Support at Home: A New Standard for In-Home Aged Care

The Support at Home program isn’t just about structural changes—it’s about shifting the mindset of care delivery. It champions independence over dependency, prevention over reaction, and partnership over fragmentation. A clinical partner for Support at Home will help you with integrated, evidence-based solutions.

As we move toward 2025 and beyond, aged care providers, allied health professionals, and clients must work together to build a system that empowers older Australians to age with strength, dignity, and choice. With the right support, home is not just where the heart is—it’s where health and independence can thrive. Click here to read an overview of what’s changing with Support at Home  

Have you implemented Clinical Care and Risk Management (Outcome 5.5: Safety of Clinical care Services), yet?

Under the new system, providers carry increased responsibility for clinical oversight. This includes regular assessments to identify and respond to high-impact and high-prevalence clinical risks, ensuring safety, quality, and proactive intervention.

Following  Outcome 5.5: Safety of Clinical Care Services  providers must:

• Identify, monitor, and manage clinical risks.

• Implement systems that proactively address potential health issues before they escalate.

• Focus on prevention, not just response.

Wellness First means acting before incidents occur—especially falls and other common risk factors.

Are Wellness and Reablement at the Heart of Care? 

A central pillar of the Support at Home program is its Wellness and Reablement approach. Effective from 1 July 2025, all registered providers must adopt this model as part of service delivery. It represents a shift from a “doing for” to a “working with” philosophy—promoting autonomy, confidence, and capability.

Key Principles Include:

• Person-Centred Support: Services must reflect the strengths, preferences, and goals of the individual—respecting their autonomy and dignity.

• Maximising Independence: A focus on maintaining and improving physical, mental, and cognitive abilities, supporting individuals to carry out daily activities on their own.

• Short-Term, Goal-Oriented Interventions: Time-limited, targeted services that help individuals regain confidence and reduce reliance on ongoing care.

• Integration in All Aspects of Care: Wellness and reablement must inform assessment, planning, and review processes to ensure a consistent, empowering care experience.

“Everything I do for you, I take from you.”
– A powerful reminder that supporting independence is about enabling, not replacing.

As your clinical Support at Home partner, we will help you embed Wellness and Reablement with easily integrated evidence-based solutions

With the introduction of price caps and stricter quality requirements, partnership models are becoming essential. Providers must ensure consistent, high-quality care that aligns with the Support at Home framework—while managing costs and complexity.

At Plena Healthcare, we offer a unique solution through our Integrated Care Pathway – A seamless extension of your existing team, this model offers:

• Proactive Health and Wellness Plans (through Occupational Therapy and Physiotherapy Wellness packages)

• Clinical Budget Utilisation

• Standard 5 Compliance

• Improved Care Management Efficiency

We work with providers and participants every step of the way, ensuring care is proactive, personalised, and impactful.

We are confident in our ability to guide clients through these changes and help them experience the full benefits of a Wellness and Reablement approach. And we’re here to support you as you prepare for this transition, too. Let’s get ready for Support at Home
and work together to embed Wellness and Reablement into everything we do.

Find out more about our Community Care Services or get in touch via community@plenahealhcare.com.au or call 136 033

Empowering Older Australians to Live Well and Independently

From 1 July 2025, the landscape of aged care in Australia is set to undergo a significant transformation with the launch of the Support at Home program. Designed to enhance in-home aged care services, this new program aims to provide older Australians with greater independence and more tailored care—allowing them to live safely and confidently in their own homes.

What’s Changing? A Major System Overhaul

The Support at Home program will replace the existing Home Care Packages (HCP) and Short-Term Restorative Care (STRC) programs. Then, from 1 July 2027, it is planned to also integrate the Commonwealth Home Support Programme (CHSP), which will continue to operate independently in the meantime for those with low-level care needs.

Here are some of the major reforms coming into effect:

• Integration of Programs: A single, unified system combining HCP and STRC from 2025, and CHSP from 2027.

• New Aged Care Act: A legislative foundation that prioritises person-centred care, safety, and accountability.

• Price Caps (from 2026): Standardised costs to ensure fairness and transparency across the sector.

• Personalised Support Plans: Care that’s tailored to individual needs and goals.

