From re-triggering to repair: How lived experience should turn the new Act’s promise of trauma-aware, healing informed aged care into everyday practice – starting at the 'front door'
Womenjeka – coming together for purpose.
I acknowledge the Wurundjeri Woi‑wurrung people of the land on which we meet today, and pay my respects to Elders past and present. I extend that respect to Aboriginal and Torres Strait Islander peoples here today.
I acknowledge that conversations about care, safety, ageing and end of life are never just service conversations. They are bound up with identity, memory, belonging, culture, and what it means to feel safe in the world.
Thank you for inviting me in today.
I want to begin by saying I don’t take your trust lightly. For many of you, trust has not been a safe thing to give because it has been broken – repeatedly – by institutions and systems that were meant to protect you.
So, I want to pay deep respect to what you have lived through, and what you have carried – often silently, often alone, and too often without justice.
And I want to say this as well: I never forget the lesson you have taught this country. Not as an abstract 'policy learning'. But as a warning written into people’s lives – and into the obligations we now have to make sure harm is never repeated, in any new uniform.
I’m honoured to be invited here and I want to be careful that you don’t feel that I am speaking at you.
What I want to do today is two things.
First, I want to share the advocacy I’ve been trying to prosecute – in relation to the experience of people who have lived through institutionalisation, and what I think must change if the new age care reform promises are to be real.
Second, I want to talk about how we can raise our voices together – because I know raising your voice on your own is tiring. I want to recognise and thank you for your tireless advocacy.
You should never have had to do this work, but you have done it anyway. And I want you to know you are not alone.
I also want to apologise. Not in a ceremonial way, but in a way that names the moral truth: what was done to you should never have happened.
My career has been predominantly focused on child rights, and that is no accident. As a child, I learned of stories like yours, and that became the engine for my career – to make sure it never happens again.
I hear from you and I completely understand why, for many Forgotten Australians, the prospect of needing aged care feels like the prospect of re‑institutionalisation. That fear is not irrational. It is a rational response to lived experience.
That is why I have called this speech 'From re‑triggering to repair'.
The new Aged Care Act promises something profoundly important: trauma‑aware, healing‑informed care. It also promises agency – power over oneself, dignity, autonomy, control.
These are not 'nice to haves' for people who have survived institutionalisation. They are the foundations of safety.
But a promise in law only becomes real when it changes what happens on an ordinary Tuesday morning – when someone calls the system, fills out a form, sits across from an assessor, tries to navigate choices, or asks for help.
And at present, despite the mandate, there is a gap that should concern all of us. Trauma‑aware, healing‑informed care has been defined very little in practical terms. We don’t yet have shared clarity about what 'good' looks like on the ground, and we don’t yet have a clear picture of what enforcement looks like when trauma‑aware care is absent.
The Government has promised trauma-aware, healing informed care with very little prescription on what that means.
And that brings me to another design problem that matters enormously for this community.
In aged care, enforcing the right to trauma-aware, healing informed care – like all the rights in the new Aged Care Act - still largely depends on the person raising a complaint.
Now, complaints matter. Advocacy matters. Oversight matters. And speaking up should always be supported.
But for people who have experienced institutionalisation, relying on complaint‑triggered enforcement is a poor way of making rights real. Because it asks someone to do the very thing their history has made them feel they can never do: challenge authority, risk retaliation, risk disbelief, risk being labelled 'difficult'.
I can understand that for many survivors, a complaint process does not feel like a neutral pathway. It can feel like the old power contest again: you versus the system; your word versus their records; your experience versus their processes.
So, when we say trauma‑aware care is now a right, but the practical trigger for enforcing that right still depends on survivors taking on the burden of complaining, a reasonable question follows: How fair dinkum is it?
If rights exist in theory, but the pathway to enforcement is designed in a way that is least accessible to the people most shaped by institutional power imbalance, then we are not delivering rights. We are delivering rhetoric.
That brings me to the deeper issue I have raised repeatedly: the operating logic of the system has become increasingly transactional. Tasks. Minutes. Outputs. Units of service. We can measure those things. We can fund those things. We can audit those things.
But trauma‑aware care is not delivered through transactions. It is delivered through relationships. For survivors, that is not a preference. It is the difference between safety and harm.
