Dementia at home: what the program covers, what to do when they refuse carers or become aggressive, and who else can help

Last updated 20 August 2026

The short version

Support at Home can fund most of what keeps someone with dementia living at home: personal care, nursing, allied health, social support, transport, household help and respite for carers.
The old dementia and cognition supplement was not carried into Support at Home. People who had it on a Home Care Package keep the equivalent amount - but a reassessment ends it permanently.
Cognitive decline is built into the assessment and can lift both your funding classification and your priority on the waitlist. Carers and family can, and should, take part in the assessment.
Two free national services sit alongside the program: the National Dementia Helpline 1800 100 500 and Dementia Support Australia 1800 699 799 - both 24/7.

Services that make a real difference

Dementia care at home is rarely about one service. It’s usually a mix: prompting and help with showering and dressing (personal care), medication management (nursing), occupational therapy to make the home easier and safer to navigate, social support and transport to keep routines and connection going, and cleaning or meal help so the caring spouse or family isn’t doing everything. All of these sit on the defined service list.

The costs follow the usual categories: nursing, allied health and care management are free for everyone; personal care, respite, transport and social support are “independence” services with a means-tested contribution; cleaning and meals sit in “everyday living”, where contributions are higher. From 1 October 2026, personal care becomes free for everyone - a significant change for dementia care, where personal care hours tend to grow year on year.

In practice, providers commonly place dementia in the middle-to-upper classifications - early-stage needs around the middle of the scale, advanced dementia towards classifications 7 and 8. Treat that as indicative only: the assessment looks at the whole person, not the diagnosis.

The dementia supplement: what changed

Under Home Care Packages, a dementia and cognition supplement added 11.5% to the package subsidy. Support at Home did not keep it as a separate payment - the government instead built cognitive-decline support into the eight classifications. New participants cannot apply for it: Services Australia’s claim form now applies only to home care provided before 1 November 2025.

If your family member was receiving the supplement on 31 October 2025, the equivalent amount continues as part of their transitioned arrangements. The catch is what happens next.

Before you request a reassessment

A reassessment moves a transitioned person onto the new classification scale - and when it does, the grandfathered supplement amount stops permanently. It is not re-granted. A higher classification may well outweigh the loss, but do the sums first: check the current classification budgets, tell the assessor about the supplement, and weigh both before requesting a Support Plan Review or reassessment. Funding otherwise has “upgrade only” protection - it can’t drop below the old package equivalent.

Getting the assessment right

The Single Assessment (arranged through My Aged Care on 1800 200 422) includes cognition, and it works far better when family are in the room. Someone with dementia may genuinely believe they shower daily and cook well; an assessor can only record what they see and hear. Before the visit, jot down a typical week - the prompting, the near-misses, the wandering, the nights - and ask for a private word with the assessor if some things can’t be said in front of your parent or partner.

Cognitive decline, a carer who is struggling (or absent), and a real risk of moving into residential care all lift priority in the national queue. Urgent cases are typically funded in about a month and high priority within one and a half to three months, while medium and standard waits are running at 8-11 months - so an assessment that accurately reflects the situation matters twice over. Our assessment guide has a fuller preparation checklist.

When your parent with dementia refuses carers in the house

A familiar scene: the package is approved, the first support worker arrives, and Dad says “I don’t need any help” and shuts the door. The provider cancels the shift, often still charges for it, and the family is back where it started - except now there is a bill and a parent who is more suspicious than before.

Refusal is part of the illness, not stubbornness. Dementia takes away insight, so your parent genuinely believes they are coping. A stranger in the house is frightening when you cannot hold on to who they are or why they came. And being told you need help with showering feels like being judged. Arguing the facts rarely works, because the part of the brain that would weigh them is the part that is failing. What works is making care feel like something else.

What tends to get care accepted

Start with what they will accept. Cleaning, gardening, a driver for appointments, someone who “pops in for a cuppa”. Personal care comes later, once a face is trusted. Support at Home can fund all of these, so ask the provider to begin with the low-threat services.
Same one or two workers every time. A rotating roster of strangers resets the fear at every visit. Ask for a small consistent team before you sign the agreement.
Introduce the worker as a helper, not a nurse. “This is Sam, who gives me a hand with the house” lands better than “your carer”. Ask for no uniform if the provider allows it.
Pick the best part of the day. Many people with dementia are calmest mid-morning and worst in the late afternoon. Book the first visits for the good hours.
Be there for the first visits. A trusted family member in the room makes the stranger “one of ours”. Stay for a few visits, then start stepping out for short stretches.
Keep it short to begin with. One hour of company that is accepted beats three hours of personal care that is refused.

