Why Australia's aged care reforms are already under scrutiny

Australia's aged care reforms promise better standards, but questions remain over affordability, privatisation and access to care, writes Jenny England.

THE MUCH-ANTICIPATED report from the recent Royal Commission into Aged Care, Quality and Safety (2018–2024) was released in October 2024.

It essentially validated the many complaints about neglect and poor standards of care in the prior system over the years, which reached a crisis point during the COVID pandemic. It lists 148 recommendations aimed at establishing a new aged care system to ensure the needs of elderly Australians for support and care in their later years.

The new Aged Care Act was subsequently passed in 2025 heralding what the Government describes as ‘a rights-based’ care model, intended to not only improve care standards and safety but also to address the coming tsunami of Baby Boomers, some with complex needs due to the increased life expectancy about to hit long waiting lists for assessment, then to receive any residential or home care support, subsidised by the Government, they need.

So, how did we get here?

The Australian Government did not take much of a role in aged care until 1954, when the Aged Care Persons Home Act (with amendments in 1963) was passed. This directed the government to provide capital assistance to help charities run nursing homes and hostels, focusing mainly on palliative and end-of-life care.

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In 1970, the Federal Government increased its involvement through the Domestic Nursing Benefit to help the elderly stay in their own home. In 1985, to strengthen their commitment to in-home care, Home and Community Care (HCC) was established, morphing into the Commonwealth Home Support Programme (CHSP) by 2015.

In 1997, what was considered a landmark development at the time was introduced by the Howard Government to provide some standardisation of aged care and to provide financial incentives for the private sector to invest in aged care for profit.

In her recent book, Where It all Went Wrong, Amy Remeikis describes how the 1997 Aged Care Act ‘ushered in the deregulation the private sector had been screaming for and prioritised profit over patient care’.

Fast forward to the present day, some of the changes in the new Aged Care Act (particularly the way it is to be subsidised by the government into the future) are quite significant. It wouldn't be surprising if a large number of people approaching their later years (or already on a list waiting for a call) are sitting around kitchen tables with their families and perhaps a financial adviser, trying to make plans for when they may need care, especially if they already have physical or cognitive health concerns.

The new co-contribution system (evolving with feedback) is a little confusing. Many are becoming concerned that the Government’s new policy, although being touted as “rights-based”, appears to be more concerned with the increasing cost of aged care by maintaining (actually boosting) financial arrangements with private operators while making sure recipients pay a fair share, than meeting the real and sometimes desperate needs of those seeking support. Complaints have already begun. But at least they now have somewhere to complain to — the Independent Aged Care Commission.

There are still over a couple of hundred thousand people on waiting lists (about half already assessed). Another sticky point is the introduction of a standardised assessment tool using an algorithm to determine care needs that cannot be overridden by an assessor. Memories of the disastrous Robodebt controversy exacerbate any simple acceptance of this new process.

Australia’s aged care continues to operate on a one-size-fits-all model

Across the nation, our culturally and linguistically diverse older population is growing faster than the systems designed to support it.

When human services like aged care are relegated to the private sector, there is always the risk that profits will become more important than care. Especially at the moment when wages of low-paid workers like carers are increasing, and the expense for private providers to expand or build new facilities needs to be factored in when establishing costs to both the Government and the residents.

This has been partly addressed by the Government by allowing residential homes to charge a much larger refundable deposit (and keeping a fair proportion of it when the resident leaves). This is going to make residential care unaffordable for many, as since 1997, the percentage of profit-making providers has increased from 21 to 41 per cent and even with financial incentives, it is projected that residential places will be desperately inadequate in the future.

Something similar has been happening to the age-in-place policy of the Support at Home programme. The Home Care Package programme was introduced in August 2013, replacing the earlier HCC programme. This is now being replaced by Support at Home, which looks good on paper by offering eight new levels of care, but unless waiting times are reduced, many in need will miss out, as care needs can change dramatically and unpredictably while they are waiting.

New funding arrangements, which can result in much higher co-contributions, may make it financially unviable for many self-funded retirees.

There are still many questions to be answered about this new aged care policy. A main one is: where is the community in all of this? I believe that just as the saying ‘it takes a whole village to raise a child’, it also takes a whole village to care for the elderly.

The CHSP was set up to provide low-level support through a variety of community-based organisations such as Meals on Wheels, Community Transport and Volunteer Visitor schemes. Many seniors have been happy with this programme over the years, even though it involves a regular co-contribution.

It is intended that CHSP will be incorporated into Support At Home in July 2027. A valid concern is whether these community-based services, mostly run by volunteers, will continue and, if so, in what form?

Although all communities are unique, if you scratch beneath the surface, you will find the seeds of a real caring society, which needs to be strengthened (along with more support for family carers) as part of an overall system, overseen by the Government, to enable elderly Australians to live the best lives they can.