When My Aged Care Gets It Wrong: How to Fight Back for a Fair Assessment

Here, we share the essential guide for families and individuals who believe their Home Care Package funding level or Support at Home classification level does not reflect their true care needs.

The Problem: Under-Funded and Under-Supported

My Aged Care (MAC) assessments are the gateway to the former Home Care Package (HCP) funding, and the current Support at Home (SAH) funding, in Australia. But what happens when the funding allocated simply does not match the complexity of someone’s needs?

It happens more often than many people realise. A person living alone, managing multiple serious health conditions, can be assessed over the phone and allocated a fraction of the funding they genuinely need. The result? Families are left scrambling, vital services are at risk, and vulnerable individuals may face preventable hospital admissions or premature entry into residential aged care.

The good news: You have the right to challenge an assessment outcome – and there are effective ways to do it.

A Real-World Example: Meet Betty – When a Level 2 Simply Isn’t Enough

Consider this scenario, drawn from a real case encountered by one of our Care Advisors:

Betty’s Profile

• Living alone
• Early-stage dementia
• Bipolar disorder
• Essential tremor
• Bilateral knee replacements

Assessment outcome: Betty is allocated a “Transitioned Home Care Package (HCP) Level 2” under the new Support at Home program, which means Betty is allocated an annual funding amount of $19,319.45.

Assessment method: Phone-based only – no in-person assessment conducted.

With an annual budget of $19,319.45, Betty has $371.54 per week to support her care at home. This covers approximately 3.7 hours of services per week based on the Government’s National median price of $100 for personal care – learn more about indicative Support at Home prices here.

At this level of funding, Betty is at risk of losing the three weekly showers she currently receives – a service essential to her dignity and wellbeing.

The critical issue here: A phone-based assessment is simply insufficient to capture the full picture of someone living with cognitive decline, mobility limitations, and multiple co-occurring conditions. An in-person assessment is essential in cases like this.

Why MAC Assessments Can Fall Short

Aged Care Assessment Teams (ACAT) do important work, but there are circumstances where assessments may not capture the full complexity of a person’s needs.

These examples may include, but are not limited to:

• Phone assessments: Without seeing a person’s home environment, mobility challenges, or cognitive difficulties first-hand, assessors may underestimate the level of support required.
• Snapshot vs. reality: Assessments capture a single moment. Fluctuating conditions like dementia or bipolar disorder may not present at their most challenging on the day of assessment.
• Underreporting: Many older Australians downplay their difficulties, wanting to appear capable or avoid being a burden. This can lead to understated needs in the assessment.
• Complexity of co-occurring conditions: When multiple diagnoses interact, such as cognitive impairment alongside significant physical limitations, the compounding effect on daily functioning may not be fully appreciated.

Your Right to Challenge: Requesting a Reassessment

If you or a family member has received a Home Care Package level that does not seem appropriate for your needs, you have every right to request a reassessment. Here’s what to do:

Step 1: Contact My Aged Care Directly

Call My Aged Care on 1800 200 422 and request an urgent reassessment. Clearly state that you are not satisfied with the current assessment outcome and that you believe the level of support allocated does not reflect your care needs.

Step 2: Request an In-Person Assessment

Specifically request that the reassessment be conducted in person, in the home. This is particularly important for people with cognitive impairment, significant mobility limitations, or complex co-occurring conditions, where a phone-based assessment is unlikely to capture the true picture.

Step 3: Use the Right Language

When speaking with My Aged Care, using specific trigger phrases can help communicate the urgency and severity of your situation. These phrases signal to assessors that higher-level support is clinically and practically necessary:

Key phrases to use in your request for a reassessment:

• Without appropriate funding, [name] is at risk of hospital admission.”
• “We are concerned that without increased support, [name] may require early admission to residential aged care.”
• “The current funding level does not allow [name] to safely remain living at home.”
• “[Name]’s conditions have significantly deteriorated since the initial assessment.”

These phrases help assessors understand the real-world consequences of under-funding and may support a referral for urgent review.

Step 4: Gather Supporting Documentation

Strengthen your case by gathering letters or reports from treating health professionals – GPs, specialists, occupational therapists, and/or other allied health practitioners.

Ask them to specifically comment on:

• The impact of the person’s conditions on their ability to manage daily tasks independently
• Safety risks associated with insufficient care support
• Why a higher level of Home Care Package funding / Support at Home classification level is clinically appropriate

What Assessors Look for at Each Level

Understanding the criteria for each Home Care Package level / Support at Home classification level can help you articulate why a higher level is warranted. Please see our in-depth guide to Support at Home Classification Levels here, which includes an overview of transitioned package levels and their equivalents also.

Someone living alone with multiple serious conditions, including cognitive impairment for example, will typically have needs that far exceed what a Level 2 classification level can adequately fund.

If the Reassessment Doesn’t Go Your Way: Here Are Your Formal Review Options

If you have requested a reassessment and still believe the outcome is wrong, there are further avenues:

1. Make a formal complaint: Via My Aged Care, see the following section ‘I don’t agree with my assessment outcome‘ for where to request a review of the decision (free of charge) via a written letter to the Secretary of the Australian Government Department of Health, Disability and Ageing.
2. Contact the Aged Care Quality and Safety Commission: You can make a complaint to the Commission at agedcarequality.gov.au or by calling 1800 951 822.
3. Seek an advocate: The National Aged Care Advocacy Program (NACAP) provides free, independent advocacy. Call 1800 700 600 to connect with an advocate in your state.

Key Takeaways: Crucial to Know

• A MAC assessment outcome is not final – you have the right to challenge it.
• Phone-only assessments may be insufficient for people with complex or fluctuating conditions – always request an in-person assessment.
• Use clear, specific language about risks: Hospital admission, premature residential care entry, and inability to remain safely at home.
• Supporting documentation from GPs and specialists significantly strengthens a reassessment request.
• Free advocacy support is available if you need help navigating the process.

How We CareAbout You

You’re never alone in your aged care journey. We’re here to CareAbout you.

Navigating aged care can feel overwhelming, isolating, and stressful, but… it really doesn’t have to be. Whether you’re starting services for the first time or looking to switch from your current provider, CareAbout takes care of everything for you.

We’ve helped over 135,000+ Australian families find vetted, suitable, and trusted Support at Home providers – and our service is 100% free, 100% independent, and 100% personal.

How we help: We match you with providers based on your location, care needs, budget, and personal preferences. If you’ve been allocated funding, we’ll help you find the right provider well within your 56-day deadline. Already with a provider but ready for a change? We’ll make the transition seamless.

Ready to get started? Simply (free)call us today at 13 13 00 and significantly reduce the time, stress, and uncertainty of organising Support at Home.