We have a system that is largely delivered through increased rigidity and regulation. How we count things. My fear is that transactional care fragments the person. It breaks care into pieces so no one holds the whole story. It creates constant rotation, so trust never settles. It prioritises efficiency over attunement to a person’s subtle cues of anxiety or comfort. Speed over safety.
And that is precisely the environment in which trauma gets re‑triggered.
So let me put a proposition on the table. All care should be relational. But trauma‑aware care cannot exist without relational practice.
Relational care is what allows someone to be seen as a human being, not processed as a client.
Relational care creates predictability. It builds the small, repeated signals that tell the nervous system: you are safe. You are in control. You will be listened to. Your 'no' will be respected.
Relational care makes consent meaningful, because it’s not a form you sign. It’s a practice that happens, gently and consistently, in the moment.
Relational care also makes choice real. Because choice only exists when someone has the time and support to exercise it, and when a system is willing to accept it.
If we want the new Aged Care Act’s promise to become real, relational care cannot be treated as an optional extra. It cannot be what staff 'try to do' if the roster allows.
Many of you have described what it feels like when the aged care system unintentionally echoes institutional patterns – having your story extracted as evidence, being disbelieved or minimised, being required to repeat painful histories to strangers, being spoken about rather than spoken to, being told there is 'no choice' because 'this is the process'.
There are two acute pressure points where this occurs.
One is residential care, which can resemble institutional environments in ways that are deeply unsettling: congregate living, shared routines, limited privacy, unfamiliar staff entering personal space, reduced control over who touches you, when, and why.
The other is the front door itself: the intake, assessment and navigation pathway.
For many survivors, the front door feels like the old gatekeeper again; the person who decides if you qualify, if you are credible, if you deserve help. My Office wrote a review on the My Aged Care system, and this is what we heard from many people who share your experiences.
That is why accessibility is not just about wait times or websites. For Forgotten Australians, accessibility is also psychological safety.
Trauma‑aware care must begin at the front door. Not after assessment. Not after allocation. Not after a fight. At the front door.
We also have to be honest about capability. Very few providers – a great minority – have achieved Specialisation Verification for delivering tailored care for Care Leavers, including Forgotten Australians.
Now, I want to be clear: Specialisation Verification is voluntary. It is not the only way a provider can be trauma‑aware. And not having verification does not automatically mean a provider cannot deliver good care.
But the low number of verified aged care providers still tells us something important: specialist capability – visible, evidenced, and independently verified – remains thin across the system. And when capability is thin, the burden shifts back to the individual to find safety, to judge risk, to navigate, and to advocate – often when they are already depleted.
We also need to talk honestly about dependency.
For many survivors of institutionalisation, dependency is not just confronting; it is terrifying. It can feel like the first step back into a power dynamic you spent a lifetime trying to escape.
So de‑institutionalisation matters. Not as an ideological slogan, but as trauma‑responsive design. While de-institutionalisation was not something the Royal Commission into Aged Care explored, I am very passionate about it being instrumental to a fulfilling ageing journey; and taking the fear out of aged care.
De‑institutionalisation means designing care that maximises privacy and control; supporting care at home and in community with continuity and relationship; reducing regimentation wherever possible; and ensuring residential care, where it is needed, does not replicate the logic of the institution.
And it also means this: power must move. From the system to the person.
I want to widen the lens now, because this matters deeply.
Ageing is not just a medical process. It is a whole‑of‑person experience: social, emotional, relational and often spiritual. It should be a beautiful stage of your human journey; not one that is narrowed down to caring for the body you live in.
But, we have built systems that can be very good at managing bodies: medications, wound care, monitoring, clinical interventions. But people are not rosters. And trauma does not live only in the body. It lives in memory, identity, meaning, relationship, and the nervous system’s sense of safety.
As people approach the end of life, those deeper layers often rise to the surface. End of life is not just a clinical event. It is a profoundly human passage. Trauma‑responsive aged care must be able to hold that reality.
So what does trauma‑aware, healing‑informed care actually mean in everyday practice? I want to offer a set of commitments as a starting point. But I need to be clear about 3 things before I do.
