Deciding when to move from home-based support into residential aged care can be one of the most significant steps older Australians and their families face. There is currently an emphasis on “ageing in place”, enabling people to remain at home for as long as possible with the right supports, but there are times when even the highest levels of in-home support can no longer meet someone’s needs safely or effectively.
With the upcoming Support at Home program replacing the Home Care Packages (HCP) system from 1 November 2025, families will see expanded in-home care levels (eight classifications instead of four). This provides greater flexibility and funding for those with high and complex needs, but it also raises questions: when is even the highest support at home not enough, and when is it time to move to residential care?
Home Care vs Residential Care
- Home Care: Services provided in a person’s own home, often including personal care, nursing, domestic support, and allied health services. The goal is to help individuals maintain independence while receiving assistance with daily tasks.
- Residential Care: Long-term care in a facility designed to provide 24/7 support. Residents receive personal care, nursing oversight, meals, activities, and social interaction, with staff trained to manage complex medical and behavioural needs.
The key difference is availability and intensity of support. Home care can be flexible, but may not offer continuous supervision, while residential care provides round-the-clock staffing and access to a range of clinical and personal care services.
Signs That Home Care May No Longer Be Enough
Even with extensive home support, there are indicators that residential care may be the safer, more appropriate option:
- Increasing Medical Complexity
When care needs involve multiple medications, wound management, oxygen therapy, or frequent monitoring, the limitations of periodic home visits become apparent. Continuous clinical support in a residential setting may be safer. - Mobility Challenges and Falls
Frequent falls or significant mobility decline, such as difficulty transferring from bed to chair or using the bathroom safely, indicate a higher risk environment at home. Residential facilities are equipped to prevent and respond to such incidents. - Cognitive Decline or Behavioural Issues
Moderate to severe memory impairment, dementia, or behavioral changes that lead to wandering, aggression, or confusion can be difficult to manage at home, especially without 24-hour supervision. - Incontinence and Nutrition Problems
Unmanaged incontinence, difficulty feeding oneself, or unintentional weight loss are practical issues that may be better managed in a facility designed for ongoing care. - Carer Burnout
Family or informal caregivers may become physically and emotionally exhausted, which can compromise the safety and wellbeing of both the caregiver and the care recipient. - Home Environment Safety Concerns
Homes not equipped with mobility aids, safety modifications, or accessible layouts can increase risk. Residential care provides a safe and adapted environment, reducing the risk of injury or neglect. - Declining Quality of Life
Social isolation, poor nutrition, or reduced participation in meaningful activities may indicate that home care alone is insufficient to maintain quality of life. Residential care can offer structured routines, social engagement, and therapeutic activities.
Even the highest levels of home support may not provide continuous 24/7 care, which is one of the primary benefits of residential care.
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Assessment and Eligibility
A formal assessment is often necessary to determine the appropriate level of care. Assessors typically evaluate:
- Mobility and ability to perform daily living activities
- Cognitive function and behavioural challenges
- Medical and nursing needs
- Home environment safety
- Caregiver capacity and support available
Based on these factors, the assessor can recommend whether increased home support is sufficient or whether residential care is more appropriate. Early assessment helps prevent rushed decisions, particularly after a medical crisis or hospital admission.
Financial and Legal Considerations
Transitioning to residential care involves financial and legal planning. Key points to consider:
1. Funding and Costs
Residential care may involve ongoing fees, which can include accommodation, care, and optional services. It’s important to understand the cost structure and funding options.
2. Support at Home Packages or Existing Supports
Unspent funds or entitlements from home care programs may need to be reconciled or redirected when moving to residential care.
3. Legal Arrangements
Ensure powers of attorney, guardianship, and medical directives are in place and up to date to facilitate smooth decision-making.
Emotional and Social Factors
While practical considerations often trigger the decision, emotional wellbeing is equally important:
- Preserving Autonomy: Involving the individual in the decision-making process helps maintain dignity and respect.
- Family Impact: Moving to residential care can relieve stress and allow family members to focus on relationships rather than constant caregiving.
- Community and Engagement: Residential settings provide structured activities, social opportunities, and peer interaction that may be limited in home care.
Planning transitions gradually, such as through short-term respite stays or visits, can help individuals adjust emotionally and socially.
Planning the Transition
A well-planned transition ensures continuity of care and minimises stress:
- Document Needs: Track daily care requirements, medical incidents, and behavioural changes to inform assessments.
- Seek Professional Guidance: Consult healthcare providers and care assessors to determine the safest care setting.
- Visit Facilities: Evaluate cleanliness, staff engagement, activities, and clinical support capabilities.
- Trial Respite Care: Short-term stays can help assess the fit and ease the transition.
- Coordinate Medical Information: Ensure care plans, medication charts, and relevant medical history are transferred to the new facility.
- Plan Financially and Legally: Clarify fees, funding options, and legal documents before the move.
Availability of Residential Care
While deciding when to move to residential aged care is an important step, availability of suitable placements can be a significant challenge. In recent years, the supply of residential aged care (RAC) places has tightened, and occupancy rates are at historically high levels. This means families may face delays or limited choice when searching for an appropriate facility that meets their loved one’s clinical, personal, and cultural needs.
Because of this, it can be helpful to start exploring residential care options early, even before a crisis occurs. While waiting for a placement, home care can continue to provide support, ensuring safety and stability as much as possible during the transition period.
Proactively contacting multiple providers, joining waitlists, and understanding funding arrangements in advance can ease pressure when the time to move comes. Early planning ensures families are not forced into rushed decisions with limited options.
With years of experience and deep industry knowledge backing us, we at Aged Care Decisions are poised to help you make a transition when you need it. If you are having trouble understanding whether a switch is the right next step for you or your family, simply let us know. We are here to offer you impartial advice, not only obligation-free, but also free of charge.
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