• Enhanced Support for Complex Needs: Targeted services for those requiring more intensive clinical care.

• Quarterly Budgets: Clearer budget management for consumers and providers.

• Defined Service Lists: Structured categories of available services to streamline care planning.

• Client Co-Contribution Framework: An equitable model to share the cost of care based on capacity to pay.

• Capped Care Management Fees: Transparent and fair administrative charges.

• Expanded Funding Classifications: 11 funding bands (8 base + 3 complex needs) to better match support levels.

Wellness and Reablement: At the Heart of Care

A central pillar of the Support at Home program is its Wellness and Reablement approach. Effective from 1 July 2025, all registered providers must adopt this model as part of service delivery. It represents a shift from a “doing for” to a “working with” philosophy—promoting autonomy, confidence, and capability.

Key Principles Include:

• Person-Centred Support: Services must reflect the strengths, preferences, and goals of the individual—respecting their autonomy and dignity.

• Maximising Independence: A focus on maintaining and improving physical, mental, and cognitive abilities, supporting individuals to carry out daily activities on their own.

• Short-Term, Goal-Oriented Interventions: Time-limited, targeted services that help individuals regain confidence and reduce reliance on ongoing care.

• Integration in All Aspects of Care: Wellness and reablement must inform assessment, planning, and review processes to ensure a consistent, empowering care experience.

“Everything I do for you, I take from you.”
– A powerful reminder that supporting independence is about enabling, not replacing.

Clinical Care and Risk Management: A Proactive Approach

Under the new system, providers carry increased responsibility for clinical oversight. This includes regular assessments to identify and respond to high-impact and high-prevalence clinical risks, ensuring safety, quality, and proactive intervention.

Following  Outcome 5.5: Safety of Clinical Care Services  providers must:

• Identify, monitor, and manage clinical risks.

• Implement systems that proactively address potential health issues before they escalate.

• Focus on prevention, not just response.

Wellness First means acting before incidents occur—especially falls and other common risk factors.

The Power of Partnership: Integrated, Evidence-Based Solutions

With the introduction of price caps and stricter quality requirements, partnership models are becoming essential. Providers must ensure consistent, high-quality care that aligns with the Support at Home framework—while managing costs and complexity.

At Plena Healthcare, we offer a unique solution through tailored Physiotherapy and Occupational Therapy Wellness Packages, that focused on:

• Symptom relief

• Functional restoration

• Regaining independence

• Ongoing implementation support—not just advice

Plena Integrated Care Pathway

A seamless extension of your existing team, this model offers:

• Multidisciplinary care

• Strong risk management

• Integrated wellness and reablement principles

We work with providers and participants every step of the way, ensuring care is proactive, personalised, and impactful.

A New Standard for In-Home Aged Care

The Support at Home program isn’t just about structural changes—it’s about shifting the mindset of care delivery. It champions independence over dependency, prevention over reaction, and partnership over fragmentation.

As we move toward 2025 and beyond, aged care providers, allied health professionals, and clients must work together to build a system that empowers older Australians to age with strength, dignity, and choice. With the right support, home is not just where the heart is—it’s where health and independence can thrive.

As we age, staying hydrated and well-nourished becomes essential for maintaining energy levels, preventing dehydration, and supporting overall health. Here are five hydrating and energy-dense foods that are perfect for seniors in aged care or living at home!

1. Nourishing Soups (Hydration + Nutrition Boost)

Water content: ~85-95%
Energy boost: Add protein-rich ingredients like chicken or lentils, plus energy-dense toppings like cheese or cream for extra calories.
Example: Try a creamy pumpkin soup or a hearty minestrone with added olive oil and soft beans for energy and hydration.

2. Smoothies (Hydrating & High-Calorie)

Water content: ~80-90%
Energy boost: Blend milk, yogurt, nut butters, and fruits like bananas or avocados for a high-energy drink.
Example: A banana & peanut butter smoothie with full-cream milk provides hydration, protein, and healthy fats to keep energy levels stable.

3. Greek Yogurt with Fruit (Soft & Hydrating)

Water content: ~75-85%
Energy boost: Full-fat Greek yogurt provides protein and healthy fats, while fruits like berries or mangoes offer natural sugars and extra hydration.
Example: A berry parfait with honey & nut butter is a delicious and nutrient-packed snack.

