Policy, accountability and the road ahead
Bujari gamaru ('Hello' in Gadigal language).
This is special country – and I want to take a minute to reflect on what happened on this country for Millenia before there was ever a Mercure here.
This place sits on what was once a well‑worn path used by the Gadigal people to walk to Sydney Harbour – Warrane - to fish, gather food and meet with one another.
This path later became known as George Street, layered with history but grounded in the enduring connection of the Gadigal people to this land and waters.
I want to acknowledge the Gadigal Elders of the land on which we meet today, and I pay my deep respect to Elders past and present. I also acknowledge Aboriginal and Torres Strait Islander Elders here with us today, and thank you for the way you guide us, and shine the light as to how we should care for elders across this Nation.
Thank you to COTA for convening this conversation at a moment of genuine consequence for aged care reform.
As Inspector‑General of Aged Care, my role is to hold the Commonwealth to account for how aged care is designed, funded, administered and regulated.
My role is not to design programs. It is not to regulate providers.
But my role is to say, publicly and independently, whether what exists in practice is delivering on what has been promised in law.
And right now, nowhere is that test more important – or more exposed – than in Support at Home.
Today I want to argue that the way we currently fund aged care is economically inefficient and humanly costly, pouring resources into crisis response while underinvesting in what keeps people well and at home. My central argument is that upstream investment is not a ‘nice to have’, but the only credible path to sustainability in an ageing Australia.
Until we realign funding towards prevention, home care and relational support, no amount of regulation or goodwill will make the numbers – or the outcomes – stack up.
I want to say at the outset: the ambition behind Support at Home is not wrong.
A system that supports people earlier, helps them remain independent, keeps them connected to community, and prevents unnecessary escalation into residential care is exactly where a rights‑based aged care system should be heading.
The new Aged Care Act makes that direction unmistakable. Dignity. Agency. Independence. Ageing in place.
These are not aspirational slogans. They are now embedded in an Act of Parliament.
But law alone does not deliver outcomes. Rights are realised – or undermined – through funding structures, assessment mechanisms, price signals, and administrative design.
And that is where Support at Home is now faltering.
The failures of delayed access
The next thing that I want to say is that delayed access to care can be conceived as both a rights failure and an economic failure.
Delays in access may seem to manage budget pressures in the short term, but over time they can make the system more expensive and harder to sustain. Delayed access undermines wellbeing for older people and, at the same time, leads to higher downstream costs for the system.
The Single Aged Care Assessment System was meant to speed access and reduce duplication. Instead, we are seeing lengthy waits for initial assessment – 3-6 months is not uncommon.
And we can see the scale of this problem in the public record. Large numbers of older people are stuck at the front door - around 100,000 people are awaiting an assessment and about 130,000 are waiting for a package allocation - meaning more than 200,000 people are effectively held in the system.
We have also heard that people can wait up to 17 weeks to receive their full entitlements, and that a very high proportion of packages released were described as “interim packages” offering only 60% of assessed services.
Now, I’m not quoting those numbers to turn this into a contest of statistics. I’m quoting them because behind every number is a predictable pattern of escalation.
When people are left waiting with inadequate support, the system quietly runs a deficit we don’t record properly: function declines, carers exhaust, preventable crises occur, and people collapse into hospital or residential either prematurely or unnecessarily.
And at that point, the cost curve steepens – not because people have done anything wrong, but because the system has waited too long to intervene.
We can see the pressure building at the other end too. Residential care occupancy is at 94.4%, with projections of full capacity within three years.
There is also a structural mismatch: we cannot build enough ‘beds’ to find our way out of this problem if we keep under‑investing upstream.
I really don’t like the idea that people can be treated as ‘beds’ to see out their last years on Earth but, if I meet the government lingo where it’s at, our only hope is to slow the rate at which people need ‘beds’ in residential care.
So when I say delayed access is an economic failure, I mean this: delays don’t save money; they convert manageable need into expensive need. They trade prevention for crisis. And no system can remain sustainable if that is the trade it makes by default.
From a rights perspective, this is indefensible.
But from an economic perspective, it doesn’t seem to add up.
Because when people wait:
- functional decline accelerates
- carers burn out
- preventable crises occur
- hospital admissions increase
- residential care becomes the default rather than the last resort.
Put plainly: late care costs more than early care.
A system that intervenes late is not a constrained system; it is a wasteful one.
The problems with the Integrated Assessment Tool and the priority classification system go directly to this.
When professional judgement is constrained by a rigid points‑based model that struggles to recognise complexity, urgency is misclassified.
When only a handful of people are deemed 'urgent' out of more than 130,000 waiting, we have to confront a difficult truth: Either the threshold for urgency is unrealistically high, or the system is failing to see what is right in front of it.
And when urgency is misidentified, resources are misallocated.
Misallocation is not just a clinical or ethical issue; it is a budget integrity issue. Because resources flow after crisis rather than before it.
