Australia’s Inspector-General of Aged Care, Natalie Siegel-Brown, has delivered a scathing assessment of the nation’s aged care reforms, warning that the system is “structurally misaligned” and risks undermining both the human rights of older Australians and the long-term sustainability of public spending.
In a farewell address to the National Press Club ahead of stepping down from the role later this month, Ms Siegel-Brown argued that Australia does not have a funding problem in aged care but a “value problem”, saying the current system rewards crisis rather than preventing it.
“The maths ain’t mathin,” she said, arguing that the system discourages older people from accessing the very services that help them remain independent and avoid costly residential aged care.
While praising the new Aged Care Act for embedding dignity, independence and human rights into legislation, Ms Siegel-Brown said its implementation is failing to deliver those principles in practice.
According to Ms Siegel-Brown, current funding arrangements send the wrong signals by making clinical care free while requiring significant co-contributions for services such as meals, transport, social participation and domestic assistance.
She argued these supports are fundamental to preventing functional decline but have effectively become optional because many older Australians, particularly pensioners, cannot afford them.
Around three-quarters of Support at Home participants are pensioners, she noted, meaning many are forced to choose between paying for services that keep them independent or covering basic living expenses.
Ms Siegel-Brown said the consequences are both human and financial.
She estimated residential aged care costs taxpayers around $123,000 per person each year, compared with about $30,000 annually to support someone living independently at home.
More than 200,000 older Australians are currently waiting for aged care support, she said, warning that long delays simply allow health and functional decline to accelerate.
“Waiting is not free. Decline is not free. Premature residential aged care is certainly not free.”
One of the speech’s strongest examples highlighted what she described as inefficiency built into the system.
She recounted the story of an older woman whose GP prescribed a $50 pair of crutches. Instead of providing the equipment immediately, the Support at Home program required an in-home occupational therapy assessment costing approximately $1,800 and creating a three-month delay.
“That’s not just inefficiency. It’s what happens when a system loses its sense of value,” she said.
Ms Siegel-Brown also revealed hardship assistance applications had increased by 88 per cent during the first two months of the aged care reforms, suggesting financial hardship is becoming a structural feature of the new system rather than an exception.
She argued Australia should shift its focus from building more residential aged care beds to reducing demand for them through earlier intervention, community support and preventative care.
Drawing on international examples, including Denmark, Japan and Australia’s own veterans’ care model, she said evidence consistently showed that investing in home care, rehabilitation, assistive technology and social connection delayed entry into residential aged care while delivering significant savings.
Economic modelling commissioned by her office suggests redesigning home care around timely access and coordinated support could generate billions of dollars in avoided residential care costs that could be reinvested to reduce waiting lists.
Responding to questions following the address, Ms Siegel-Brown rejected suggestions that workforce shortages were the primary reason for long home care waiting lists, saying providers had repeatedly indicated they were ready to deliver additional services.
She also renewed concerns about the future of the Commonwealth Home Support Programme (CHSP), describing it as one of Australia’s most important preventative aged care programs despite receiving only around eight per cent of total aged care funding while supporting approximately 65 per cent of aged care clients.
Rather than winding CHSP back, she argued it should be strengthened.
Looking ahead, Ms Siegel-Brown urged governments to move beyond short-term political fixes and instead redesign aged care around measurable outcomes such as maintaining independence, preventing hospital admissions and delaying entry into residential care.