4. Mashed Potatoes with Gravy (Comforting & Moisture-Rich)

Water content: ~75%
Energy boost: Butter, cheese, or cream increase calorie density, while adding broth or gravy keeps the dish easy to eat and hydrating.
Example: Serve buttery mashed potatoes with a savory chicken gravy for a soft, high-energy meal.

5. Stewed Fruits with Custard (Hydrating & Easy to Chew)

Water content: ~80%
Energy boost: Slow-cooked apples, pears, or prunes with honey or custard provide natural sweetness, hydration, and essential calories.
Example: Stewed apple & pear with vanilla custard is a perfect hydrating, high-energy dessert that’s easy to eat.

 Caregiver Tips:

• Encourage small, frequent meals to help seniors meet their hydration and energy needs.

• Offer drinks with meals (soups, smoothies) instead of just plain water to maximize hydration.

• Use full-fat dairy and healthy oils (olive oil, nut butters) to increase energy intake without increasing portion sizes.

By incorporating these nutrient-dense, hydrating foods into a senior’s diet, caregivers and family members can help support their loved ones’ overall health, energy levels, and hydration needs effectively.

Need more advice? We’re here to help – https://www.plenahealthcare.com.au/dietetics/

Our new approach focusses on Clinical Wellness – Occupational Therapy and Physiotherapy

At Plena Healthcare, we understand that the right support is crucial to achieving optimal health outcomes. That’s why we have co-designed our new Physiotherapy and Occupational Therapy Wellness Packages—  Each wellness package has been carefully tailored to provide a combination of services that best suit individual needs.

Whether it’s Occupational Therapy support for functional independence or Physiotherapy wellness programs to improve mobility and strength, our expert clinicians ensure everyone receives the care they need. Learn more about our new tailored packages via links below:

Occupational Therapy Wellness Packages

8 packages with tailored support ranging from Home Safety checks and basic equipment/Modification packages to complex equipment or Modification packages.

Physiotherapy wellness packages

• Balance and Falls Prevention Wellness Program

• Cardiac and Respiratory Wellness Program

• Musculoskeletal and Neurological Wellness Program
• Community Access and Pre/Post Op Care

Why we transformed our service delivery to Physiotherapy and Occupational Therapy Packages

Our Clinical Wellness Packages focus on client-driven goals: staying at home, reducing hospitalisations, and improving health outcomes in line with Support at Home reforms. We shift the focus from reacting to incidents to reablement – conducting early risk assessments, identifying potential health issues, and implementing proactive wellness strategies. This holistic service extension also enhances access to care and empowers clients while supporting their independence.

Optimising client and therapist support

Through improved referral processes to Plena Healthcare, and new and improved packages options we aim to:

• Enhance the experience for both client and providers through education and ease of processes.

• Service offering awareness – We want to increase awareness and understanding of our service offerings.

• Minimise delays and streamline the approval process.

• Optimise Unspent Funds – We want to utilise clients’ unspent funds towards restorative care, fostering independence and confidence in preparation for upcoming reforms.

• Enhance outcomes – We provide services that align improve outcomes of clients through clinical evidence-based practice.

Unlocking a new era of health and well-being with Plena Healthcare Wellness Packages

Whether targeted interventions are required, preventative care, restorative treatment, or support for wellness and active ageing, our comprehensive packages provide holistic, client-centered care designed to enhance overall well-being.

The aim is to provide tailored support to keep our elderly population in the comfort of their homes.

Let’s work together to improve client outcomes with Plena Clinical Wellness.

Find our more on our wellness pages

• Physiotherapy Wellness Packages
• Occupational Therapy Wellness packages

or get in contact community@plenahealthcare.com.au

A Functional Capacity Assessment (FCA) in the National Disability Insurance Scheme (NDIS) is an evaluation that assesses an individual’s ability to carry out everyday activities across various domains of life, considering their primary disability. This assessment is crucial in helping the NDIS determine the participant’s support needs, goals, and the types of funding that may be appropriate to enable a more independent and fulfilling life.

