Oversight, reform and the consumer voice: Advancing positive ageing in a changing system
Marni naa budni. Hello and welcome. “It’s good that you came.”
I want to acknowledge that we are meeting today on Kaurna Country, and I pay my deep respect to Kaurna Elders past and present, and to all Aboriginal and Torres Strait Islander people here today.
We are meeting here in Tarndanyangga - the place of the Red Kangaroo Dreaming, the creator ancestor who shaped the land. This area was a sacred central meeting place for the Kaurna people; a place where stories were told, law was discussed, decisions were made, and ceremonies were held. It was a site of gathering, knowledge‑sharing and collective responsibility, where Elders were central, authoritative and visible.
Age, in Kaurna culture, brought not marginalisation, but standing. Elders were not hidden away; they were present, listened to, and entrusted with responsibility for knowledge, culture and continuity.
I start here deliberately, because what I want to talk about today – system reform, oversight, and the future of ageing – is deeply connected to this older understanding.
When we talk about positive ageing, we are not simply talking about ‘services’ or ‘interventions’. We are talking about whether our systems allow people to remain seen, connected, respected and meaningful as they age.
My central argument today is simple: the future of ageing in Australia will only be sustainable if we design our systems around human connection, meaning and agency. And when we do that well, the dividend is not just dignity, but fiscal resilience.
Put simply: a system that invests in human connection and meaning is not only more humane – it is the only one that makes economic sense. And it’s promised by our new Aged Care Act.
That is not the system we have right now. It takes a complete re-founding of the system we have now, but we can make changes in the immediate term that actually mean the plumbing delivers the promise of the Act.
Let’s just pause for a minute on the poetry of the Act. The flurry of reform we are in right now is meant to bring the Act to life.
But the question I worry we have lost sight of is: What are we actually reforming for?
To reflect on that, I want you to hold one question quietly for a moment: When I am older, what will make my life still feel worth living?
I am going to guess that you’re not answering that question based on what services you’ll get or how many minutes of care you’ll receive.
But you’ll be asking yourself: “what will make my life still feel like mine?”
Because when I ask older people that question - the answers are strikingly consistent.
People say:
- I want to feel connected.
- I want to feel useful.
- I want to belong.
- I don’t want to disappear.
- I don’t want to be treated like a problem to be managed.
That, right there, is the heart of positive ageing.
It is a human, relational and social transition; one that systems should support, not flatten or medicalise.
Positive ageing is not a side project. It is a stress test for whether our system understands ageing at all.
Yet, over time, we have built systems that quietly tell a different story.
A story that says:
- ageing equals decline
- decline equals frailty
- frailty equals cost
- and – overwhelmingly now, cost must be contained.
That framing matters, because how we define the 'problem' determines the system we build.
When ageing is framed primarily as a frailty journey, the system responds late, expensively, and often in ways that strip people of identity rather than preserve it.
Now, for those of you who may not be familiar with my role, my job as Inspector‑General of Aged Care is to hold the Commonwealth Government to account for how aged care is designed, funded, administered and regulated.
My Office exists to ask a very simple but very uncomfortable question: Do the systems we run in practice match the promises Parliament has made in law?
The new Aged Care Act promises dignity, autonomy, respect, kindness, connection and inclusion.
Those are not aspirational words. They are commitments codified now in law.
So, the test is not whether the system is busy, or compliant, or administratively defensible.
The test is whether older people – in their own opinion – actually experience:
- agency rather than powerlessness
- connection rather than isolation
- identity rather than invisibility.
And that test matters deeply here at the Positive Ageing Summit.
Because this forum is explicitly about reconceiving ageing itself; moving from decline management to wellbeing, reablement and meaning.
But we will not get there unless system design catches up to that vision.
My concern is this: We have taken something profoundly human – ageing, care and dependency – and translated it into a system that struggles to handle the very things that matter most.
Not because people intended to design it badly. But because the system absorbed a quiet assumption about ageing, and then built itself around that assumption.
The assumption is:
- ageing equals decline
- decline equals frailty
- frailty equals cost.
Once that logic takes hold, everything else follows. Systems respond late. Support arrives only when people are already in trouble. Identity is narrowed to physical need, and cost containment becomes the organising principle.
How the current system undermines positive ageing
From where I sit, that logic plays out in 3 consistent ways, each of which undermines positive ageing and drives cost at the same time.
First, transactional systems crowd out relational ageing.
Our funding, access and regulatory design revolves more than it ever has before, around transactional tasks, minutes and outputs. These are easy to count and easy to audit. They make the system feel controllable to its administrators.
But connection, trust, continuity and meaning are not transactional. They are built over time, through relationships.
And those relationships are not incidental. They are what slow cognitive and physical decline, reduce anxiety and distress, strengthen resilience, and help people remain independent for longer.
When systems reward speed, throughput and constant rotation, they erode the very relationships that prevent escalation. What looks efficient on paper quietly generates higher need later. And they undermine the promises in the Act.
Second, late intervention becomes the default.
People do not typically enter the aged care system early, curious and supported.
They arrive exhausted and frightened, after coping alone for too long, after family support has burnt out, and after choices have already narrowed.
Not because they did not want help, but because the system makes early engagement complex, intimidating, and hard to navigate.
By the time support arrives, the work is no longer about preserving independence. It is about managing damage. That is not positive ageing. It is late-stage triage, and it is extraordinarily expensive.
Third, the system places the burden of protection on those least able to carry it.
