Inspector-General of Aged Care Progress Report finds sector transformation not achieved
AHPA welcomes the Inspector-General of Aged Care 2025 Progress Report on Implementation of the Recommendations of the Royal Commission into Aged Care Quality and Safety. This third Progress Report comes four years after the Royal Commission’s findings and asks whether Commonwealth Government reforms have had the collective impact we should expect by now, and if we are on track to deliver the transformation the Royal Commission called for.
The Report concludes that on balance the answer is ‘no’, and that Australians cannot be confident that our aged care system will deliver the high-quality care and human rights envisaged by the new Aged Care Act.
The Report continues the critique by the Acting Inspector-General in 2024 that despite reforms, the aged care system does not implement what was called for by the Royal Commission – provision of a universal entitlement to aged care and services based on each person’s assessed need. Instead, aged care remains rationed, including via waitlists for both home and residential care.
The new Act will also require older Australians to contribute towards the cost of their care. These policies disadvantage the people who need services the most, as well as leading to unintended consequences like undermining the Government policy of encouraging people to live at home as long as possible.
AHPA has engaged extensively with the Office of the Inspector-General and it is pleasing to see the Report identify fundamental problems in what it calls the ‘architecture’ of the new system. Many stakeholders have experienced rushed or cursory consultations on important aspects of aged care, producing piecemeal rather than systemic change. These outcomes are associated with lack of a clear evidence base for policy decisions. The Report clearly articulates why genuine transformation cannot be achieved without returning to first principles and ‘how we know what works’. Because this did not happen, there are various weaknesses in the new approach, including failures to make the new human rights framework enforceable, encompass diversity, support those with complex needs and achieve equity for Aboriginal and Torres Strait Islander peoples.
Most significantly for allied health, the Report explains why the Act’s goal of high-quality care is not assured by the design of the new system. As AHPA advocated when the new aged care legislation was being developed, the Report recommends that delivery of high quality care should be enshrined in law, including in the Statement of Rights, and with real consequences if that standard of care is not provided.
The Report also continues the 2024 critique that allied health, as part of more holistic care, is disadvantaged by the focus of AN-ACC funding and mandatory benchmarks on only nursing and personal care. AHPA agrees that ‘non-clinical’ care is the ‘poor relation’ of clinical care, as it is not 100% funded by Government. However allied health services all have at least a clinical component, and yet three allied health services under the new Support at Home program have still been deemed to require consumer co-contributions. Other allied health care will in practice need ‘informal’ contributions due to consumer budgets or funding caps being too low, such as where significant home modifications are required under Support at Home; Some allied health may not even be funded at all, such as knee-ankle-foot orthoses. In residential aged care, allied health service provision is now the lowest it has been since data collection began, and under the new Aged Care Rules older people will continue to have to seek and at least partly pay for some services themselves.
The Royal Commission envisaged ‘care’ as being defined more holistically and fully funded by Government. For allied health, this requires recognising (as the Royal Commission did) the connection between reablement – maintaining or regaining function and reducing or preventing functional decline – as critical to older people’s health and wellbeing, and allied health care as the key to achieving this. Once this philosophical shift is achieved, Government must then address the current inconsistencies in how – or even if – allied health needs are assessed in both home and residential care, and ensure commensurate funding.
The need for policy decisions to be based on robust evidence is a strong theme in the Report, and AHPA agrees. Allied health care is often preventative or intervenes at an early stage. We know this not only benefits older individuals’ wellbeing and quality of life – it also costs less than unnecessary hospitalisations and avoidable moves to residential aged care. We therefore strongly support the Inspector-General’s call for proper and public economic modelling. Better data collection can also only improve mapping and strategic planning to address aged care workforce shortages. Most significantly, the impact of aged care reforms must be monitored and evaluated. If as the Report suggests, Government implementation of the Royal Commission’s recommendations has lacked a systemic theory of change and so necessitates retrofitting, then analysing what is working and what is not – and why – is critical to keeping faith with the Commissioners’ vision.