When the Anthony Albanese government’s new Aged Care Act 2024 came into force last November, it was promoted as the sector’s most significant reform in a generation.
Aged care minister Mark Butler announced it as a “new era of aged care”, built around dignity, choice and person-centred care. The law was Labor’s response to the Royal Commission into Aged Care Quality and Safety, whose findings exposed a system characterised by neglect, underfunding and poor accountability.
At the heart of the reforms was a promise that the elderly would be treated as rights’ holders, rather than passive recipients of increasingly hard to find care. The new Support at Home Program (replacing Home Care Packages) intended to help people remain in their homes longer, while exercising greater control over the services they received.
Seven months later what has emerged is an all-too-familiar story: Ambitious public policy promises colliding with the realities of privatisation, workforce shortages, algorithmic decision-making and chronic under investment.
As with the National Disability Insurance Scheme (NDIS), the consequences of outsourcing aged care to a privatised market are becoming apparent.
Doctors, advocates and older Australians have raised alarm over the new Integrated Assessment Tool, which uses algorithmic processes to determine support needs. Critics say it is generating unsafe assessments and denying adequate funding to people with complex health conditions.
Despite Robodebt and the fallout from automating NDIS assessments, federal Labor is proceeding with the plan, displaying a political arrogance that comes from a second-term government with no real opposition.
The Commonwealth Ombudsman is now investigating complaints about the assessment process, as a variety of parties demand urgent action to fix aged care.
Australians now have a legal right to aged care support, but given insufficient resources many are unable to access it. Current wait times expose the scale of the problem; in May the median wait time exceeded 365 days, meaning the elderly die as they wait for help.
More than 100,000 older people are waiting for approved home-care help, while hundreds of thousands remain somewhere in the assessment and allocation pipeline. Many more are simply waiting to be assessed.
The final report of the 2021 Royal Commission into Aged Care Quality and Safety said unmet need for services is one of the system’s central failures. Yet, five years later, the government continues to ensure the assessment process focuses on rationing help in the name of cost control, with urgency of need coming a distant second.
Private providers winning
The deepest flaw of the reforms is in the public-private structure of the aged-care sector itself.
As with health and disability, successive governments have increasingly outsourced responsibility for care to private and not-for-profit providers. While often presented as community or “faith-based” organisations, many of the largest operators are substantial corporate entities, managing extensive residential-care, home-care, hospital and palliative-care networks.
Religious organisations dominate large parts of this landscape, particularly in regional areas.
Faith-based providers account for a majority of residential aged-care services and home-care programs. They also operate significant hospital and palliative-care networks across the country.
The model creates a perverse incentive structure. When governments and the contracted private providers fail to provide timely and affordable home-care services, older people are more likely to be forced into residential care, hospitals or hospices owned and operated by those same providers.
The system rewards failure-driven institutional care while claiming to prioritise choice and control in ageing at home. It means elderly people’s “choices” come in second to the managed pathway through the increasingly privatised care economy. They end up at the mercy of private providers, waiting for care that often never comes.
Religious providers are notorious for cherry picking which publicly-funded health care they provide in their privately managed facilities. Go Gentle Australia published a report in January into end-of-life care in residential aged care. It found that the majority of residential aged care providers do not give voluntary assisted dying (VAD) the same support as other legal end-of-life choices, despite some states having had VAD laws for more than six years and despite the Aged Care Act rendering it unconstitutional to impeded elderly residents’ care choices.
Another example is Queensland’s new “public” hospital, the Mater in Springfield, which will cost taxpayers $638 million in the next four years. Mater’s management has said publicly it will refuse voluntary assisted dying care, abortions and contraception for religious reasons.
Commodities care trading
Perhaps the most contentious aspect of the aged care reforms was the expansion of means-tested contributions. Critics labelled it as a move to a United States style user-pays system.
The federal government initially insisted that existing recipients will be “no worse off” under the act and that only new entrants would face higher out-of-pocket costs under the Support at Home program.
Labor argued these contributions were essential to make the system financially sustainable as the population ages. Widespread outrage about $50 showers led to a backtrack, with it announcing in April it will unwind its co-payment model for in-home showering, dressing and continence care adding $1 billion to the cost over the next four years.
This is a drop in the bucket compared to the additional $18 billion over five years Labor has sunk into the unpopular AUKUS military pact.
The new Aged Care Act was, in principle, largely sound. Had governments not spent the last three decades corporatising public and human services so they could pretend to balance the budget, they might have pulled it off.
Under Labor, aged care, NDIS, housing, health and social services all tell the same story: Market-based systems that are supposed to meet complex and deeply human needs will, first and foremost, meet the needs of the market, not humans.
The results are predictable — soaring profits for some, endless waiting lists for others and society’s most vulnerable left to pay the price.
[Suzanne James is an advocate for voluntary assisted dying and has worked in governance, risk management and regulatory compliance frameworks.]