Aged Care in Australia: Have the Lessons Been Learned?

For many Australians, few decisions are more emotional than choosing aged care for a parent, partner or loved one. It is often a decision made after illness, a fall or the gradual loss of independence, and it usually comes at a time when families are already under enormous stress.

The Royal Commission into Aged Care Quality and Safety exposed heartbreaking cases of neglect, poor nutrition, inadequate staffing and failures in basic care. Those findings prompted sweeping reforms, new legislation and significantly increased government funding.

The question today is whether those reforms have been enough.

A system that is changing

Australia's residential aged care sector is dominated by private and not-for-profit organisations. While many providers are privately owned businesses, a large proportion are operated by charities, religious organisations and community groups. Government-operated residential aged care facilities now represent only a small part of the sector.

Although ownership differs, all approved providers operate within the same national regulatory framework and receive substantial Commonwealth funding.

Who pays?

Residential aged care is funded through a combination of:

• Commonwealth Government subsidies.
• Resident contributions.
• Accommodation payments from those with sufficient financial means.

Government funding remains the largest source of revenue for most providers, with taxpayers contributing many billions of dollars each year to support the sector.

Residents may also contribute through:

• Daily living fees.
• Means-tested care fees where applicable.
• Accommodation payments, often as a Refundable Accommodation Deposit (RAD) or an equivalent daily payment.

The accommodation deposit system has long been controversial because many residents effectively provide providers with access to large sums of capital while they remain in care.

Supporters argue it helps finance new facilities.

Critics argue it creates a significant barrier to entry and favours those with greater wealth.

Staffing reforms

One of the most significant changes since the Royal Commission has been mandatory staffing requirements.

Residential homes are now required to provide minimum daily care minutes for each resident, including care delivered by registered nurses. Funding is increasingly linked to achieving these care-minute targets, with financial incentives for providers that meet them and reduced funding for some metropolitan providers that do not.

There is also a requirement for registered nurse coverage around the clock in residential aged care.

These reforms are intended to ensure that staffing levels better reflect the increasingly complex medical needs of residents.

Staff qualifications

Modern aged care relies on a mix of professionals, including:

• Registered Nurses.
• Enrolled Nurses.
• Personal Care Workers.
• Allied health professionals such as physiotherapists and occupational therapists.
• Lifestyle and recreation staff.
• Hospitality and catering staff.

Residents today generally require much higher levels of medical care than previous generations because many remain living independently for longer before entering residential care.

Medical care

Residential aged care is not a hospital.

General practitioners continue to play an important role, with many facilities arranging regular GP visits.

Residents may also receive visits from:

• Physiotherapists.
• Podiatrists.
• Pharmacists.
• Speech pathologists.
• Mental health professionals.
• Specialist nurses.

Telehealth has become increasingly important, particularly for regional and rural facilities.

Food and nutrition

Food became one of the most visible criticisms during the Royal Commission.

The new standards place much greater emphasis on nutrition, resident choice and dining quality. Providers are now required to offer varied, appetising meals that meet each resident's nutritional needs while involving residents in decisions about food wherever possible.

Public discussion has often focused on the amount spent on meals. While providers are required to report food and nutrition expenditure, there is no single legislated national dollar amount that every facility must spend on food per resident each day. Instead, providers are assessed against quality standards and reporting obligations rather than a fixed mandatory meal budget.

Can Australians stay at home longer?

Increasingly, the answer is yes.

Government policy has shifted towards helping older Australians remain in their own homes through expanded home support and home care programs.

For many Baby Boomers, remaining at home is both financially attractive and emotionally preferable.

Technology, telehealth, home modifications and community care services are making this increasingly practical.

However, advanced dementia, significant disability or complex medical conditions still make residential care essential for many people.

What happens to Australians with little money?

Australia's aged care system is designed so that inability to pay should not prevent access to care.

Government subsidies support residents with limited financial means, while wealthier Australians contribute more towards accommodation and some everyday living costs.

In practice, however, finding vacancies at preferred facilities can still be challenging, particularly in high-demand metropolitan areas.

The industry of ageing

Aged care has become one of Australia's largest service industries.

An ageing population means demand will continue growing for decades.

The sector represents:

• Tens of billions of dollars in annual expenditure.
• Thousands of businesses.
• Hundreds of thousands of workers.
• Significant investment in new accommodation.

As Australia's population ages, the financial pressures on governments, providers and families are likely to intensify.

A debate that will continue

One aspect of the system continues to generate discussion.

Many Australians question whether requiring large refundable accommodation deposits is the fairest way to fund residential care.

Some argue that a transparent weekly accommodation charge, similar to rent, would be simpler and more equitable.

Others argue that refundable deposits reduce ongoing accommodation costs and provide providers with access to capital needed to build modern facilities.

There is no simple answer.

The challenge for governments is balancing affordability for residents, financial sustainability for providers and quality care for older Australians.

The Times View

Australia's aged care system is significantly stronger than it was before the Royal Commission. Staffing requirements have increased, oversight is more rigorous, funding has grown and residents' rights have been strengthened. Those reforms deserve recognition.

At the same time, Australians are entitled to continue asking difficult questions. Is the accommodation funding model the fairest available? Will there be enough workers for an ageing population? Can more people remain safely in their own homes? And can quality care remain affordable for taxpayers and families alike?

As the Baby Boomer generation enters advanced age, these questions will become central to Australia's social and economic future. They deserve thoughtful debate based on evidence, compassion and the expectation that every Australian should receive dignified care in later life.