Changes to the federal Aged Care Act 1997 were implemented in November 2025. However, some recipients of care still feel let down by providers, calling the system “unforgivable”. (Image: Jomarc Nicolai Cala)

By Leia Vlahos | @leiavlahos_

“It’s disgraceful” is what 94-year-old Joyce Poole had to say about the current state of aged care in Australia. Poole has been assisted by a well-known home service provider for four years and feels let down by the quality of care she and many others have received. 

“Where does the word care come into it?” she asks.

“They’re supposed to care and don’t.”

Poole recounts a summer Sunday after the reform, when her fridge broke down. With growing concern about her groceries going off as the ice in her esky melted, she had a new fridge delivered and needed help with assembly. Poole was promised help on Monday by a carer she’d never met, despite the carer being assigned to her for six months.

Poole waited on Monday, Tuesday and Wednesday but heard nothing from the home service provider. 

On Thursday, she lost hope in the promise. She received a phone call at 9am from the carer saying Poole did not have the funds to purchase a new fridge. This was a miscommunication — Poole’s carer didn’t listen and thought she needed help buying a new fridge.

Poole “saw red” at her needs being disregarded and thought of those in need of more help than a faulty fridge. As she recollects the story, she shifts in her padded armchair and lets out a groan. She sits in silence for a few beats, recollecting herself through the uncomfortable wave of pain.

“I slammed down the phone and I cried,” she says, hands trembling slightly as she smooths out her gown, trying to keep her cool through her recollection. 

“Somebody could have died and you wouldn’t have known because you never came.”

On November 1, 2025, the Australian Government implemented changes to the Aged Care Act 1997 (Cth) to include a new set of rights and co-funding between the government and the consumer to improve accessibility and relieve waiting lists.

In 2023–24, about 835,000 people were assisted under the Commonwealth Home Support Programme. Prior to the changes, the government would contribute more to individual aged care plans, but now, the individual pays more. 

Adelaide University Professor of Elder Law Eileen O’Brien says there is a catch to these new rights: they are not enforceable by law.

“For the first time, older Australians in government-funded care have a set of named rights, but the practical means of enforcing them are so limited that many people will find those rights mean little when things go wrong,” she says.

“It is genuinely cruel to tell people they have rights and then design a system in which those rights are practically impossible to enforce, and in which failure to provide care does not result in any sanction unless the harm reaches the level of serious injury or death.”

A person’s access to the federal government’s subsidised aged care is assessed according to their needs through a numbered ranking system — from one, requiring the least assistance, to four, requiring the most. Poole was receiving a level one package before and throughout this incident. 

After she was bumped up to level two, the standard of care shifted entirely — Poole suspects it was because she had money to spend. She is disappointed that despite being moved up a ranking and having more funds to spend in her package, she still is waiting on the everyday care she needs.

“All you hear is [no because] you haven’t got enough money,” she says. 

“Then suddenly [your ranking goes up] and they can’t help enough.”

Poole believes there is too much disparity between the funds provided to level one and level four recipients.

“[That rating] makes all the difference in the world,” she says, waving her hands in the air, emphasising her point. 

“Now, I’ve got all this money but I’m still waiting four years on a walker [for mobility to be fixed].”

Former Chief Executive Officer of not-for-profit aged care provider UnitingSA Jenny Hall acknowledges that many are facing long waiting lists for care in the industry with minimal help from the reform. 

“That’s really tough… We’ve heard from a lot of people that they’re really frustrated,” she admits.

O’Brien believes many of the explicit goals of the reform, such as reducing extended waitlists, are being missed by a considerable margin.

“A waiting list of over 120,000 people is not a minor administrative inconvenience: it is a gap in care that mirrors exactly what the Commission identified… older people falling through the cracks of a system that was never adequately resourced to meet demand,” she says.

Hall believes those receiving support at home felt the biggest impact of the law reform.

“Sometimes, I think this system is just focused on the transactions when it should be about relationships and value and meaning and showing respect to older people,” she says.

The reform altered the way aged care is funded, with most Australians expected to pay more for in-home and residential services. Prior to the changes, advocates were concerned about recipients receiving the same amount of funding, with the same or less services provided, due to the increased costs.