Key Areas Covered in an Functional Capacity Assessment:

The Occupational Therapist (OT) will review the below domains using subjective and objective testing and questioning;

1. Physical Abilities
   Examines the participant’s mobility, strength, endurance, and coordination, identifying areas where they may require support or adaptive aids.
2. Communication
   Evaluates both expressive and receptive language skills, considering any support needed for clear and effective communication.
3. Social and Community Engagement
   Assesses the participant’s ability to interact in social settings, develop relationships, and engage in community activities.
4. Cognitive Skills
   Reviews memory, problem-solving, and decision-making abilities, focusing on how these affect daily tasks and overall independence.
5. Self-Care and Personal Tasks
   Looks at personal care tasks (e.g., dressing, bathing, and eating) to determine the level of assistance required for the participant to maintain personal hygiene and health.
6. Domestic Skills and Living Arrangements
   Examines skills related to cooking, cleaning, shopping, and home management, as well as suitability of current living arrangements.
7. Work and Education Abilities
   Assesses capacity for employment or learning, including any support needs in job skills, task management, and workplace or educational accommodations.

The findings and then compiled into a comprehensive report and submitted to inform the participant’s NDIS plan, ensuring that the supports and services provided align with their unique needs and personal goals.

Purpose in the NDIS Framework

The Functional Capacity Assessment provides the NDIS with a comprehensive picture of the participant’s functional abilities,
which helps in:

• Planning and Funding: Determining the level and types of supports needed.
• Goal Setting: Supporting participants to set realistic and achievable goals for improved independence and quality of life.
• Progress Monitoring: Serving as a baseline for evaluating improvements or changes in the participant’s functional abilities over time.

Why Choose Plena Healthcare?

• Personalised Care
  We take the time to review each clinical case independently to ensure that our services are tailored precisely to meet your needs.
• Efficient Turnaround
  Enjoy a swift process with Plena Healthcare; experience wait times in weeks, not months!
• Quality Assurance
  Senior clinicians conduct thorough reviews of each case before submission, ensuring quality outcomes and high standards of care.
• Comprehensive Support Services
  We offer a full range of services, including Functional Capacity Assessments, Manual Handling assessments, and tailored training, all designed to meet diverse participant needs.
• Experienced Professionals
  Our team consists of highly trained and experienced clinicians who specialise in delivering client-centred and outcome-focused support.
• Commitment to NDIS Standards
  We are committed to aligning with the NDIS’s best practices, ensuring that our services are accessible, reliable, and results-driven for all participants.

Plena Healthcare is dedicated to providing the support, responsiveness, and expertise you need to achieve positive outcomes and a seamless experience.

Our Scope of Services

Plena Healthcare offers services to complete Functional Capacity Assessments (FCAs) as well as Manual Handling assessments and plans. We also provide both individual and group-based Manual Handling training sessions for individual participants and providers in a wide range of settings such as within the community and various housing environments.

For Functional Capacity Assessments we will review each referral carefully to ensure it aligns with our service capabilities. Specific factors, such as participants under 40 years of age, bariatric needs, initial FCA requests, individual goals, or a primary diagnosis of a psychosocial disability, may require further consideration or additional information from referrers to confirm suitability.

Please submit your referral using our referral form and send it to Plena Community at Community@plenahealthcare.com.au. Our friendly team will review your referral and our clinical team will ensure your request matches our scope and be in touch with you for next steps.

To learn more about Plena’s Occupational Therapy services, visit our Occupational Therapy page.

Navigating the approval process for occupational therapy hours can often be cumbersome and time-consuming for both therapists and their clients. However, transitioning to a system of pre-approved Occupational Therapy hours can significantly enhance the service delivery process, offering numerous benefits for both consumers and therapists.  

Enhancing Service Delivery and Client Satisfaction 

Pre-approved hours streamline the therapy process, making it easier for consumers to access consistent and uninterrupted services. This reliability increases consumer engagement and satisfaction. Consistent support helps in achieving better long-term outcomes, fostering a stronger client-provider relationship. 

The traditional process of waiting for approval from case managers can be frustrating for clients, often leading to complaints. With pre-approved hours, it allows for a smoother, more responsive service experience. This reduction in delays and uncertainties directly correlates with a decrease in client complaints, creating a more harmonious service environment. 

