From Compliance to Compassion: The Real Reason Behind Aged Care Reforms

The 2018 Royal Commission into Aged Care Quality and Safety placed intense scrutiny on Australia’s aged care system—revealing distressing truths that sparked debate, incited outrage, and raised serious concerns about older Australians.

During the inquiry, findings from the Commission discovered that  1 in 3 Australians accessing residential aged care and home care services—or over 30%—have experienced substandard care, mainly abuse and neglect. Regrettably, incidents of assault were as high as 13-18% in residential aged care, with a clear overuse of physical and chemical restraint in those settings.

Changing demographics, the types of care required by older people, and problems with access to the right care also posed significant challenges. 

The aged care sector is facing an increasing ageing population: it’s projected that by 2058, more than 1.5 million people will be aged 85 and over and will most likely require care. Such care is not a one-size-fits-all solution; it ranges from routine support to complex care, depending on the person. 

To make matters worse, the current aged care system is notoriously difficult to access and navigate. Many older people reported it as time-consuming, overwhelming, frightening, and intimidating, lacking helpful and comprehensive information. My Aged Care is the single entry point to government-subsidised aged care—forcing older people who may not be technologically-savvy or fluent to navigate digital systems. Add to that funding and regulation issues, which are often insufficiently addressed and leave older people vulnerable to losing out on care.

Most older Australians reported wanting to remain living in their own homes, a feat that has proven challenging given the lengthy wait times (as of 30 June, 2020, 102,081 older people were waiting for a package). And that’s not even mentioning older people from diverse backgrounds. Aboriginal and Torres Strait Islander people, people living in regional, rural, and remote areas, culturally and linguistically diverse (CALD) people, and LGBTIAA+ people often have trouble accessing non-discriminatory and appropriate care.

It wasn’t just concerns about the older people themselves. 47% of respondents to the inquiry said they had doubts about residential care staff, including understaffing, unanswered call bells, high rates of staff turnover, and staff not knowing the residents and their needs. In home care, one-third of people voiced unease about the continuity of staff and staff not being adequately trained. 

Additionally, 2019 findings found that there are 4.2 working-age people for every Australian aged 65 and over; by 2058, this will have decreased to 3.1, creating further complications. What’s even more distressing is how desensitised older people have become to the state of their care: they expect substandard care to be the norm.

All of these factors combined were a wake-up call for the Australian government and the community as a whole. A response was needed urgently. As a result, the New Aged Care Act was developed in response to the Royal Commission’s recommendations. Under the proposed New Aged Care Act, the strengthened Aged Care Quality Standards will come into effect.

Much debate has surrounded the release of the Act and Standards, especially as delays have continued. They were set to come into effect on 1 July 2024, then pushed back to 1 July 2025, and are currently slated for release on 1 November 2025.

But despite the controversy and delays, there is a shared desire to make genuine reform. The goal behind the strengthened Act and Standards is to address systemic issues and restore trust, moving from a tick-box compliance approach to a rights-based, person-centred one.

One common theme throughout the reforms was dignity and respect, control and choice, and high-quality, safe support. This theme is carried across the Standards, even reflected in their language. Let’s look at Standard One: The Person. As the first Standard, it immediately outlines that the person is at the centre of everything, viewing the person as an individual over their own preferences, needs, identity, and goals for their care.

It also represents the shift from task-oriented models, which view the physical completion of a task or support as the primary measure of success. For example, Annabelle supported Mariana with brushing her teeth, so Annabelle’s job was done. This old approach often stripped people of their dignity, as resistance to care tasks or other conditions was put down to ‘old age.’

In contrast, a person-centred approach looks at the person more holistically, encompassing their emotional, spiritual, and psychological wellbeing. For example, through a person-centred approach, Annabelle should ask Mariana how she would feel most comfortable brushing her teeth. Mariana could respond with her preferences and feel seen and heard. In doing so, her dignity and choices are respected.

Each Standard also comes with an explanation of intent and expectation statement to help clarify how providers should interpret and apply the Standards and outline what older people can expect from the services they receive. 

Star Ratings have also come into play, allowing older people to make informed decisions about their care. Aged care providers receive ratings from the people they support, which are available on a database for older people to search and compare providers based on key performance indicators.

A common misconception is that providers cannot comply with their new requirements under the Standards. But the move away from a one-size-fits-all approach means that providers will only need to apply the Standards based on the specific nature of the services they provide and their registration level. For example, Standard 7: The Residential Community does not apply to Home Care providers.

At the end of the day, the reforms have not been created to make life difficult for aged care providers and workers. Rather, they offer a hopeful vision for the future, with the end goal of creating better outcomes for older people and helping them live comfortably. Older Australians deserve compassion, safety, and, above all, the right to dignity and choice.