 10am to 2pm.
• Online: myagedcare.gov.au has a portal but the phone is faster for first contact.

What to have ready before you call:

• Your parent's full name, date of birth, address.
• Their Medicare number.
• Their My Aged Care registration number, if they have one (most don't yet, on first call).
• A short list of what you're worried about. Three lines. "Mum lives alone, she's had two falls in six months, she's not managing meals or cleaning, I'm her son and I'm calling on her behalf."

You can register on her behalf if she's given you verbal consent. The call taker will note it. If she's in the room, even better; they may want to speak to her briefly to confirm.

A practical note: have your parent in the same room or on speakerphone for the first call. The system needs her voice on record. Otherwise you'll be asked to call back.

The two assessments: RAS and ACAT

Once registered, the system funnels you into one of two assessment teams, depending on what level of help is needed:

• RAS — Regional Assessment Service. For entry-level support. Cleaning, gardening, transport, basic personal care. The assessor is usually a registered nurse or social worker. They visit the parent's home. The visit takes 60 to 90 minutes. Outcome: approval for the Commonwealth Home Support Programme (CHSP).
• ACAT — Aged Care Assessment Team. For more complex needs. Home Care Packages, residential aged care, transition care after hospital. The assessor is usually a clinician (geriatrician, nurse practitioner). The visit is similar in length but goes deeper. Outcome: approval for HCP levels 1-4, residential care, or both.

Most parents start with RAS, then escalate to ACAT when needs grow. Some go straight to ACAT if there's been a hospital admission or a clinical referral.

Two real things to know about the assessment:

1. Don't let your parent perform. This is the same problem as the GP visit. The assessor walks in, your parent sits up straight, makes them a cup of tea, says "I'm fine really," and walks out underassessed. Be there. Tell the assessor, in front of your parent, what you've been seeing. "Mum will tell you she's managing, but the kitchen tells a different story. Can I show you?" The assessor knows this is the dynamic. They'll thank you.
2. The assessment is for the highest level of need they might have. Not the floor. The ceiling. If there's any chance Mum needs Home Care Package level 3, get the ACAT to assess for level 3. Once approved at a level, you can use less. You can't use more.

Home Care Packages, levels 1 to 4

The middle tier of the system. Subsidised in-home support, paid as a budget the parent (or you, on her behalf) directs.

• Level 1. Basic care. Around $10,000 a year. A few hours of help a week.
• Level 2. Low-level care. Around $18,000 a year. Help most days.
• Level 3. Intermediate care. Around $40,000 a year. Daily personal care plus other supports.
• Level 4. High-level care. Around $60,000 a year. Multiple visits per day, complex care.

(Numbers approximate, indexed annually.)

The package pays for: personal care (showering, dressing), domestic help (cleaning, laundry), transport, meal prep or delivery, allied health (physio, podiatry, OT), some equipment, some home modifications. It does not pay for: rent, mortgage, utilities, food itself, holidays, or anything not care-related.

A package is administered by an approved provider. The provider takes a management fee (typically 10-30% of the package). This is the single biggest variable in how much actual care your parent gets. A provider with a 30% management fee on a Level 3 package is taking $12,000 a year off the top.

Push for a low-management-fee provider. Look at the My Aged Care provider directory. Ask the fee directly. Don't accept "around 20%, it depends" as an answer. Get the percentage in writing before signing.

The wait time for a package, after ACAT approval, is the part nobody warns you about: typically 3 to 12 months for level 2, longer for higher levels. This wait is shrinking as the system reforms (the Aged Care Taskforce 2024 reforms have the pipeline being cleared faster), but plan for it. While you wait, CHSP through RAS is the holding pattern.

Residential aged care

The other end of the spectrum. Full-time care in a facility.

Three financial gates to clear before placement:

1. ACAT approval for residential care. No approval, no admission to a subsidised place.

2. The means test. Centrelink (or DVA) assesses your parent's assets and income. The result is a daily means-tested care fee, capped annually and over a lifetime. This sits on top of the basic daily fee everyone pays.

3. The accommodation cost. This is the big one. Either paid as a Refundable Accommodation Deposit (RAD), a lump sum (typically $300,000 to $700,000, refundable when the parent leaves or dies), or as a Daily Accommodation Payment (DAP), an interest-style daily charge on the equivalent of the RAD, or a combination of both.

The RAD vs DAP decision is one of the most consequential financial calls in aged care. Get a Centrelink Financial Information Service (free) appointment and an aged care financial adviser before deciding. The wrong call costs $30,000-$50,000 over a typical 2-3 year stay.

Wait times for residential care vary wildly. A high-demand facility in a desirable suburb has 6-18 months waits. A facility you'd be happy with that's 30 minutes away has 0-3 months. Look earlier than you think. Tour at least three. The website doesn't tell you what the smell at 4pm tells you.

Respite care

The most underused part of the system. A residential facility takes your parent for a short stay (1-9 weeks) so the carer can rest, recover, travel, or just sleep through the night.

• ACAT approval covers respite as well as permanent care.
• The federal subsidy covers up to 63 days of respite per financial year.
• The daily fee is similar to permanent care basic daily fee, no RAD.
• It's also a low-pressure way to test whether residential care would suit, before committing.

If you are a primary carer for an ageing parent and you have not used respite, use it. The body of the carer breaks before the body of the cared-for. We come back to this in module 5.

What to push for, what to skip

Push for:

• ACAT, not just RAS, the moment needs feel like more than basic help.
• Assessment at the highest plausible level.
• A package provider with the lowest management fee you can find that delivers in your area.
• Respite, early.
• A Centrelink Financial Information Service appointment before any RAD decision.
• A home modifications grant, if mobility is becoming the issue (grab rails, ramps, shower seats).

Skip:

• Glossy private services that bypass My Aged Care entirely, unless your parent is fully self-funded and you've costed it out.
• Single-provider quotes. Always get at least three.
• The first residential facility you tour. Tour three.
• Any provider who won't put their fee structure in writing.

The one phone number that matters most

Save this in your phone now: 1800 200 422.

Save it under "Mum aged care" or "Dad aged care", not "My Aged Care", because at 8pm on a Tuesday when she's fallen for the third time, "Mum aged care" is the search term you'll think of.

The system isn't easy. It's navigable. Start now, not after the crisis.

Further watching

• Navigating the Aged Care System in Australia
• It's tough navigating aged care with parents, here's how some families did it | ABC NEWS