Have we learned the lessons of ACFI?

Last week, the Aged Care Quality and Safety Commission announced it was investigating operators over their use of Higher Everyday Living Fees (HELF). 

Two days later, Channel 9 aired Age of Greed, raising serious questions about Additional Services under the previous funding model while acknowledging the sector’s transition to HELF. 

Since then, we’ve spoken with aged care executives, sector leaders and advocates. One question keeps coming up. 

Have we learned the lessons of ACFI? 

Government has made its position clear. Providers aren’t expected to generate a margin from care. If residential aged care is to become financially sustainable and investable, then that return must come from accommodation and Higher Everyday Living Fees. 

HELF is one of the few commercial levers Government has deliberately left available. 

Yet rather than defining exactly what constitutes an additional everyday living service, the framework relies on guidance, principles and intent. That inevitably leaves boards making judgement calls. 

Some will get them right – but some won’t. 

In the absence of clearer boundaries, the sector faces two risks. 

The first is creating a two-tier experience, where residents who purchase HELF enjoy a different experience to those who don’t – the haves and the have nots. 

The second is more subtle and potentially more damaging. How far do operators push the boundaries before they stop delivering choice and start testing the intent of the reforms? 

The Department’s guidance allows individual services. It allows bundling. It encourages consumer choice. But every additional service raises the same question. 

Should this be part of HELF, or should every resident already receive it? 

This is where every executive and every board need to apply the pub test. 

If it doesn’t sit comfortably with residents, families or the wider community, don’t be surprised if it ends up on prime-time television. 

The sector has lived through this before. 

Under ACFI, some providers pushed the boundaries of the funding model. Government eventually tightened the rules. Flexibility disappeared. Everyone paid the price. 

HELF mustn’t become the next ACFI. 

Government also has responsibilities. 

It can’t ask providers to become investable, create HELF as one of the few legitimate revenue levers available, then criticise every operator trying to interpret the framework. 

Equally, executives don’t get a free pass. Providers that deliberately repackage standard services as premium offerings should expect scrutiny. 

Trust remains the sector’s most valuable asset. Once it’s lost, Government, regulators and the media inevitably respond. 

Where operators are acting in good faith, the first response should be clearer guidance and the opportunity to course correct, not assumptions of poor intent. 

That view is shared more broadly across the sector. Catholic Health Australia’s Director of Aged and Community Care, Alex Lynch, says the HELF rules have proven “very complex to put into practice” and supports the Commission investigating providers where concerns arise, while distinguishing between deliberate wrongdoing and genuine implementation errors during the transition to the new framework. 

That’s the tension of investability at a time when we need operators building. 

Providers need the confidence to exercise commercial judgement. Government needs confidence that providers will respect the intent of the reforms. 

If either side gets this wrong, we know how the story ends. Everyone loses. 

For a deeper look at HELF, this week’s edition of SATURDAY features James Saunders on why it has become one of aged care’s most important commercial levers – and how providers can get it right.