Category: Home Care

The aged care crises continue

The aged care crises continue under a Labor government

It has been four years since the Royal Commission into Aged Care Quality and Safety’s final report was tabled in federal parliament. Unfortunately, Labor’s so-called “generational” reforms to aged care fail to address fundamental systemic issues.

In her recent damning report on the progress of the recommendations of the royal commission, the aged care inspector general, Natalie Siegel-Brown, cuts through Labor’s spin. She states: “Despite the volume and pace of reform, a number of actions that would have seeded transformational change have not yet been delivered, some actions are not actively being considered, and indeed the manner of implementation in some areas may bring about unintended consequences.”

The government has celebrated the passage of its new Aged Care Act 2024. This is undoubtedly an important reform. However, it fails to take the leap from a provider-focused system to one that genuinely places the rights of older people front and centre.

The new aged care act has been promoted as a rights-based framework for the delivery of aged care. However, Stephen Duckett described the new aged care act as “rights washing”. According to Duckett: “(The) high sounding rhetoric is simply there to placate consumers and advocates, allowing providers to continue on their way unimpeded.”

Although the new Aged Care Act includes a Statement of Rights that outlines the rights older people will have when accessing aged care services, these rights are not legally enforceable. When a right is breached, the only recourse will be to make a complaint.

Thankfully, older people have the right to “live without abuse and neglect”. However, other important rights have not been included in the new aged care act, including the right to freedom from restraints. Despite the royal commission identifying an urgent need to respond to the significant over-reliance on chemical restraint in aged care homes, the new aged care act does not restrict the prescription of psychotropic medication or adequately address the use of restraints.

Most importantly, the Labor government has chosen not to implement the Royal Commission’s call for a demand-driven system providing universal access to aged care based on assessed need. The rights-based framework established under the new aged care act does not give an older person an entitlement to receive care. It only gives an older person an entitlement to an assessment.

Labor has introduced a Single Assessment System. It has also handed out nearly $1.5 billion to private operators to conduct aged care assessments. We now have aged care assessments being conducted by organisations that also deliver aged care support, a clear conflict of interest.

Catholic Healthcare, for example, operates 42 residential aged care homes and provides home care services to about 4,000 older Australians. It was awarded nearly $136 million to undertake aged care assessments until 2029. The Aged Care Royal Commission expressly warned against this, recommending that all assessments be undertaken by an assessor who was not involved in providing aged care so that a person’s level of funding would be determined independently.

After rejecting the recommendation to finance the aged care system through an aged care levy, the Labor government convened yet another taskforce in 2023. It was Aged Care Taskforce, not the Royal Commission, that recommended a funding model in which people should make a co-contribution to their care costs based on their ability to pay.

The new co-contribution funding model is primarily focussed on a medical not social model of care. While the new Support at Home program will cover costs of clinical care, non-clinical care such as domestic help and gardening will be subject to co-payments. The out-of-pocket costs for domestic and gardening services will range from 17.5% for full pensioners to 80% for self-funded retirees.

Assistance with showering has been categorised as non-clinical. The cost of a shower will range from 5% for full pensioners to 50% for self-funded retirees. If an older person cannot afford the co-payment for a shower, they may need to skip it. This not only has implications for a person’s hygiene but also their dignity.

While exceptions will be made for people who satisfy hardship provisions, the process of making the application with Services Australia will be difficult for some older, vulnerable people.

The aged care inspector general, Natalie Siegel-Brown, described charging fees for services that support social and community engagement as “inconsistent with the [new aged care] act’s approach to high quality care, particularly the importance of individuals participating in meaningful and respectful activities”.

After a royal commission that cost $92 million, and a Labor government that campaigned in 2022 on implementing aged care reforms, many of us expected genuine aged care reform. Instead, here we are again with media headlines declaring an “Aged Care Crisis”.

First published in Pearls and Irritations on 12 September 2025

Aged care “free market”

Aged care “free market” where a home care package deal masks a crisis

Seven years after Scott Morrison surprised everyone by announcing the Royal Commission into Aged Care Quality and Safety, media headlines are again describing an ‘Aged Care Crisis’. This is not surprising, given Labor’s “generational (my italics) aged care reforms” fail to address fundamental systemic issues.

These systemic issues began when the Howard government’s Aged Care Act 1997 encouraged an increase in private investment in the aged care sector. Private equity firms, new foreign investors, and superannuation and property real estate investment trusts entered the aged care ‘market place’.

Labor’s “Living Longer Living Better” 2012 reforms continued to treat aged care as a free market – describing older people as “consumers”. The 2016 Aged Care Roadmap called for “lighter regulation” and a “consumer driven and market-based system”.

Treating aged care as a free market led to the Royal Commission into Aged Care Quality and Safety because some providers prioritised profits over care.

The Royal Commission found the aged care system was based around “transactions” rather than care. However, the commissioners did not agree on the changes necessary to shift from a provider-focused system to one that places the rights of older people front and centre.

Across 148 recommendations, there were 43 points of disagreement between the two commissioners. While Pagone recommended fundamental systemic changes, Briggs did not. For example, Pagone recommended the creation of a new independent statutory agency — the Australian Aged Care Commission. In contrast, Briggs recommended the Department of Health added “and Aged Care” to its name.

Both Liberal and Labor governments accepted Briggs’ recommendations – thereby forgoing the opportunity for fundamental systemic changes to the aged care system.

