The ‘vanilla’ culture of aged care: Why has mediocrity become the norm?

The phrase “person-centred care” is so frequently used in aged care that it has become little more than a marketing slogan.

Every provider claims to offer it, yet in reality, many aged care environments are still driven by rigid routines, task-focused workflows, and systemic barriers that prevent true person-centred care from being implemented.

As dementia care expert David Sheard has observed, the term has been hijacked to the point of meaninglessness – every organisation boasts of “best practice” care, yet few live up to these claims.

Registered nurse and clinical educator Michael Page believes that the root of this disconnect lies in workplace culture. Leadership is often detached from frontline workers, staffing levels are stretched thin, and compliance demands overshadow meaningful care.

To bridge this gap, Page argues that aged care providers must invest in cultural change, ensuring that leadership engages directly with staff, empowering them to deliver genuine person-centred care.

The disconnect between leadership and frontline staff

One of the fundamental issues affecting workplace culture in aged care is the distance between leadership and frontline staff.

Page notes that in large organisations, whether not-for-profit or private, “managers of homes report into group managers, and then head office,” creating a structure where those making decisions have minimal direct contact with those delivering care.

This disconnect fosters a reactive rather than proactive approach to leadership. “When there’s been a Commission visit and the Commission have asked difficult questions, the blame – whether intentional or not – falls on the carers,” Page explains.

“The perception is that carers are not working properly, but the real issue is a lack of leadership, direction, and vision.”

Without clear leadership and consistent guidance, care workers often default to a task-oriented approach.

“If you’re working an afternoon shift and there are two of you for 30 or 40 residents, many of whom require two or even three-person assistance, how can you realistically be person-centred?” Page asks. “The focus becomes completing tasks efficiently rather than truly engaging with residents.”

This shift towards task-driven care is exacerbated by ever-changing managerial priorities. Staff become confused and revert to the safest, most efficient way of working, which prioritises routine over individualised care.

Instead of blaming care workers, Page argues, providers should acknowledge systemic barriers and implement practical solutions that empower staff to deliver person-centred care.

A critical step towards cultural change is for leadership to engage directly with staff and understand their challenges.

“If you want to be person-centred for your residents, you have to be person-centred for your teams,” Page asserts. While it may not be realistic for a CEO to be on the floor daily, senior leaders within the organisation should make an effort to be present and supportive.

“Even clinical nurses, or clinical educators, which I have been, find it difficult to get out on the floor. But that was my approach, and I think that’s the only way to develop a culture—go and talk to your people, find out their pain points, and actually listen to them,” Page says.

“Deliver one or two of their requests. Often, their requests aren’t about money. They might ask for more time for handover or a chance to sit and have a cup of tea with a resident. These small changes can make a big difference.”

Addressing Staffing and Resource Constraints

A common argument against increasing time for engagement is staffing limitations. Providers often claim they lack the funds to hire more staff, creating a vicious cycle where workers feel rushed, frustrated, and unable to provide quality care.

Page acknowledges the funding complexities but believes many organisations choose to prioritise compliance and administration over frontline staffing.

“Many not-for-profits pour their surpluses into compliance teams instead of investing in extra staff or activities for residents,” he says. “My view has always been that if you get the care right in the first place, you don’t need to worry about the Commission. Provide good care from the bottom up, and you’ll start to embed a culture that people want to work in.”

Retaining experienced staff is also crucial for cultural stability, yet many aged care workers feel undervalued and unsupported. Overseas workers, in particular, are often seen as transient, with little effort made to integrate them into a positive workplace culture.

According to Page, they are often undervalued and expected to simply “follow the policy” rather than bring their authentic selves to work.

Page highlights a prevailing bias: “Many Australians, particularly older residents, would prefer an Australian-born carer. This is often attributed to communication difficulties, particularly for residents with hearing impairments.

However, when you consider that 60-70% of aged care residents have dementia – a number that is only going to increase – the ability to communicate empathy and care through body language and emotional intelligence is far more important than perfect English.”

Despite this, many providers fail to support and integrate their overseas staff effectively.

“They’re not trusted enough, they’re not empowered, and they’re often set up to fail by being expected to document everything in compliance-language, even when English is their second language.”

However, Page has seen firsthand how embracing diversity can strengthen workplace culture.

“At one home I worked for, the residents loved the multicultural aspect of their carers. On one shift, we staff members of 40 nationalities. When a beloved resident passed away, 20 of our staff attended her funeral, and her family called them the ‘United Nations of Care.’”

Instead of treating diversity as a challenge, providers should celebrate it. “It shouldn’t be a once-a-year token cultural event; it should be embedded in the daily life of the home. When staff are encouraged to bring their cultural identities to work, it fosters a sense of belonging and strengthens team morale.”

Moving Beyond Compliance to Excellence

Aged care providers often operate within a “vanilla” culture of compliance—meeting minimum standards without striving for excellence.

Page recalls a conversation with a CEO of a large organisation who made a shocking admission.

“I said that in aged care, 20% of homes are exemplars, 10% are awful, and 70% are just ticking compliance boxes,” Page recalls. ” He agreed and, while he has bold plans for the future, actually admitted to the aged care part of the organisation being in the ‘vanilla” category”.

To break out of this mediocrity, providers need to prioritise ethical leadership and invest in staff development.

“Many aged care managers tell me they love dementia care and have completed specialist training, yet they won’t fund training for their staff. They staff memory support units inappropriately and unsafely. There’s a real disconnect between what they say and what they do.”

Aged care leadership should be about more than just business acumen. “A CEO doesn’t have to be an expert in everything, but they need to pick the right team,” Page emphasises.

“Unfortunately, many good people are promoted into high-paying roles and then simply follow the party line, focused on hitting KPIs rather than fostering a culture of care.”

The industry needs leaders who prioritise people – both residents and staff – over financial metrics. True person-centred care requires an organisational shift where care quality is seen as the foundation of success, rather than an afterthought.

Improving workplace culture in aged care is not just about better policies or compliance; it requires active leadership, investment in staff, and a commitment to putting care before bureaucracy.

As Page highlights, “Provide good care, and you don’t need a whole backroom of people trying to get you out of trouble – you’ll already be doing the right thing.”

Michael Page co-hosts the With All Due Respect podcast alongside Creative Elder Engagement Specialist Maurie Voisey-Barlin, where they explore aged care topics as part of the Open The Doors 2030 knowledge-sharing movement, of which they are both co-founders.