Older man talking with health worker at kitchen table with food

Reforming aged care: a practical plan for a rights-based system

by Stephen Duckett, Anika Stobart and Hal Swerissen


Australia needs a new aged care system. Spending an extra $7 billion a year could provide all older Australians with the care and support they need.

The current system has let down older Australians, with unacceptable waiting times for home care, shocking stories of neglect and abuse exposed by the aged care Royal Commission, and hundreds of COVID-19 deaths among aged care residents.

A new Aged Care Act should create a rights-based system that guarantees care and support for all who need it.

Australia should be divided into 30 regions, each with a ‘system manager’ responsible for individual support plans for older Australians in their area. Each older Australian would have the help of a local ‘assessment officer’ to draw up their support plan, and a local ‘support manager’ to act as their advocate in obtaining necessary services.

Many more Australians would receive care and support in their own homes. Rogue proprietors of residential aged care facilities would be driven out of the system. Aged care homes would have to meet minimum resident-to-carer ratios, and provide nursing supervision 24 hours a day. Carers would be registered, better trained, and better paid.

Residents of aged care homes would contribute to their accommodation costs by paying rent, but a means-test would be applied to ensure people who couldn’t afford the rent would pay less or not at all.

The Grattan model would require the Federal Government to spend 35 per cent more than the current failed system – an extra $7 billion a year – and even more in coming decades as Australia’s population continues to age. But it would also create an extra 70,000 jobs, not just improving care but boosting the economy after the COVID recession.

The new system should be phased in over three years, starting next year with a trial in the two smallest states, South Australia and Tasmania.

But before then, the Federal Government should create a one-off $1 billion national ‘rescue fund’ to force the worst providers of residential care to lift their game or get out of the system.

Australians already have universal access to health care via Medicare, and universal access to disability support via the NDIS. It’s time older Australians had universal access to aged care.

Australians should be ashamed of aspects of the present aged care system. This report provides a blueprint for something we could all be proud of – an aged care system that protects the rights, upholds the dignity, and celebrates the contribution of older Australians.