What to ask the provider

Ask whether their workers have dementia training, whether they can guarantee a small consistent team, and whether they will write a slow introduction plan into the care plan. Ask plainly what happens when your parent refuses at the door - some providers charge the full shift, some charge a shorter cancellation period, some will have the worker wait or try a second approach. Get the answer in the service agreement. If the current provider cannot do this, switching providers is straightforward and the funding follows your parent.

Can they legally refuse, and when does it become unsafe?

An adult who still has capacity to make a decision about their own care can refuse it, even when the family thinks it unwise, and providers must respect that. Once capacity for that decision is lost, an enduring guardian (if your parent appointed one while well) can consent to services on their behalf; where there is no enduring guardian, the family can apply to the guardianship tribunal in their state or territory for someone to be appointed. A guardian can agree to care; they cannot force a frightened person through the door, so the tactics above still matter.

If refusal is leading to falls, missed medication, the stove left on or wandering, stop managing it alone. Tell the GP, who can arrange a capacity assessment and a medical review. Ask My Aged Care for a reassessment that reflects the risk and the carer strain, which lifts priority and can lift the classification. And if a crisis does come, a hospital admission is often the point at which services are finally accepted and residential respite can be arranged. Dementia Australia and Dementia Support Australia (both listed below) will talk through a specific refusal situation with you, free, at any hour.

Caring for someone with dementia who won’t accept help?

Tell us what’s happening - diagnosis, stage, who’s doing the caring, and whether carers are being turned away at the door or there has been aggression - and we’ll match you with providers near you whose staff are trained in dementia, work in small consistent teams and are used to reluctant clients.

Get matched - it’s free Prepare for the assessment

Respite, and the free services beside the program

Carer burnout ends more home care arrangements than dementia itself does. The Support at Home budget can fund in-home respite (a support worker comes to you), community or centre-based respite (a day program), and cottage respite (short overnight stays in a home-like setting) - all as independence services with the usual contribution. Residential respite in an aged care home is funded separately, not from the budget, and is arranged through My Aged Care.

Two free national services are worth saving in your phone:

Dementia Australia - National Dementia Helpline, 1800 100 500. Free and confidential, 24 hours a day, every day of the year, with live chat online. Beyond the helpline: free counselling for individuals, couples and families, post-diagnostic support, the Living With Dementia Program, peer support, Memory Lane Cafés, The Dementia Guide, and an “At Home with Dementia” home-assessment service.
Dementia Support Australia, 1800 699 799. Runs the government-funded Dementia Behaviour Management Advisory Service - free, 24/7, and family carers can self-refer. If you’re dealing with aggression, agitation, wandering or sundowning, DSA can assess (by phone or in person), provide written strategies and coach you and the care team through them. It sits alongside Support at Home, not inside it - using it costs your budget nothing.

Aggression at home: can care still be done safely?

Many spouses have been shoved or hit for the first time and told no one, because it feels disloyal and because “he was never like that”. Say it anyway. Aggression in dementia is a symptom of a damaged brain, not a choice, and it is one of the most common reasons families call for help. Your safety comes first - if you are being hurt, leave the room, lock a door if you need to, and call 000 if you are in danger.

Rule out the fixable triggers first

A sudden change in behaviour often has a physical cause the person cannot name: pain (teeth, joints, a fall nobody saw), a urinary or chest infection, constipation, a new or changed medication, poor sleep, or hunger and thirst. Ask the GP for a review before assuming the dementia has simply progressed. Then look at the triggers around care itself - being rushed in the shower, being undressed by someone they do not recognise, noise, too many people in the room, and the late-afternoon restlessness known as sundowning, which is why anger so often peaks in the evening and at night.

Help that actually comes to the house

Dementia Support Australia. Runs the Dementia Behaviour Management Advisory Service, and for more severe behaviour a Severe Behaviour Response Team can visit the home. They work out what is driving the aggression, write a plan, and coach the family and the support workers through it. Free, 24/7, and family carers can self-refer (helpline details below).
GP and geriatrician. For the medical causes above and a medication review. Medication for behaviour is a last resort, but a geriatrician or old-age psychiatrist is the right person to decide that.
Dementia-trained support workers. They do things differently: two workers for showering rather than one, the same faces each visit, a slower routine with no rushing, approaching from the front, and stopping and coming back later rather than pushing through. Ask any provider you are considering whether their staff are trained in dementia behaviours and whether they will roster two workers for personal care.