Simultaneously, we are seeing the emergence of perverse economic incentives that actively undermine ageing in place
Co‑payments are changing behaviour. They discourage uptake.
They cause people – particularly pensioners – to reduce or withdraw from care.
They push people to hold on until crisis.
Three‑quarters of people receiving home care are full or part pensioners.
When co‑payments land most heavily on those with the least capacity to absorb them, the outcomes can be regressive, regardless of intent.
And it is not only co‑payments themselves, but also the way pricing and complexity interact with co‑payments that matters. Work in our orbit has pointed to the risk that Support at Home pricing settings can unintentionally incentivise opaque and unreasonable pricing – undermining trust and creating uncertainty for consumers.
Now I must acknowledge something important. I have recently congratulated the government for strengthening access to essential home‑based supports like showering, dressing and continence care, because those supports are absolutely fundamental. They protect dignity, health and safety, and for many people they are the difference between coping and crisis.
But my argument today is that home care is much more than this, and that how we define it shapes how we fund it.
Seen properly, home care is a preventive investment: a bundle of supports that maintain independence and connection, delay escalation into acute or residential care, and demand a different way of thinking about value and return across the system.
When we say 'preventive investment', we should be explicit about what we mean, because prevention in aged care is not abstract.
My office is rigorously testing whether smarter upstream investment – such as home modifications and basic in‑home support – can enable more people to live at home for longer, while reducing downstream pressure and costs in hospitals and residential aged care.
The first phase of the work focuses on two supports that are already funded under CHSP and Support at Home: home modifications and in‑home personal care, including showering support.
But the broader suite of preventive supports goes well beyond that initial phase. The project scope expressly identifies other supports for possible future consideration, including social supports, carer support and planned respite, reablement and restorative care, nursing and allied health services, and nutrition and hydration.
That list matters, because it is the architecture of independence. Social supports reduce isolation and cognitive decline risk.
Carer support and respite delay burnout and the collapse of informal care. Reablement restores function after illness or injury and reduces the slide into dependence.
Allied health and nutrition reduce falls, frailty, and deterioration that becomes expensive once it turns into hospital presentations and premature entry into residential care.
And we will also look at home modifications, which we know are life‑enhancing and cost‑effective interventions that enable ageing in place safely, and can reduce or delay entry into higher‑cost and more intensive care.
But we also know that access to those modifications can be deterred by complexity and hidden costs, including dealing with councils, heritage restrictions, or bodies corporate; and, for renters, the legal complexity of negotiating with landlords.
Add in a front‑door that is hard to navigate – including a 'find a provider' journey that can return dead ends such as “No providers found matching your search criteria” – and what you get is a quiet but profound economic failure: a preventive intervention that could keep someone safe at home is delayed or abandoned, and the system pays more later.
This is the core shift I’m urging: to see home care not as a set of discrete 'services', but as the infrastructure of independence, and to fund it accordingly.
Financial hardship provisions
Before I get to where I think the heart of the solution lies, I want to talk briefly about how the system’s treatment of hardship as a 'backstop' – and not a safeguard – exacerbates all of this.
Financial hardship provisions are often held up as the safety net.
Early data suggests hardship applications are not an edge case, they are at serious risk of becoming a structural feature of Support at Home. In the 2 months before the program commenced on 1 November 2025, Services Australia received 1,429 hardship applications. In the 2 months after commencement, that figure rose by 88%, to 2,598 applications.
That is not a safety net being lightly touched. I think many would argue that it reveals a system signalling distress.
And it’s not just the volume that concerns us. It is the nature of the process itself.
Hardship applications are long, complex and administratively demanding. They presuppose capacity, literacy, energy, digital access and trust in government systems: precisely the things many older people do not have, particularly at moments of vulnerability.
People tell us they abandon applications, withdraw, or never apply at all – not because they won’t qualify, but because they cannot navigate a multi‑step, highly bureaucratic system that feels overwhelming, intimidating, or undignified.
For some groups, this is even more acute. We have heard that Aboriginal and Torres Strait Islander Elders – including Stolen Generations survivors – are disproportionately deterred by hardship processes because of historical and institutional trauma. ACCOs have reported elders outright refusing to apply.
What does this mean happens next?
When people disengage from Support at Home because they cannot afford care – or cannot navigate the hardship process – they do not disappear from the system. They return later, sicker, frailer, and with fewer options. And at that point, the only pathways left are hospital admission, residential care, or crisis responses that cost the system far more than timely, preventive support at home ever would.
In that sense, hardship reliance can actively undermine budget integrity. It delays intervention, accelerates decline, and shifts cost into the most expensive settings. A system that assumes hardship will absorb design flaws elsewhere is a system that is planning to pay more later – not less.
This is why my Office has said plainly that hardship should be the exception, not the engine of affordability.
A well‑designed aged care system does not rely on hardship pathways as routine correctives. It designs affordability upfront.
But it also incentivises uptake of prevention; it incentivises measures to age in place, upfront.
