IF Australia’s elderly citizens could get a Level 4 home care package at the same speed they could be given a bed in a residential aged care facility “it would be a very different world”, according to an expert in the aged care system.

Associate Professor Craig Whitehead, a geriatrician and Director of Rehabilitation and Aged Care with the Southern Adelaide Local Health Network, told InSight+ that Australia has an aged care system “perfectly designed to give us the results we’ve got”.

“On the one hand, we have a rhetoric that says older people – and in fact, older people will say this – they want to remain living at home as long as possible, but we’ve designed a system that encourages them into care, which probably is more expensive in the long term,” Associate Professor Whitehead said in an exclusive podcast.

“And therefore, even though we’re underspending [on long term care generally], we’re also overspending on residential care facilities. And that is a real problem.

“I can find someone an aged care bed in about, on average 18 or 19 days, but to get an equivalent high level care package [in the home] is a year,” he said.

“That’s the problem. We regularly will see people who say, ‘I need more help’. We say, ‘yes, it’s going to take you this long to get it’ and they say, ‘well, I’ll go into care then’.”

Associate Professor Whitehead was commenting on a Perspective published by the MJA, authored by Dr Suzanne Dyer, Senior Research Fellow at Flinders University, and colleagues.

In response to a request from the Royal Commission into Aged Care Quality and Safety, Dyer and colleagues undertook a review of international approaches to the provision of aged care.

“Australia provides institutional long term care for almost 20% of the population aged [80 years and older], and 6% of those aged [65 years and older],” they wrote.

“This places Australia as the nation with the highest proportion of older people living in institutional care compared with 11 other nations.

“The relative use of institutional care, as opposed to home or community care, was also highest for Australia, with 52.5% of long term care recipients aged [65 years and older] and 58.6% of long term care recipients aged [80 years and older] in institutional care.

“This is in comparison to a range of 21.6% in Japan to 34.6% in the Netherlands for recipients aged [65 years and older], and 23.1% in Japan to 41.8% in Canada for those aged [80 years and older].”

When comparing the amount of money each country invested in long term care for the elderly, Australia did not fare well.

“The data indicate that in Australia a comparatively high proportion of older people live in institutions, with a relatively low financial investment in the whole aged care sector,” wrote Dyer and colleagues.

They also backed up Associate Professor Whitehead’s comments about waiting times.

“While many countries have wait lists for home care services, the wait times of over 12 months [in Australia] for home care packages at the approved level (for level 2 and above; ie, beyond basic care needs, providing low to high level care) may lead to premature admission to institutional care for some people,” they wrote.

“In November 2019, the Australian government announced funding of an additional 10 000 home care packages at a cost of $496 million. However, in September 2019, there were about 63 000 people waiting for an approved home care package, and an additional 49 000 people were offered, while waiting, a package at a level lower than that approved.”

Associate Professor Whitehead told InSight+ that the continuing divide between federal and state control of health, including aged care, was an impediment to improving the system.

“Is rehabilitation better serviced in an Australian context via the specialty services that exist funded by the states? Or is it better serviced in a Commonwealth-funded, aged care environment, which is generally constituted without a specialist focus?

“You probably need both. Unfortunately, in our Commonwealth/state divide, our older population sits right in the middle of that,” Associate Professor Whitehead said.

“You can understand why aged care has been a third-term priority for Commonwealth governments. You’ve got to be pretty confident or not too worried about whether you’re going to get to be elected.

“It’s a real challenge for government. And in a post-COVID world, will the Royal Commission have dropped down the agenda?

“Unfortunately, I think there’s a very real likelihood it will have, but we have to keep the conversation going.”


The funding of the Australian aged care system needs root-and-branch reform
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33 thoughts on “Aged care system “perfectly designed” for poor results

  1. Anonymous says:

    I just did my training in Cert III under the new reforms being introduced by ACSQC started my role as an AIN the facility was clean and beautiful however some of the staff were horrible toward me and the mostly the residents where digity and respect of choices were ignored I myself tried to put into practice my compassion and empathy which bothered the staff which they reacted with eye rolling and sighing to me the resident was inconvenience their time if you had to wait for their consent and responses for each task the existing staff clearly wanted to rush through their tasks and clearly the residents needs were neglected choices removed and that annoyed me even me trying to manditory report was difficult because I was shut down being new and was Intimidated by their HR staff , So I left and then later trying to be accused of changing the way they do and run things and trying to make it my fault.
    So why get highly trained if your set up to fail is the question , there are staff in the those nursing homes eventhough there maybe lack of resourses it should not affect the way staff treat the residents and costs absolutely nothing to be kind and show love and compassion to the poor vulnerable people, it is our job to make every effort to make them feel safe and protected in their homes and yes these ACRF are the residents homes and we are there to give them best they deserve.

