By Steve Hadfield, AgedCareActionPlan.au · Last updated: 26 April 2026
Someone you care about can't manage alone any more. Or you're starting to realise that you can't manage alone yourself. The system says there's help available. Nobody is telling you how to get it, in what order, or what you'll miss if you get it wrong.
This guide is for whoever needs to act right now — whether that's you sorting things out for a parent, a partner working out care for a spouse, or an older person getting ahead of something they can see coming. The steps are the same regardless.
Ask the hospital social worker about Transition Care today — before you leave the hospital. Transition Care provides up to 12 weeks of post-discharge support, but the assessment must be arranged while the person is still an admitted patient.
Hospital social workers are usually excellent and usually overloaded. If they haven't raised Transition Care, you raise it. Say it by name.
Call My Aged Care on 1800 200 422. This is the Australian Government's central entry point for all aged care services — home care, residential care, assessment, everything. You cannot access government-funded aged care without registering here first.
The call takes about 20–30 minutes. Have ready: the person's full name, date of birth, Medicare number, and current address. If you're calling on someone's behalf, have your own contact details too.
"Hi, I'm calling to register [name/myself] for aged care services and to understand what help is available. [Name/I] recently [describe the trigger — had a fall / was discharged from hospital / the GP said they can't manage alone]. I'd like to find out what support is available and get an assessment started."
Before you hang up, ask for your client reference number. Write it down. You'll need it for every future call.
My Aged Care is the single government gateway for all Australian Government-funded aged care. Every service — home care, residential care, assessment — requires registration with My Aged Care first. Without a client record, an assessor cannot be allocated and services cannot start.
The system wasn't built with simplicity in mind. But this part — the first call — is genuinely the right starting point. Once you've called and have a reference number, everything else can be organised.
My Aged Care operates Monday to Friday, 8am to 8pm, and Saturday 10am to 2pm. The website at myagedcare.gov.au also allows online registration.
Transition Care is a government-funded short-term program that provides support after a hospital stay to help recovery and avoid premature residential care admission. It can include nursing, physiotherapy, occupational therapy, personal care, and case management.
Transition Care is one of the most underused programs in aged care because families don't know to ask for it. The hospital social worker knows about it — but with multiple discharges to manage simultaneously, they may not raise it for every patient unless you ask.
CHSP is the government's entry-level home care program — it provides basic support services like cleaning, meals, transport, social support, and personal care for people who need some help to live at home but don't yet need the full Support at Home program.
CHSP is important in the first 72 hours because it can often start faster than Support at Home — which requires a full assessment and classification. While the assessment process runs, CHSP can bridge the gap.
Ask about it specifically when you call My Aged Care. Not every operator will mention it unprompted. Say: "Is there anything available in the short term while we wait for an assessment? What about the Commonwealth Home Support Programme?"
Aged 65 or over (or 50 or over for Aboriginal and Torres Strait Islander people). Australian citizen or permanent resident. Needs-based — income and assets do not affect eligibility, only what you pay. CHSP will transition to Support at Home no earlier than 1 July 2027 under current government plans.
After registration, My Aged Care will arrange a triage to determine what type of assessment is needed and how urgently. An assessor will then contact you to schedule a visit.
Assessment wait times vary significantly by location and assessed urgency. In some areas, assessments happen within days. In others, waits of several weeks are common. If the situation is urgent — recent hospitalisation, safety risk at home, significant decline — say so clearly when you register. It affects how quickly an assessor is allocated.
Some families wait weeks. If two weeks pass with no contact from an assessor, call My Aged Care back. Have your reference number ready. Ask politely and specifically: "I registered on [date], reference [number]. Can you tell me what the expected timeline is for an assessment?" Politely persistent is how things move in this system.
While you wait, start preparing for the assessment. Read the assessment preparation guide — preparation significantly affects the classification outcome, and the outcome determines years of funding.
Medicare card
Required for registration with My Aged Care.
Pension or concession card (if applicable)
Affects what you pay for some services — not whether you can access them.
Current medications list
A complete list or the actual medication packets. The assessor will need this.
GP referral letter or health summary
Ask the GP specifically to describe functional limitations — what the person cannot do, not just diagnoses. Book this appointment early; it accelerates the process.
Recent hospital discharge summaries
Contains clinical assessments that support the picture you're presenting to the aged care assessor.
Power of Attorney or Enduring Guardianship documents
If the person has reduced capacity to make decisions, these documents establish who can act on their behalf. State-specific — check your state government's requirements.
Once the person is discharged, the Transition Care pathway closes. Assessment must happen while they're still admitted. If you find out about discharge on a Friday, call the social worker on Friday.
My Aged Care can't create a client record without it. The call will either take significantly longer or you'll need to call back. Have the card in hand before you dial.
My Aged Care operators handle many calls. CHSP may not be raised unless you ask about immediate options. Say the name.
Every interaction with My Aged Care should generate a reference number. Without it, following up requires starting from scratch. Get it every time.
Assessment wait times are real. But families who follow up get scheduled faster than families who assume the system will contact them automatically.
The first 72 hours establish the client record, set the assessment in motion, and (if relevant) secure Transition Care or CHSP support. After that, the focus shifts to the assessment itself.
Read the assessment preparation guide before the assessor visits. Preparation significantly affects the classification outcome — and the classification determines years of funding. A single domain score point can mean $8,260 more or less in annual care budget.
Once a classification is confirmed, the next step is choosing a provider and activating services within the 56-day window. The provider selection guide covers how to compare providers and what to check in a service agreement before signing.
If you need support as a carer — not just for the person receiving care but for yourself — the Carer Gateway provides free advice and support services. Call 1800 422 737.
Get a personalised step-by-step plan for your specific situation — who to call, what to say, and what to do next, based on your answers.
My Aged Care is the government entry point for all aged care services. You cannot access government-funded home or residential care without registering first. Call 1800 200 422 to create a client record and get a reference number. Have the person's Medicare number, date of birth, and address ready. The call takes about 20–30 minutes.
Transition Care provides up to 12 weeks of post-hospital support — nursing, physio, personal care. Assessment must be arranged while the person is still an admitted patient. A one-time 6-week extension is available on request. Ask the hospital social worker by name the day you find out about discharge. If they don't raise it, you raise it.
CHSP (entry-level support) can sometimes start within days. Support at Home (ongoing program) requires assessment first — wait times vary from weeks to months depending on location and urgency. When you call My Aged Care, say clearly if the situation is urgent or involves recent hospitalisation. Urgency affects how quickly an assessor is allocated.
To access government-funded aged care: aged 65+ (or 50+ for Aboriginal and Torres Strait Islander people); Australian citizen or permanent resident; and assessed as having care needs related to ageing. Eligibility is needs-based, not means-tested — income and assets affect what you pay, not whether you can access care.
CHSP is entry-level home care — cleaning, meals, transport, personal care — for people who need some help to live at home but don't yet need the full Support at Home program. Often the fastest to access. Ask about it specifically when you call My Aged Care. CHSP will transition to Support at Home no earlier than 1 July 2027.
Need a complete personalised plan for your situation?
This guide is for information only — not legal, medical, or financial advice. Verified against the Aged Care Act 2024 and Aged Care Rules 2025. Check myagedcare.gov.au for current rates and rules.