Immediate Access to Therapeutic Services 

Immediate access to necessary therapeutic services without the wait enhances enables consumers to access services when they need them. Clients feel valued and cared for when their needs are met promptly, which is crucial for their overall treatment experience and recovery process. Pre-approved hours ensure that clients receive the right support at the right time, significantly enhancing their overall experience and satisfaction. 

Reducing Administrative Burden on Therapists 

The administrative load on Occupational Therapists and their support staff is considerably reduced with pre-approved hours. Typically, preparing and processing Payment Service Providers (PSP) requests can take about 10-15 minutes each. By eliminating the need for frequent approvals, Occupational Therapists can redirect their focus from paperwork to patient care, increasing productivity and service quality. 

Effective Planning and Resource Management 

With pre-approved hours, Occupational Therapists can plan and execute treatment plans more effectively. They can schedule sessions in advance, secure in the knowledge that the hours are already approved. This not only helps in better resource management but also ensures that the treatment is delivered in a timely and organised manner, which is often crucial for therapeutic success. 

Transitioning to pre-approved Occupational Therapist hours can transform the therapeutic landscape by making services more accessible, reducing delays, and enhancing overall consumer satisfaction. This approach not only benefits the clients, who receive timely and uninterrupted care but also empowers therapists, allowing them to deliver high-quality care with reduced administrative hassles. Ultimately, pre-approved hours signify a step towards a more efficient, client-centered healthcare system where the focus is squarely on recovery and well-being. 

Since 2021, Plena Healthcare has been working with the North Western Melbourne Primary Health Network (NWMPHN) to bring an exercise-based strength and balance program to residents of aged care homes within the northern and western suburbs of Melbourne.  

At the program’s core is a modified version of the Sunbeam Program, which has been proven effective in preventing falls in older adults.  

• Over 60% of homes recorded a decrease in resident falls  

• Over 92% of homes recorded an increase in resident strength and balance  

• Over 80% of homes recorded a decrease in fear of falling among residents who participated.  

Sunbeam was commissioned by NWMPHN in 2021 as a Covid-19 initiative to improve resident strength and mobility post lockdown, with Plena clinicians leading small groups of residents through 13 weeks of bi-weekly exercise sessions. The aim was to focus on on some of the areas that contribute to falls risk in older people by improving mobility, spatial awareness and core strength.  

As part of the program’s evaluation, the Plena team monitors progress by taking measurements at set intervals.  

Following the program’s success after pandemic lockdowns, 2024 has seen 53 aged care homes participate in the program, with about 1400 residents taking part.  

The ongoing nature of Sunbeam has seen a strong relationship develop between NWMPHN and Plena Healthcare, fostering collaboration and enabling continuous improvement through the sharing of insights regarding benefits and outcomes of the program.   

Plena also operates Sunbeam as an added initiative inside aged care homes we already provide services in, funded by NWMPHN. Providers appreciate Plena bringing additional funded services to their homes, delivering benefits to their residents and further strengthening these relationships.  

Due to the ongoing success of Sunbeam, other primary health networks (PHNs) and aged care providers across Australia have also joined the program, offering improvements in balance, mobility and strength for even more aged care residents.   

In combination with the Plena Care Pathway (Plena’s AN-ACC approved evidence-based program), Sunbeam offers the opportunity for Plena to provide even more valued allied healthcare services within residential aged care homes, and more time to provide care to residents.   

For our clinicians, the opportunity to deliver a range of evidence-based programs to ageing adults provides variety in their work, and inspiration to improve the lives of those living in aged care.   

In conjunction with NWMPHN and the care staff at each home, Plena Healthcare is exceptionally proud of what it has accomplished for resident mobility, strength and falls prevention through the SUNBEAM program.   

If you’d like to know how Plena Healthcare can help reduce resident falls via evidence-based allied healthcare, get in touch today.

The Plena Care Pathway was the winner of the 2023 Allied Health Award for Innovative Product Excellence and is Plena Healthcare’s industry-leading physiotherapy & occupational therapy service model.

The Plena Care Pathway supports residents with access to tailored allied health services, through their entire residential aged care journey. The Pathway is available to all residents; it incorporates mobility and functional assessments and co-designed programs, falls management frameworks, care plan reviews, one-to-one therapy interventions and dynamic group-based active ageing services.

