Aged care reform needs to be systemic, Inspector-General warns

A new statutory report from the Inspector-General of Aged Care has delivered a stark assessment of Australia’s progress in transforming its aged care system, warning that more action is needed to fully implement the recommendations of the Royal Commission.

The report, released on Thursday, highlights significant gaps between policy intent and practical outcomes, prompting calls for a renewed focus on systemic change ahead of the new Aged Care Act’s commencement.

Inspector-General Natalie Siegel-Brown emphasised that while there has been considerable activity, reforms have largely addressed isolated issues rather than driving fundamental change. She acknowledged the legislative commitment to person-centred care but stressed the need for these principles to translate into tangible improvements.

“There has been furious activity to make progress, but reforms have largely addressed isolated issues rather than driving the systemic change required,” she said.

“We now have legislated, unprecedented rights and person-centred care. This is a major achievement by any government. But it is too valuable to be just words on a page.

“This is our opportunity to work together and bring the Royal Commission’s vision to life.”

The Inspector-General’s report raises concerns that some implemented reforms may inadvertently create negative consequences.

Specifically, the design of co-payments under the Support at Home program risks deterring vulnerable individuals from accessing essential services, potentially pushing them into residential care prematurely.

Furthermore, the report critically examines the decision to ‘mainstream’ Aboriginal Community Controlled sector services for the next four years, arguing it runs contrary to the Royal Commission’s recommendations for a dedicated pathway.

This approach, Ms Siegel-Brown warned, risks undermining culturally responsive care and could lead to the loss of vital Aboriginal Community-Controlled Organisations (ACCOs).

“I want to make sure the legacy promised will be made real, and I know the government does, too. The new Aged Care Act 2024 represents an unprecedented commitment. Never before has legislation entitled older people to care that is kind, compassionate, centres respect for their life experiences, dignity, quality of life, mental health and wellbeing. But the reform actions the Royal Commission said were needed to bring this to life, are not yet there,” the Inspector-General said.

“Chiefly, questions still remain about how the human rights and high-quality care described by the Act, will truly be enforced.

“And while reform action lacks in some areas, there are others where the action taken may bring about unintended harm; the way in which co-payments under the Support at Home program have been implemented risks leading those most in need to delaying or declining essential supports, or even being pushed into residential care.”

The Older Persons Advocacy Network (OPAN) responded to the Inspector-General’s report, echoing many of its concerns and underscoring the urgency of addressing ongoing challenges.

Carolanne Barkla, chief executive officer of Aged Rights Advisory Service and OPAN South Australian member, emphasised the report’s role as a crucial benchmark for the sector.

“We welcome this report and its crucial insights and findings,” Ms Barkla said.

“The release of it is timely, with the new Aged Care Act commencing on 1 November, which is only weeks away.

“There are several challenges and risks that need to be addressed before we reach this milestone, and this is a useful report card for government and industry stakeholders to measure aged care delivery against.”

The report also points to a significant shortfall in mandatory training for aged care workers, particularly concerning cultural safety and trauma-informed service delivery.

Despite the Royal Commission’s recommendation for compulsory training as a condition of provider approval, the new Aged Care Act does not implement this model, instead making it a condition of registration that providers meet prescribed requirements. This, the report suggests, is insufficient to ensure a truly culturally safe and trauma-aware system.

Another area of concern highlighted is the gap between services available under the National Disability Insurance Scheme (NDIS) and those offered through aged care.

The Inspector-General noted that the transition between these systems must not leave older people with disability without critical support simply due to misaligned funding streams.

With the implementation of the new Aged Care Act postponed to 1 November 2025, Ms Siegel-Brown views this period as a critical opportunity. She urged stakeholders to reassess and realign reforms with the Royal Commission’s original recommendations, ensuring that the vision for a truly transformed aged care system becomes a reality.

The report serves as a clear call to action for government and the sector to collaborate more effectively in addressing these systemic issues.