After rejecting the recommendation to finance the aged care system through an aged care levy, the Labor government convened yet another taskforce in 2023. Most members of the Aged Care Taskforce were the usual suspects, ignoring Einstein’s adage “We cannot solve our problems with the same thinking we used when we created them”.

It was Aged Care Taskforce, not the Royal Commission, that recommended a funding model in which people should make a co-contribution to their care costs based on their ability to pay. In fact, co-payments are contrary to the recommendations of the Royal Commission that called for guaranteed access to aged care based on assessed need.

The new co-contribution funding model is primarily focussed on a medical not social model of care. Activities such as nursing care, wound management, physiotherapy, and medication assistance, remains fully funded by a home care package. In contrast, services supporting daily living and independence, such as domestic and gardening help, showering and lifestyle activities are subject to co-payments. The out-of-pocket costs for domestic and gardening services will range from 17.5 per cent for full pensioners to 80 per cent for self-funded retirees.

While exceptions will be made for people who satisfy hardship provisions, the process of making the application with Services Australia will be difficult for some older, vulnerable people.

Co-payments will undoubtedly undermine some basic rights for those least able to afford care. The cost of a shower, for example, will range from 5% for full pensioners to 50% for self-funded retirees. If an older person cannot afford the co-payment for a shower, they may need to skip it. This not only has implications for a person’s hygiene but also their dignity.

Much has been made of Labor’s new aged care act that will be introduced later this year. The new aged care act has been promoted as a rights-based framework for the delivery of aged care. However, Stephen Duckett described the new aged care act as “rights washing”. According to Duckett: “(The) high sounding rhetoric is simply there to placate consumers and advocates, allowing providers to continue on their way unimpeded.”

In her recent damning report on the progress of the recommendations of the royal commission, the aged care inspector general, Natalie Siegel-Brown, described charging fees for services that support social and community engagement as “inconsistent with the [new aged care] act’s approach to high quality care, particularly the importance of individuals participating in meaningful and respectful activities”.

The new aged care act does not confer an entitlement to receive care. A person is entitled only to assessment – not to receive the care they are assessed as needing. Again, this is contrary to the recommendations of the Royal Commission.

Why has the Labor government failed to deliver a new aged care act that genuinely enshrines the rights of older people who use aged care services – either residential or in-home care? Kathy Eagar offers a possible explanation: “The current government appears captured by the aged care sector itself and by a small group of Canberra public servants.”

After a royal commission that cost around $92 million, and a Labor government that campaigned in 2022 on implementing aged care reforms, many of us hoped that stories about an aged care crisis were behind us. Sadly, that is not to be.

First published in Michael West Media 9 September 2025

Let’s restore humanity to aged care

After the heart-breaking revelations of the Aged Care Royal Commission, I hoped stories of neglect and poor treatment of older people were behind us. Not so, thanks to the decision of some local councils to wash their hands of aged care services.

Just this week we have heard that thousands of vulnerable of older people have been left without home care after Mornington Peninsula Shire Council and Boroondara Council outsourced their services to corporate providers.

The Age

Profits over People: in-home care a cash bonanza for greedy aged providers

he only aspect of in-home care for older people that makes the news is the ridiculously long queue for home care packages. Flying under the radar is the chronic rorting, with corporate providers skimming off vast profits. 

The Aged Care Royal Commissioners noted that a recipient of a Level 4 home care package worth $53,000 received on average just 8 hours and 45 minutes of support. Surely this was a big red flag.  

Michael West

KPMG – A SIRs for home and community care settings

KPMG’s ‘A SIRs for home and community care settings co-design paper’ highlights that co-design is merely a buzz word in aged care.

KPMG SIRS co-design paper

I attended KPMG’s co-design focus groups on Serious Incident Response Scheme for home and community care. I have no words to describe just how bad it was. I don’t blame the facilitator – she appeared to be very inexperienced. I do however blame the federal department of health for commissioning this type of work from organisations with no expertise in genuine co-design of health and social services.

I wrote to the organiser to express my views of the focus group.

Hi [Name of facilitator]

I apologise if I was unduly critical of yesterday’s group discussion/consultation. 

I am committed to genuine co-design of health and social services, including aged care services. Not surprisingly, it frustrates me when organisations appropriate language without any regard for the practice that underpins a community engagement methodology.

When I read KPMG’s “A SIRs for home and community care settings co-design paper”,  I was concerned by the document’s lack of substance.  Do the authors have any expertise in home care? I attach my feedback to this document.

I have also included Mary Ivec’s feedback below. Mary self-manages her mother’s Level 4 HCP.

I read some of Mary’s feedback during the meeting. The participant who said “That did not answer the question” was correct. It didn’t. But I felt it needed to be said. 

Like Mary, I support relationship based regulation for older people who receive services in the home. I also agree with Mary’s comment about “natural circles of support” (i.e. family members, neighbours, church group members, friends, GP, pharmacy, podiatrist, medical specialist, dentist, and if no-one is around – community visitors)

Based on my research with over 100 older people and families who use home care, it is a mistake to model SIRS for home and community care on residential care – given the different capacity of residents in aged care homes and older people who receive support to live at home.

In my view, it is worth considering successful approaches to elder abuse in home and community.  For example, have you reviewed New Zealand’s restorative approaches to elder abuse? Or Senior Rights’ successful model to support those who have experienced abuse in home and community?

To assist with yesterday’s meeting, I collected some wonderful ideas from recipients of HCPs and CHSP. However, the questions you asked provided no opportunity to share these ideas. 

I had intended to thematically analyse this ‘consumer feedback’ but, after yesterday’s meeting, I see no point.