We reassure ourselves that safeguards, like hardship provisions, exist. But they are complex and alienating and their widespread reliance means they are actually a pillar of the system, not an emergency backstop.
Their complexity deters engagement.
Trauma, cognitive decline, language barriers and digital exclusion make navigation unrealistic for many people.
When people disengage, they do not disappear. They re-enter later, through hospital admission, crisis intervention or by way of bigger costs to the aged care system: premature residential care.
Across all 3 of these failures, the pattern is the same. We intervene late, we strip agency, and we pay more.
Disconnection does not just harm people. It actually drives cost.
At the moment, we do not just fail to invest in connection. We actively disincentivise it.
Around 75% of people using Support at Home are part- or full-pensioners. They are, by definition, people with limited capacity to pay extra for support.
Yet when those same people try to access the parts of home care that are most directly about participation in life – getting out into the community, maintaining social connection, staying engaged and visible – those supports attract the highest co‑payments in the system.
In other words, the aspects of care most likely to preserve independence, purpose and wellbeing are also the least affordable, and therefore the most out of reach.
We have designed a system where social connection is treated as optional, discretionary, and expensive – while clinical and personal care is subsidised as essential.
That design choice has consequences.
When connection is priced out, people disengage sooner. Isolation deepens faster. Decline accelerates. And people enter higher‑cost parts of the system earlier than they need to.
By making social supports the most expensive part of the system, we are not just failing to deliver positive ageing. We are actively driving demand towards the most expensive forms of care.
That is not a market failure. It is a design failure. But it is one we can change.
This is the place where human purpose and fiscal logic actually converge.
We often hear the refrain from Government that demand is rising, and we receive the signals that the budget ‘will never be enough’.
The question should not be: How do we stretch a finite aged care budget to meet ever‑growing demand?
The better framing is: How do we use that $40 billion to prevent frailty, slow decline and support people to remain connected and independent, so that fewer people need the most expensive forms of care, and need them later?
This is where the Positive Ageing conversation is so important.
Because reablement, mental wellbeing and social connection are not 'nice to have' extras.
They are:
- prevention strategies
- demand management strategies
- and sustainability strategies.
That means fewer people flow into the tertiary, more expensive, residential aged care system – and sometimes not at all.
Residential aged care is the most expensive setting in the system.
Much of what drives that cost is how early people enter and at what level of acuity.
Every month that entry into residential aged care across the population slows, equates to millions and millions of dollars in savings.
A system that:
- supports independence rather than dependency
- intervenes early rather than late
- invests in connection rather than crisis
will:
- serve more people
- with shorter waits
- deliver fewer emergency escalations
- lower cumulative cost.
What shifts are needed?
In my view, 3 shifts matter if we are to make this become real.
- We must stop pretending that tasks alone equal care. If independence, continuity and delayed escalation are what we want, then funding and accountability must reward those outcomes.
- We must design to incentivise early, relational engagement. The 'front door' of the system must feel navigable, humane, trauma‑aware, and relational.
- We must treat community and connection as core infrastructure.
Connection cannot remain volunteer‑dependent, incidental, or unfunded.
Connection is not a soft outcome.
A system that invests in connection does not cost more. It costs differently – and it costs the whole system less over time.
Learning positive ageing from other cultures
Before I finish, I want to talk about what I see to be one of our greatest blind spots – and that is what we can learn from Indigenous and CALD cultures
You would know that many Aboriginal and Torres Strait Islander cultures – and many culturally and linguistically diverse communities – see ageing very differently.
In those cultures:
- Elders are not hidden away
- age brings authority, not invisibility
- older people are knowledge‑holders, carers, teachers, and stabilisers.
Ageing is not a retreat from society, but a deepening of contribution.
Care, in that context, is not about removing people from community. It is about wrapping support around them so they can remain in it.
To me, the core issue is that, as a society, we’ve lost these things – and we are asking government to fill the gap that, arguably, society’s values should fulfill. We aren’t going to fix society, but we are reinforcing the opposite message
Those cultures give us starting points to make our aged care system both more human and capable of delivering better value for money
The Act already promises these things; but the system hasn’t followed
The problem is not what the Act promises. It promises aged care that delivers positive ageing!
The problem is the dissonance between the promise and implementation.
You cannot deliver a relational system through transactional design. You cannot legislate dignity and then fund dependency. And you cannot promise connection while designing isolation into the architecture.
This is a big reason why we keep seeing perverse outcomes:
- people disengaging from home support
- entering residential care earlier than needed
- consuming the budget at the most expensive end of the system.
An economic alternative to support positive ageing
Now I want to apologise if I have made this sound like a doom and gloom story. It’s not.
My Office is doing the economic research work to demonstrate how we could make the very large amount of $40 billion go further – by asking a different question
How do we use $40 billion to prevent decline and delay the need for high‑cost care?
We have $40 billion. From where I sit, I see too much of that investment lost to red tape, over‑regulation and systems that only mobilise when people hit crisis; rather than preventing crisis in the first place.
At the same time, I hear a constant refrain that we don’t have enough beds.
I can see better ways to spend that keep people out of beds. Ways that don’t reduce ageing to beds. That see more people supported to live the life we are all attending this summit to see made real.
I want to see $40 billion spent to support reablement and connection instead of examples where a pensioner whose GP clearly sees they urgently need a $50 pair of crutches to stay independent at home is suddenly shown a bill for $1,800 and simply gives up.
This is not about spending more.
It is about spending upstream, where the returns are greatest.
So I want to leave you with this: Positive ageing is not sentiment. It is the smartest economic strategy we have.