  2. Anonymous says:

    Until our Elderly are valued and not seen as a commodity to be exploited then nothing will change.
    I have worked in aged care for at least 10 years now and sadly it is getting worse and not better.
    Our federal GOV denied there was a problem for years, ( knowing full well there is a big problem), and then when forced into having another enquiry come royal commission they have acted surprised but downplaying it all the way. We will never see change as long as our elderly are treated this way. CARE is now a business word and its meaning has been commercialised and has little resemblance to what Real Nurses and carers consider it to mean.
    I ca assure you that there are many of these people out there that would love to give the care and dignity that the elderly deserve but have no hope up against a commercial giant. Money is all that matters to these organisations.
    When I get to the point of not being able to take care of myself I hope euthanasia is legal and if its not, I know how to take care of it myself. Sorry but that’s how it is, I’ve seen enough. The way the system is going I hold out little hope it will change. our GOV just doesn’t seem to have the courage or care enough to deal with it.

  3. Dr. Chien-Che Lin, Palliative Medicine Specialist and General Practitioner says:

    In addition to asking ourselves whether we would put our parents in the Aged Care Facilities, we should also ask ourselves whether we would have our children working as nurses / carers in the Aged Care Facilities.

  4. Maggie says:

    What distresses me most as a “consumer”, “Carer”, “volunteer”, “ex-health admin”, is that all these comments are just so true – from the most highly trained and experienced (Lu Mykyta – I remember and knew well, the days you describe, before the public system was so massively reduced – “In SA in the late 1990s and early 2000s we provided comprehensive home-based care including rehabilitation, dementia support, falls and balance clinics, continence care and other medical. nursing, and allied health services, starting with comprehensive assessment and case management. Urgent needs were met urgently. The whole team was made up of public servants, strongly associated with a public hospital. We faced rigorous accreditation as health units.”
    Recent Home Care experience for an ailing husband, current volunteering in Res. Care leave me frustrated that there are soooo many people with the right intentions, but the system fails miserably. The “privatisation” aspect, even with “Not for profit” providors… the lack of cohesion amongst the stakeholders, the fragmentation of it all, just has to change. We need to “unite” to force the system to change

  5. Anonymous says:

    AIN is the main core of the Aged Care, been treated, paid poorly. Improvement need to start from there.
    All the profit usually goes to the private owner, management plus not effective Management.

  6. Ludomyr Mykyta says:

    The state that the system is in can be put down to bad government. A big part of it is due to short-termism. For half a century the Australian members of the International Association of Gerontology tried very hard to persuade the Australian governments of both persuasions that the population pattern that was evident in the Northern and Western European nations and the UK, where I was learning to be a geriatrician in the early 1970s was coming our way and that we should prepare to meet it, with the evidence of effective working models to help us plan like a proper welfare state. In SA in the late 1990s and early 2000s we provided comprehensive home-based care including rehabilitation, dementia support, falls and balance clinics, continence care and other medical. nursing, and allied health services, starting with comprehensive assessment and case management. Urgent needs were met urgently. The whole team was made up of public servants, strongly associated with a public hospital. We faced rigorous accreditation as health units.
    The ageing population had arrived before the Hockey budget of 2014 revealed it. The demolition of the public service was nearing completion and the business model replaced it. The NGOs for all their rhetoric are now businesses first and foremost. Money that is intended for people in urgent need of services gets spent on infrastrucure and the need to show a profit. This is one of the meanings of trickle down, We don’t need forensic accountants to prove it. It’s obvious.
    The Royal Commission refuses to hear that the System is now the problem, and will tinker with the status quo. its long-term contribution will be negligible unless it looks at all the factors that are causing and perpetuating this sorry situation.

  7. Yolanda Newman says:

    I have been waiting 2 years for a level 3 package. I have a level 1 package currently which costs me approximately $300 a month. I recently contacted my federal MP to ask for assistance with processing my level 3. I have no intention of entering a nursing home but the $300 a month is a lot on a pension.

