Aged care provider viability is an operating question, not just a funding one.
The sector data behind the word viability is the worst on record: margins near zero, a first negative quarter, care managers carrying far more clients than a year ago. Funding settings matter, and the advocacy on them will continue. But at the same funding settings, some providers are under water and some are comfortably viable, and the distance between them is the operating model.
- By Qurrat Shafqat
- August 2026
- 12 min read
In this article
Viability used to be a word that lived in board papers. In home care right now it has moved into the corridor, and the sector’s own benchmark data explains why.
StewartBrown’s survey of the first nine months under Support at Home, covering roughly a quarter of the sector’s packages, put the average operating result at around 58 cents per client per day, down from several dollars the year before, with the March quarter negative for the first time since the benchmark began. Average package utilisation sat near 77 per cent. The average care manager was carrying around 53 clients, up from 38 before the reform. Those are survey figures, not universal truths, but the direction is unambiguous: the economics of home care tightened hard, fast.
There are two ways to read numbers like that. The first is that this is a funding problem, and partly it is; the peak bodies are pressing that case and should. The second reading matters more to any individual provider: sector averages hide an enormous spread. Some providers are under water at today’s settings. Others, at exactly the same settings, are viable and steady. This piece is about what separates them, because that part is inside your control this quarter.
01
The numbers behind the word viability
It is worth sitting with what the benchmark actually measures, because “viability” gets used loosely.
An operating result of cents per client per day means the average provider is delivering care roughly at cost, with no buffer for a bad quarter, a system project, or a single funding change absorbed badly. Utilisation in the mid-seventies means that, on average, close to a quarter of the funded budget participants hold is not being converted into delivered, claimable service. And a care manager load that has jumped by more than a third means the function the reform made mandatory, and funds through a pooled 10 per cent deduction, is being delivered under strain, which shows up later as evidence gaps and churn.
That spread is the most useful fact in the whole dataset. It says the settings alone do not decide any single provider’s result. The operating model does the rest.
02
The half of viability you control
None of this argues against the funding advocacy. Pricing advice, deferred caps, indexation and program settings will keep moving, and the sector should keep pressing for settings that make good care economically sane. Government support also exists for providers in acute distress, and using it is a sign of management, not failure.
But waiting for the settings to improve is not a plan. The providers who will benefit most when settings move are the ones whose operating model is already converting funding into delivered, claimed, paid service with minimal leakage. And the providers most at risk are not always the ones with the worst funding mix. They are the ones who cannot see, week to week, where their own leakage is.
The principle
03
The four operating levers
Across the providers we work with, viability concentrates in four levers, and every one of them is an operating-model lever rather than a funding one.
1. Budget utilisation
Unspent participant budget is care a person is funded for and not receiving, and revenue the provider is resourced to deliver and not earning. Persistent under-utilisation is rarely a demand problem. It is scheduling capacity, workforce availability, slow care-plan activation and weak reactivation follow-up, all of which are visible and fixable once utilisation is reported weekly by participant and by branch rather than discovered at quarter end.
2. Claiming discipline
Under transaction-based claiming, revenue is not earned when the service is delivered. It is earned when the claim is accepted. Every rejected claim, every miscoded service, every resubmission cycle nobody owns is delivered cost waiting for its revenue. Providers who treat the claim-to-payment cycle as a managed operational process, with one owner, one coding standard and a weekly rejection review, convert the same delivered care into cash weeks faster than providers who treat claiming as an admin task.
3. Care management economics
The pooled 10 per cent deduction makes care management a funded obligation with a defined envelope. At 53 clients per care manager, the question of what care management actually is, who delivers it, how it is rostered and how it is evidenced stops being philosophical. Left undefined, it becomes either unfunded effort quietly absorbed by other roles, or an obligation not demonstrably delivered, which surfaces at audit. Defined, rostered and evidenced, it is a service line that pays for itself.
4. Price and cost to serve
With caps deferred, refund powers active and provider prices published quarterly, pricing has to be defensible now. That requires something most providers have never built: cost-to-serve visibility per service type, so leadership knows which services recover their cost and which are quietly subsidised. A price list without a costing method underneath it is a guess, and under the current transparency settings, a published guess.
04
What viable providers do differently
The providers holding their position in this environment are not doing something exotic. They share a short list of unglamorous disciplines.
Leadership sees a weekly view, built from the same data operations uses, covering utilisation by branch, claim rejections and cash conversion, care management delivery against the funded envelope, and margin by service type. Each of those cycles has a named owner. Pricing has a method and a review rhythm, not a history. And when something moves outside tolerance, it is discussed that week, not reconstructed at month end after the position has already drifted.
Nothing on that list requires new funding settings. All of it requires an operating model deliberately rebuilt for how the program now works, which is exactly the work most providers have not had the space to do while absorbing the reform itself.
05
What to fix first
For a provider feeling the squeeze, the order that has held up is the one that returns cash fastest.
01
Fix the claim-to-payment cycle first. One coding standard, one owner, a weekly claiming rhythm with rejection review built in. This is the shortest path from delivered care to banked revenue, and it usually moves the cash position within a quarter.
02
Make utilisation visible weekly. By participant, by branch, against budget. Then work the causes: activation speed, scheduling capacity, follow-up on lapsed services. Every point of recovered utilisation is funded revenue the business is already resourced to deliver.
03
Define and roster care management. What it includes, who delivers it, how it is evidenced, and how the pooled funding maps to the delivery. Plan the onboarding quarter gap so growth does not quietly drain cash.
04
Build cost-to-serve and a pricing method. Margin by service type, a defined basis for each price, a named pricing owner and a review rhythm, so the published price and the audit conversation both stand up.
Then hold the rhythm. Every one of these disciplines decays under pressure unless it is reviewed weekly by someone whose job it is to notice.
06
Viability as a weekly discipline.
The uncomfortable truth in the benchmark data is also the hopeful one. If viability were purely a funding question, the spread between providers at identical settings would be narrow. It is not. The providers above the line are running a different operating model, not receiving a different program.
Viability is not a submission you make once a year. It is the compound result of utilisation converted, claims paid first time, care management delivered inside its envelope, and prices that recover cost. Each of those is decided in ordinary weeks, by whether the operating model makes the right thing the default. The settings will keep moving. The providers who thrive under the next version of them will be the ones who used this stretch to rebuild the model underneath.
The margin is thin. The levers are yours. That is the whole argument.
QS
Qurrat Shafqat
Director, Aged Care Practice
Qurrat works with aged care, disability and allied health providers on the operating models behind reform-ready delivery under the Aged Care Act 2024. She also leads Infinikey Consulting’s aged care research track with Western Sydney University. She writes from inside the engagements.
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02
Start Here
Begin with a Transformation Diagnostic.
A short, structured engagement that shows where funding is leaking between delivery, claiming, care management and pricing. And what to fix first.
- 2–4 Weeks
- Senior-Led
- Fixed Scope
- A clear view of where utilisation, claiming and care management are leaking funded revenue.
- A 90-day plan that prioritises the changes most likely to restore margin and cash under Support at Home.
- Conducted personally by senior consultants, not handed to a team of analysts.