What the funding can do

Aggression and a carer under strain both count at assessment. Ask for a reassessment if things have changed - a higher classification can pay for more hours, two-worker shifts and regular in-home respite so the spouse gets a break. (If your family member still has the grandfathered dementia supplement, read the warning above before requesting one.) If you cannot keep going, Carer Gateway can arrange emergency respite, and residential respite in an aged care home is funded separately through My Aged Care, not from the package budget.

When home is no longer safe

Be honest about these signs: repeated injury to the carer; a carer who is frightened in their own home; violence at night when no one else is there; or behaviour that support workers will no longer attend. At that point a stay in residential respite is worth treating as a trial, not a verdict. It gives the carer rest, lets specialists observe and adjust the plan, and sometimes the person settles and comes home with more support in place. Sometimes it shows that home has run its course, and that is nobody’s failure.

Common questions

Did the dementia supplement stop?

As a new payment, yes - Support at Home has no dementia and cognition supplement, and new participants can’t apply for one. People who were receiving it on their Home Care Package as at 31 October 2025 keep the equivalent amount until they’re reassessed onto the new classification scale, at which point it ends permanently.

Will Mum lose money if she’s reassessed?

Her base funding can’t fall - transitioned clients have “upgrade only” protection. But if she has the grandfathered supplement, that part stops after reassessment and isn’t re-granted. If her needs have clearly grown, a higher classification will often more than cover it; if they haven’t, there may be no reason to ask for reassessment yet.

What classification does dementia get?

There’s no fixed answer - the assessment looks at function, risk and carer support, not the diagnosis alone. In practice, providers report early-stage dementia commonly landing mid-scale and advanced dementia in the top classifications, but treat that as a rough guide. See the 8 classifications for current budgets.

Can we get respite paid for?

Yes. In-home, centre-based and cottage (overnight) respite can all be funded from the Support at Home budget as independence services, with a means-tested contribution. Residential respite in an aged care home is funded separately through My Aged Care and doesn’t draw on the budget.

Who helps with wandering or aggression?

Dementia Support Australia on 1800 699 799 - free, 24/7, government-funded, and you can call as a family carer without a referral. They assess what’s driving the behaviour and give you and the care team practical written strategies. For everything else dementia-related, the National Dementia Helpline is 1800 100 500, also 24/7 and free.

Our provider charges us when Dad refuses the carer at the door. Is that allowed?

Usually yes, if the cancellation terms are in the service agreement you signed - many providers treat a refusal at the door as a late cancellation. But a provider who keeps billing for refused shifts without changing approach is not doing its job. Ask for a shorter cancellation window, a consistent worker and a written introduction plan; if nothing changes, raise it formally or switch providers.

What stage of dementia does aggression appear in, and does it pass?

Most often in the middle stages, when the person is still physically able but has lost much of their language and understanding, so frustration and fear come out as anger. It commonly eases as dementia advances, though not for everyone, and it tends to come in episodes rather than all the time. Because so many episodes have a trigger - pain, infection, being rushed, the evening - a lot of aggression can be reduced without medication once the cause is found.

What should we not do with someone with dementia who refuses help or gets angry?

Don’t argue the facts or correct them; don’t rush or crowd them; don’t stand over them or grab an arm; don’t push on with a task once they are distressed - step away and try again later; don’t take it personally, and don’t hide it from the GP, the provider or the rest of the family. The behaviour is information about what the person is feeling, and the people listed on this page can help you read it.

Sources

Department of Health, Disability and Ageing, health.gov.au - Support at Home supplements and grants, accessed August 2026.
Services Australia, servicesaustralia.gov.au - dementia and cognition supplement claim form (AC014, home care provided before 1 November 2025).
Dementia Australia, dementia.org.au - National Dementia Helpline and support programs, accessed August 2026.
Dementia Support Australia, dementia.com.au - Dementia Behaviour Management Advisory Service, accessed August 2026.
My Aged Care, myagedcare.gov.au - assessment, respite and Support at Home guidance, accessed August 2026.