  8. Anonymous says:

    The tone of this article is close to the truth but the figures aren’t quite right. The waiting times for home care packages are worse. It’s actually 1.5 to 3 years for high level (level 3 – 4) Home Care Packages (unless a person is one of a small minority who get “high priority”). It’s 9 – 12 months for a Level 2 and 3 -6 months for a Level 1. And it’s never been easier to get a bed in an aged care facility. Occupancy rates have never been lower…currently under 93%.

  9. Anonymous says:

    I care for 2 elderly people in my home, 1 quadriplegic, 1 Alzheimer’s sufferer. Have highest homecare package for quadriplegic, who gets 3 showers per week, 4 bed baths per week, 1 SPC change per month. Level 4 package is not sufficient to pay for this. As primary carer, I administer enemas, lift out of bed for showers, provide all meals & feed patient, administer all medication, arrange medical appointments & get patient to them. Alzheimer’s patient is on level 3 package, but unwilling to accept anything that I don’t do, apart from some physiotherapy & gardening. I am younger than both, but in my 70s. The ravages of Alzheimer’s can make it difficult to give adequate care to both at times, but the prospect of residential care is terrifying to all of us.

  10. Anonymous says:

    Reading your stories is soo sad.. I’m a Carer an have been for 20+ yrs.. an know a good Carer is hard to find. I work in an Aged Care facility of 160 Carers .. out of that 160/16 would l have look after my 85yr. Mother.. l feel sad every day l work.

  11. Anonymous says:

    As a child of 14 (56 years ago) l did work experience in the local aged care home once a week. I was intrigued by the elderly folk. On leaving school l nursed in nursing homes for many years in SA and NSW l loved it, most of the staff were there for the same reason. These days it seems a large amount of the staff are there for the money, as jobs are hard to get and aged care is easy to get into. Same reason as the owners, that claim NOT FOR PROFIT What a lot of crap that is. How about one family owning an aged home and own 3 Ferraris. Bring in the forensic accountants PLEASE. In the past 8 years l have nursed my father for 5 and my mother for 3 years 24 /7. She deteriates more every day and is almost 90 now. I absolutely refuse to put her in an aged care home. 3 times l have put them in aged care for respite, and pulled them out early twice, due to lack of care and neglect. The stories l could tell. Something needs to be done NOW. Unfortunately those that could do something choose to do nothing. YES l agree the aged care system is, ” perfectly designed for poor results”

  12. Anonymous says:

    Hey, I think I’m with Nicola Emanuel. Make VAD legal, and make it able to be fun, like her example. Who does it hurt..? No-one. But you can imagine what the nay-sayers would have to say about the concept.

  13. Elaine says:

    I am half way through Certificate III course in individual support, Aged care. Things I am already very aware about are facilities are chronically understaffed, most PC workers have atleast 2 jobs as they’re so poorly paid. There appears to be a total misconception by Goverments Federal and State that training people through courses similar to what I am doing will improve the situation. I have found the course reasonably difficult, very time consuming and quite daunting when we cover so many aspects that we need to be trained in re: having to provide financial advice, help clients to apply for further funding, comply with legal requirements to name just a few. Many sad undignified incidents observed in 2 weeks of work placement. Everyone in these facilities has had to come up with atleast $500K to have a room the size of an average single bedroom with shared bathroom, no wonder their homes have been sold to get access. (Oh yes, once their home is sold there’s no where to go back to) As a 64yr old female I am personally inspired to stay out of these places as a person receiving “Care” for ever.

  14. Anonymous says:

    Ass. Prof. Whitehead is right. My relative living alone with dementia died before his Level 4 package “came through”. Another friend was admitted to residential care before the package that he had been assessed for “came through”. I would refuse to be admitted to any private, for profit, aged care facility. I intend to put this in an advanced care directive. I would also decline a lot of church run services. I would rather self euthanise as would many friends of similar age

  15. Kathy Eagar says:

    The idea that there is a low bar to get into residential care is not supported by our evidence. We independently assessed over 5,000 residents in care homes when we did the AN-ACC study in 2018 and the overwhelming conclusion is that they are an extremely frail, high need group. Only 15% are independently mobile (and this 15% mostly have significant cognitive and/or behavioural problems), 50% need physical assistance to get around and 35% cannot mobilise. The Home Care Package model is broken and needs to be fixed. But I don’t think there is any real evidence that significant numbers of people are going to residential care when there were other real choices. Residential aged care is no longer a lifestyle choice. That said, I do think we have evidence that many people in receipt of both residential and home aged care are not getting medical rehabilitation services they should be getting and would benefit from

  16. Anonymous says:

    I agree councils with home care hacc did the best job. Now most councils do not have funds and private providers take out up to 69 % out of your package and yes they push clients to sign up even if family are not there even clients with dementia
    You need to be with your family listening to what they say and research some more before you sign
    I work in aged care see this all the time now Its all about the money.