O’Brien says several government promises have gone “sideways” since the reform commenced.

“For people already in the system, the government promised a ‘no worse off’ principle, meaning budgets would match or exceed previous funding and unspent funds would carry over,” she says.

“In practice, many people have reported unexpected cost increases and confusion about what they are actually entitled to.”

This follows the 2021 Royal Commission into Aged Care Quality and Safety which found the “aged care system is failing its older people notwithstanding the extent of the Australian Government’s involvement, regulation, participation and control”.

“It is essential in understanding why the system has developed as it has to realise that decisions made by Government, when working as it should, are influenced by costs,” the report said.

“The consequences of these decisions can be serious, especially for the marginalised and disadvantaged.”

Hall believes that some royal commissions can do “so much damage”, such as focusing on care failures and applying those failures to all providers, leading to a cynical public view of the industry. 

“[At UnitingSA] we wrap everything around what would be great for the client, for the person living with us,” Hall says.

In her view, the public’s assumptions often do not consider the financial pressures providers are navigating.

“I think the government is not… [prioritising] care minutes, and I think they should because it’s something I care about and think is really important,” she says. 

Care minutes refer to the number of minutes a person requires care from providers.

“For governments to recognise that and to include those staff in the minutes of care so they’re recognised and funded, that would be a big improvement in terms of what older people want,” she says.

“We support all the intentions of the reform, but I think the actual costs and funding of it doesn’t necessarily meet the requirements for us to be able to deliver that.”

According to the royal commission, approximately 80 per cent of Australians use an aged care program at some stage before their death. South Australia had the highest per capita usage among older people for permanent residential care.

“People ask me, ‘why do you care about pensioners?’” Poole recalls.

“Well, because nobody else does.”

She says her limitations are purely physical as her brain is still sharp.

“I’m luckier than most, I know I am,” she says.

“It’s very tough to be old when you’re falling apart at the seams.”

She empathises with those receiving care who are unable to constantly follow up or correct the constant mistakes made by the care providers.

Hall understands that consistency is of the utmost importance for those like Poole who receive support at home.

“That’s the thing that older people want: they want that relationship, continuity. They want to know [their carer] is a person they can trust,” Hall says.

“They want to know [their regular carer] is the one coming and it’s not going to be some anonymous person rocking up who they’ve never met.”

Poole doesn’t blame the individual carers for the issues imposed by a “disorganised” and overloaded system. She describes carers rushing around frantically while caring for her due to them only having five minutes leeway between patients. 

“Most of the people are lovely,” Poole says.

“It’s not the staff; it’s the hierarchy that’s the problem.”

Hall agrees the staff are not the issue, as the changes have made it harder for providers to meet compliance needs and regulations.

“We spend more time responding to all of the standards, regulations, the governance … replying to enquiries from the commission,” she says.

“So that’s a pretty big burden to providers.”

Similarly, O’Brien hopes to see the federal government open an honest conversation about how to improve the aged care workforce.

“No reform works if there are not enough trained workers to deliver the care the legislation promises,” she says.

In May, Prime Minister Anthony Albanese said the state of aged care in Australia “is not good enough” after a new report revealed patients were waiting an average of a year for services between November 2025 and March 2026. Hall says the federal government must look into the funding instruments and the realistic inputs of delivering care to older Australians.

“I don’t think [the government] should ever relax on expecting high-quality care but they should also reward and incentivise providers who are doing things more creatively and design things with the people who are receiving them,” she says.

Poole agrees and believes something needs to be done to “tighten up the system” before more people are denied access to the care they need.

“[The lack of care we receive] is unforgivable in my book,” she says.

Since November, O’Brien believes the reform has made progress in improving regulations and provider accountability, but structural problems continue to enable neglect to persist.

“When someone is waiting eight months for home support, falls at home, ends up in hospital, loses capacity to return, that is a system failure even if no individual provider is legally responsible for it,” she says.

“Neglect does not only happen inside provider organisations: it also happens when people simply cannot access the system at all.”