So here is the guts of my message: A system that wants to save money must make it easy – and attractive – for people to choose home care early. That means reshaping incentives and resetting public understanding, so aged care is seen not as a last resort in a facility, but as everyday support that keeps people well, independent and out of expensive care for longer.
We will not fix the economics of aged care unless we reward people for choosing ageing in place, at home, early – and stop letting residential care dominate the public imagination.
When people understand that aged care is about staying well at home, not just entering a facility, the budget benefits as much as older people do.
That is not a novel concept. It is ‘public health approach 101’, and it was the overarching finding of the Productivity Commission’s most recent Inquiry ‘Delivering quality care more efficiently’, which proposed a National Prevention Investment Framework that includes aged care.
When I talk about incentives, I don’t just mean a moral appeal to do the right thing. Incentives are the practical forces that shape what people actually do: what they can afford, what they can understand, what feels safe to take up, and what feels too complex to touch.
If we want timely uptake of home support – which slows decline and avoids premature entry into the most expensive part of the system – then incentives must push in that direction.
That means the system has to reduce the frictions that delay take‑up: uncertainty about price, complexity of navigation, lengthy waits, and the sense that seeking help is the beginning of institutionalisation rather than the support of living well at home.
And it means building public understanding that aged care is not synonymous with nursing homes. It is, at its best, the support that keeps people in their own homes and communities for longer.
It also means being clear about the stakes: residential care is the most expensive setting in the system, so every design choice that nudges people away from early home support is not cost control; it is cost deferral into a more expensive place.
That is why the Government’s changes – to make showering, dressing and continence support free of charge under Support at Home alongside clinical care – matters: it shifts one key incentive back toward early, stabilising support at home.
The question now is whether we follow that logic through: do we treat prevention as core fiscal infrastructure across the suite of home supports? Or do we keep designing a system where people are nudged, by cost and complexity, toward the most expensive end?
Reframing the budgetary question
This brings me to the heart of the economic argument, and why my Office has deliberately stepped into this space.
The problem government keeps describing is this: “The aged care budget is static, demand is growing, and the system is becoming unaffordable”.
But that framing encourages:
- rationing rather than redesign
- cost shifting rather than cost avoidance
- crisis management rather than prevention.
The Aged Care Act requires us to pose a different question: How do we use the existing aged care budget more effectively to support more people, earlier, so fewer people need the most expensive care, sooner?
That is not a theoretical question. It is a concrete economic one.
If we want the budget to stretch further, we must actively incentivise people to take up home care earlier - because the longer we keep people healthy and capably living independently at home is a saving in far higher residential costs.
Educating people that aged care is not synonymous with nursing homes is therefore not communications 'nice‑to‑have', but core fiscal strategy.
Preventive aged care economic project
This is why my Office has commenced a preventive aged care economic project.
Not because we are trying to make arguments to increase the budget, but because we don’t think the budget is yet working this way.
We want to examine whether the existing aged care budget is being used in a way that:
- serves the greatest number of people
- supports ageing in place
- preserves long‑term system sustainability.
Specifically, the project is examining whether investment in upstream, low‑cost preventive supports can:
- reduce downstream demand
- delay entry into residential care
- shorten average length of stay
- improve both equity and efficiency.
Our initial focus is on the following supports already funded:
- in‑home personal care
- home modifications
Why these? Because they are repeatedly identified – by older people, providers and advocates – as the supports that most often prevent escalation.
We are testing whether:
- current policy settings are inadvertently limiting access
- whether different investment patterns within the same budget envelope could deliver better outcomes.
This work is not just advocacy for human rights. It is economic accountability. It is about testing whether funding design and implementation align with the outcomes Parliament has mandated.
I want to say something directly to this room, because this reform will not succeed on legislation and rules alone.
Providers, community organisations, Aboriginal‑controlled services and advocates: You are the ones who see – every day – whether the system is enabling prevention, or the reverse.
Your work keeps people independent longer, keeps carers going longer, reduces avoidable hospital or residential care stays, and preserves dignity.
Those are not soft outcomes; they are the difference between a budget that collapses under demand and one that stretches further and holds.
If we want government – including central agencies – to listen, we have to keep making the argument in the language that matches the moment: prevention cannot be conceived as a cost pressure. It is the most credible strategy we have to keep the aged care budget working as hard as it can, sustainably.
And that’s why my Office will keep doing 2 things at once: telling the truth about where the design is undermining the Act’s intent; and rigorously testing whether different investment patterns within the same budget envelope can deliver better outcomes and better value for money.
Because the promise of the new framework is dignity, agency and rights; and the opportunity before us is to show, unequivocally, that those things are not in tension with fiscal responsibility.
They are the pathway to it.
The new Aged Care Act demands that we stop asking only how to ration a finite budget, and start asking how to use that $40 billion to prevent decline and support people to age well at home, so fewer people need the most expensive services, and they need them later.
That’s how the budget works harder, for longer, for more people. And it's how we ensure the plumbing matches the poetry of the Act.