  17. A/Prof Ralph Hampson says:

    Here is a piece I wrote for The Conversation on this issue –

    “Most older people want to stay at home as long as they can. When this is no longer possible, they move into residential aged care facilities, which become their home. But Australia’s care facilities for the aged are growing in size and becoming less home-like.

    In 2010–11, 54% of residential aged care facilities in major Australian cities had more than 60 places, and the size of the average facility is growing.

    Today, more than 200,000 Australians live or stay in residential aged care on any given day. There are around 2,672 such facilities in Australia. This equates to an average of around 75 beds per facility.”

  18. Anonymous says:

    The whole system needs a total overhaul from carers nurses ect especially in dementia section some of the residential care facility need the authoritys to have a look at there is a royal commission but don’t see much change.

  19. Anonymous says:

    It is all about profit.No two ways about it.
    An executive in aged care is on more money than the prime minister.
    An executive is performance based on profit.Profit is government money per resident (subsidies ),resident fees and accommodation bonds.(Interest)some dont go any where near a resident ! And then they whinge about no money to care for residents !
    Absolutely a system in despair.Needs a big overhaul.

  20. John mccourt says:

    I have cared for my wife at home since she had a devastating stroke in 2007!.I am 69 ,and starting to find it increasingly hard to care for her due to back ,hernia and age related conditions .we applied for a homecare package and were a assesss ed for a level 3 my 2 year wait $5000 a year cost to us and after all her other medical supplies ,fees fees fees we would have got 2 hours a week..I lose the carers allowance @ 89,C an hour (70) hours a week I put in so we told them to shove it lol .they charge $62 an hour weekdays And $72 after hours and weekends .

  21. Anonymous says:

    I had to deal with my mother being in aged care and all the heartache that came with it. Many aged care workers are underpayed, under qualified and without an empathetic bone in their body. The good ones are run off their feet trying to meet ridiculous deadlines and targets. It really opened my eyes and I tell anyone who will listen to VISIT THEIR LOVED ONE AS OFTEN AS THEY CAN AND AT DIFFERENT TIMES OF THE DAY/NIGHT because “they” cover a lot up and tend to “blame” it always on the resident NEVER on the carer. If your loved one tells you a different story from what they say happened dig deeper TRUST ME. They are quick to use the “dementia card” !!! 1 star or 5 star rating they are all the same once you remove the furniture and decor.

  22. Anonymous says:

    HCP are a rort that seem to benefit the providers more than the clients. I work in the community and assist our elderly clients access services. There are over 50 HCP providers and more popping up every day because they see this as easy money. The elderly in the community are supposed to navigate their way through all these HCP and determine which is best for them. The HCP providers are also made aware when a person has been approved a package and they’re like wolfs at the door calling trying to get their business.
    It seems to me that the Gov has decided they would rather outsource and make it someone else problem ACAT/RAS have quotas/KPI regards the amount of assessments required, they then advise that a package is necessary, but the client is forced wait for over 12 months to receive assistance. I have had many of my clients say, they think the Gov hopes they’ll be dead before receiving funding, that way they wont have to pay.

  23. BarryB says:

    Governments should tell people getting home care packages how much the government will charge them before signing any home care agreements.

  24. Anonymous says:

    Just going through this nightmare now. Impossible system, a good theory, but it’s ok if you don’t get too sick, too quickly. The time to get an assessment then back to Gov. then wait for support is absolutely ridiculous. Then with the support through, to get someone to help is useless. Not happy. It will be better just to die here than go through this. They will be old one. !!!

  25. V Eldridge says:

    I could not agree more that the previous system worked better. Older people want to stay in their homes. Nursing homes are all about profit not care. There are aged care services still denying access to family members in care (appauling). My friend’s mother just passed he was not permitted to see his mother devasting.