In our modern age, where bustling lives often overshadow concerns about safety, there’s a prevalent yet often overlooked danger lurking in our homes: falls. These seemingly mundane accidents can have devastating consequences, particularly for older adults.

According to the Australian Institute of Health and Welfare, people over the age of 65 are more likely to be hospitalised or die from a fall compared with other life stages. But falls need not be an inevitable part of ageing, and there are many things we can do to reduce our risk.

According to Plena Community Occupational Therapist Laine Harris, 30-40% of her clients have experienced a fall in the past 12 months and are seeking support to recover and make their homes a safer environment to prevent subsequent falls.

“Older people are at high risk for falls due to lower bone density, reduced muscle tone, and conditions affecting balance and eyesight” advises Laine. “These factors not only impact on a person’s tendency to fall, but also affect ones ability to recover from a fall”.

Older people recover more slowly from injuries like hip fractures, and are more vulnerable to post operative and best rest complications. Another risk factor is what healthcare professionals refer to as “The Long Lie” – that is time spent immobilised on the floor after a fall. If an individual falls and remains on the floor for longer than 60 minutes, this can be a marker of other risk factors like weakness and illness. It is also an indicator that an individual may be experiencing social isolation, associated with higher mortality rates, and may need increased care services.

Occupational Therapists are specially trained in identifying and addressing fall risk factors in an individual’s home, and Laine shares her top tips on how to make your home a safe environment.

Home Modifications

• Eliminate hazards in your home such as loose rugs, slippery surfaces and poor lighting to reduce the risk of falls.
• Make modifications when a hazard cannot be removed – tape down mats and rugs or install brightly coloured or high contrast options for improved visibility.
• Install grab bars, handrails, non-slip maps and shower chairs or stools to enhance stability and safety, especially in high-risk areas like bathrooms.
• Wear supportive, well-fitting, non-skid footwear indoors and outdoors to prevent slips and trips.
• Implement sensor pads and devices to alert carers if an older person gets up out of a bed or chair without assistance.
• Install a lowered bed to minimise the risk of a fall, and consider the use of urinal bottles or bedside commodes to remove the need to walk to the bathroom in the night, which is when falls are particularly prevalent.

A common but less understood side effect of falls is what is called “Post fall syndrome”, where an individual has long term health impacts and limitations because of a fall.

“If an individual has experienced a fall and ‘long lie’ they may suffer from muscle damage, pneumonia, pressure sores, dehydration or hypothermia” explains Laine. “These long-term conditions can contribute to a loss of confidence and increased fear of falling again. The psycho-social consequences can mean a person may restrict their own movements and activities out of fear, reducing their quality of life and independence” she continues.

The long-term impacts of a fall are also a significant factor in older people needing to enter residential aged care, which can further impair independence.

Laine says there are many things we can do to reduce our risk of falls in general, including;

• Engage in regular exercise programs to improve strength, balance and flexibility, thus reducing the likelihood of falls.
• Be aware of medications that may cause dizziness or drowsiness and consult healthcare professionals for adjustments if necessary.
• Use mobility aids like walking sticks or frames consistently, especially indoors.
• Seek the expertise of allied health professionals like Occupational Therapists and Physiotherapists for comprehensive assessments and personalised fall prevention strategies.
• Stay proactive. Maintain overall health and fitness through regular physical activity, proper nutrition, and social engagement to reduce the risk of falls.

Plena Occupational Therapists take a multi-disciplinary approach to client care, acknowledging that falls prevention has a broad scope within the allied health industry.

• A dietitian can ensure a client’s nutrition is adequate, to maintain strength and muscle mass.
• A podiatrist can assess a client’s foot health to ensure safe mobility, and prescribe appropriate footwear to improve gait, steadiness and grip.
• A physiotherapist can identify weaknesses in movement which may contribute to falls, and program strengthening exercises to regain safe mobility.

“Falling isn’t a natural part of ageing” Laine explains. “Just because you get older does not mean you are going to increase your risk of falls. If you stay proactive, keep fit, and assess your environment for hazards you don’t need to become another fall statistic and you’ll be in a good position to age well”.