Sleepless nights: how the New Aged Care Act affects the elderly who need respiratory support devices

Many older Australians have encountered significant difficulties accessing respiratory support devices under the new Support at Home program.

Heather* sits across from me in my public hospital clinic, hands folded neatly in her lap. We return, again, to the discussion of her respiratory failure — a condition in which her lungs can no longer adequately remove the carbon dioxide her body produces. We have been here before. The only solution is a bilevel ventilator, a “BiPAP” device, which she has been renting for $200 a month. Without it, she will end up back in hospital.

At her last visit, I explained that she needed this device permanently for night time use. She nervously asked about the price. 

“Around $5,000”, I told her. 

“Does the government pay for this?”, she asked. She was, after all, approved for a Home Care Package with funds to spare. 

I explained that her provider is obliged to fund her device, provided sufficient funds are available.

Today, she tells me that her provider has denied funding for the device — not once, but repeatedly, despite her attempts to escalate the request. Her voice was soft as she walks me through her finances with the detail of someone who justifies the use of every dollar: a fortnightly pension of $905, in a Department of Housing unit, $476 left for everything else after rent and electricity. Then there’s the water bill, the phone, the internet, transport, medications. 

This device keeps her alive, I think. This is not optional. 

Heather looks at me, eyes glistening, “How do I pay for this?” she asks. 

I have nothing to offer her.

The Aged Care Act 2024

The new Aged Care Act 2024 was intended to mark a transformative shift in the delivery of Aged Care in Australia. The Act was introduced in direct response to the Royal Commission into Aged Care Quality and Safety, which found that the existing system was vastly inadequate to meet the needs of an ageing population. Implemented on 1 November 2025, it represented a philosophical shift that places the elderly receiving care at the heart of the system.

Yet in the pursuit of reform, a vulnerable group has been overlooked — older Australians living with obstructive sleep apnoea and respiratory failure. Under the new Support at Home program, which replaced the Home Care Packages (HCP) program, many have encountered significant difficulties accessing respiratory support devices, particularly CPAP devices and bilevel ventilators. For most patients, these devices are not optional. They play an essential role in preventing the worsening of chronic conditions, reducing hospitalisations, and maintaining quality of life.

The Funding Gap

Introduced as part of the Support at Home program, the Assistive Technologies and Home Modifications (AT-HM) Scheme was designed to provide a dedicated funding stream for equipment that supports safe and independent living for older Australians. However, the AT-HM list of approved products under this scheme explicitly excludes “respirators” — a category that, according to the Assistive products - classification and terminology (ISO 9999:2022) definition, encompasses both CPAP devices and ventilators. This represents a stark departure from the previous HCP program, under which funding for these devices was available to eligible older Australians.

Their exclusion rests on the assumption that alternative funding sources exist. In New South Wales, EnableNSW is the primary alternative. However, EnableNSW’s eligibility criteria explicitly exclude older Australians who qualify for Australian Government aged care services — leaving them caught between two systems, funded by neither.

The Current Predicament

Trapped between federal and state funding frameworks, older Australians are left without access to essential respiratory support devices. The consequences are serious: poorly controlled respiratory failure, increased risk of hospitalisation, and a diminished quality of life. The gap also deepens existing health inequities by imposing significant financial burdens on an already vulnerable population. Legislation designed to improve their circumstances has, in this regard, made them worse.

The legislative impact extends beyond individual patients. Against the backdrop of an already overstretched healthcare system, the lack of access to these devices compounds existing pressures — delaying hospital discharge, increasing bed occupancy, increased readmissions, and ultimately raising overall healthcare expenditure.

The solution is, in principle, straightforward: the federal and state governments must clarify which funding body is responsible for these vulnerable patients, or explicitly confirm that respiratory devices are covered under the AT-HM scheme. Until they do, the situation for these older Australians remains untenable — and the cost of systemic shortcomings should not be borne by those with the greatest need.

*Name changed to protect privacy.

Julian Han is a Respiratory Advanced Trainee at Nepean Hospital.

Devesh Thakkar is a Respiratory Staff Specialist at Nepean Hospital.

Benjamin Gerhardy is Respiratory Staff Specialist at Nepean Hospital, affiliated with University of Sydney.

Lucy Morgan is Respiratory Head of Department at Nepean Hospital, Respiratory Staff Specialist at Concord Hospital, Clinical Professor at University of Sydney and Chairperson of Lung Foundation Australia.

We do not have any conflict of interests