First, these commitments are not intended to compete with the Aged Care Standards or with Specialisation Verification. They are intended to operationalise them; to translate what the law promises into what should be experienced in real life.
Second, many of these commitments are system‑wide. They cannot be delivered by providers alone – particularly the front‑door experience, information portability, and the way enforcement is triggered and tested.
Third – and most importantly – these commitments are only my idea. They are an offering.
The people who need to define what trauma‑aware, healing‑informed care truly means are Forgotten Australians themselves. These ideas may sound like an okay starting point, or you may want to start again entirely. That is not only valid. It is essential.
Because as you know, trauma‑aware care cannot be designed about you, without you.
Here is the offering.
First: 'Do no further harm' must be designed into the front door. People should not be required to repeat traumatic histories to multiple strangers. Consent must be real – including the right not to disclose.
Questions must be asked with care, and with clear explanation of why they are needed. Information should be portable, so people don’t have to relive their story at every handover.
The default tone must be: you are believed, and you are in control.
Second: relational continuity cannot be optional. Trauma‑aware care cannot be delivered by a constantly rotating cast of workers. Continuity is not a luxury. It is safety.
Stable care teams wherever possible. Rostering that prioritises relationship – not just coverage. Accountability for trust‑building as an operational requirement.
Third: consent must be treated as a practice, not a form. Consent must be ongoing. Touch must be explained before it happens. Choice must be offered even in small things. And when an older person withdraws, refuses, or becomes distressed, the question should not be 'how do we make them comply?' It should be, 'what is being communicated, and how do we restore their own personal sense of safety?'.
Fourth: power must be visible – and shared. Trauma is often about powerlessness. So, trauma‑responsive care must actively rebalance power: transparent decisions; genuine choice of provider and worker where possible; supported decision‑making; escalation pathways that do not punish the person for speaking up.
Fifth: care must include the emotional and spiritual domains. This is not about turning aged care workers into counsellors or chaplains. It is about facilitation: making room for meaning, connection, identity, culture, spirituality, reconciliation. It is recognising that safety is not only physical. It is existential.
I also want to speak directly about restrictive practices.
For people who have experienced institutionalisation, restrictive practices are not neutral risk‑management tools. They are experienced as control, coercion and very often, re‑traumatisation. Whether physical, chemical, environmental or procedural, restrictive practices can echo the very conditions under which earlier harm occurred.
A system cannot claim to be trauma‑aware while continuing to rely on practices that replicate institutional power and override autonomy. Reducing – and, ultimately, eliminating – restrictive practices is not just a clinical challenge. It is a moral imperative.
Any behaviour is a form of communication. It requires us to move away from asking, 'How do we control risk?' and towards exploring what a person is experiencing and how we create safety for them without stripping their agency.
And that shift cannot occur unless care is fundamentally relational, because restrictive practices flourish where relationships are thin, time is tight, fear dominates, rather than a human being to be understood.
As my Office moves into more focused work on restrictive practices in aged care, I want to be explicit: I intend to amplify the voices of Forgotten Australians and others who have lived with trauma.
Reform in this space must be shaped by lived experience, not just by risk frameworks or system convenience. Because those who have survived institutions are best placed to tell us what safety should feel like.
Finally, I want to come back to enforcement. If trauma‑aware care is a right, but enforcement depends primarily on people having to complain, then we have not solved the problem of power imbalance; we have replicated it.
Trauma‑responsive enforcement must not depend primarily on survivors re‑entering a power contest. We need assurance mechanisms that are proactive and observable; that test what care feels like, not just what policies say. We need a different operating logic.
So how do we advocate together?
I understand reform machinery. I understand how systems are built to keep moving, even when harm persists. But trauma‑responsive reform does not happen because the machine moved. It happens because the moral centre held.
If we are going to win hearts and minds, we do it together. By defining what good looks like. By insisting relational care is non‑negotiable. By measuring safety by how it’s felt – not just services delivered.
And we do it by creating accountability that does not rely on people exhausting themselves to be heard.
I am not interested in trauma‑aware care as a fashionable phrase. I am interested in whether an older person with your lived experience can walk through the front door of aged care and feel safe, respected, believed, and in control.
That is the test of this reform. And I want to work with you to make sure the promise becomes practice.
Thank you.