  26. Nicola Emanuel says:

    Bring in euthanasia.
    Stop the elderly from suffering.
    If they have had enough of life , let them choose to go. Dying or not.
    Do it as a out patient hospital.
    Charge a fee.
    Make it like a wedding, they can have the people who they like around them, have a small celebration, flowers, favorite pet, etc.
    Have different packages.
    It can be a beautiful way of leaving this world.
    Booked for different amount of time.
    When the person is ready, they buzz in the Dr/ Nurse/ scientists???
    If they change their mind, they go home.
    They had a lovely day one way or another.

    The Government gets a few, the Out patient hospital gets a fee and employment for providing the packages.
    Everyone wins!!!

  27. Barry pratt aged 80 says:

    It’s not about funding
    It’s about getting rid of and prosecuting the criminal people in and operating the old age system. Jail those responsible for criminal acts and criminals who are there to only fort the money and funds and don’t care about how the elderly are treated.jail them.
    Even criminals who kill the old people are NOT charged or prosecuted. No one is properly trained.i mean NO-ONE.
    ITS ALL about which CROOK makes the money,as the incapable governments keep on pouring the money in and not checking.
    CORRUPTION AT ITS BEST. That’s the best way to describe the elderly system in australia. The elderly will always suffer while the incompetent governments keep up the rubbish way the providers and carers treat the elderly.do criminals always win ???????

  28. Anonymous says:

    Over the last 2 years I have been grappling with how to manage the application process for NDIS to cope with my complex physical and mental disabilities. Unable to face the daunting and overwhelming task, I could not do so, even with family support.
    So I am waiting to turn 65 years old to apply for in home aged care assistance, knowing it will not meet my needs, is not well funded, and has a long wait time for services. Little is said about the stress trying to obtain assistance places on clients and their families, if indeed they are lucky enough to have family support.

  29. Anton Hutchinson says:

    It doesn’t matter if you approve of residential care or not but it is likely to be part of our lives when living alone at home fails.
    Lots of talk about “our society”, what society exactly are you talking about? Does “society” expect the government to pay to take Nan shopping or to mow Pops lawn? That’s not society, that’s a lot of people living together and nothing like a society. What happened to the kids and grandchildren doing these jobs? Do not tell me they are busy! The population has never been less busy and laziness is the issue. The planned expansion of home care, while Utopian, is simply unaffordable. At the same time absolutely necessary residential care is underfunded to a chronic degree.
    Why doesn’t someone ask the Government why they aren’t fixing their mess? Why don’t the seven associations force the repairs needed. What’s the agenda here?

  30. Wynne. Tucker says:


  31. Anonymous says:

    No argument there Barbara. It appears to be a national pandemic, if I can use that word advisedly, that if it is possible to make a system – any system – complicated and illogical, that is the pathway this country almost inevitably follows. Not sure why…but it does.

  32. Andrew Renaut says:

    It’s the same with many things. If people with obesity could get a life-coach for 3 months (at a cost of $25000 which is the cost of a sleeve gastrectomy) with the same speed that they can get a sleeve gastrectomy in the private sector, then the world would be a completely different place. Firstly there would be no need to do that ludicrous operation. I’m a gut surgeon BTW.

  33. Barbara Connor says:

    For over 13 years I worked in local gov Home and Community Care program and before that a NFP provider of home care services. The original HACC program was beautifully simple and uncomplicated, a local council assessment officer went to clients after receiving a referral from either the client/ family or health professional. Then there was the case managed clients, those with complex health, isolated and/or cognitive impairment. The only reason people need HCPs is if they can’t coordinate the services themselves. Then along comes My Aged Care and Fed Gov takes over the funding. What we saw was an extraordinary amount of clients being referred for HCPs unnecessarily. They did not have any cognitive impairment, they had family support and needed only basic assistance available under CHSP. Instead, the HCP waitlist blew out and private providers moved in to collect the case management fees for doing close to nothing. Clients on Level 4 HCPs hardly heard from their case managers but were having enormous amounts of money taken from their packages. At the Royal Commission someone referred to the private providers as bottom feeders, an apt description.
    Home care needs to be in the hands of Government, the CHSP and HCPs put back into local government as in Victoria, with full funding, so no expense to rate payers. The support workers were fully trained, with First Aid certificates and a high level of compliance was expected. This ensures quality and safety for the residents. I have heard stories of poorly trained male support workers being sent to undertake personal care tasks like showering on elderly, frail female clients, something the 2 providers I worked for would never allow.
    Both CHSP and HCP need to be stripped back to a needs based level, with simple fee structures and efficient administration.

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