Seven years after the Australian Government announced the Royal Commission into Aged Care Quality and Safety in 2018, titled Neglect for its damning findings of systemic failures, the Office of the Inspector-General of Aged Care released its 2025 Progress Report, late last week.
This comprehensive assessment evaluates the Albanese Government’s implementation of the Royal Commission’s 148 recommendations, which aimed to transform Australia’s aged care system into a rights-based, person-centred model prioritising dignity, self-determination, and high-quality care.
While acknowledging “meaningful change,” the report delivers a strong critique of the government’s fragmented approach, highlighting a litany of shortfalls that betray the Royal Commission’s vision.
The most significant and harmful deviation is the government’s rejection of a tax levy in favour of means-tested co-payments, a decision that economists, senior aged care figures, and Inspector-General Natalie Siegel-Brown agree will force some of the most vulnerable to forgo essential services due to cost, perpetuating the very neglect the Royal Commission sought to end.
The Royal Commission’s vision: Ending neglect through transformation
The Royal Commission, led by Commissioners Pagone and Briggs, envisioned a radically reformed aged care system that eradicates neglect and places older people at its core.
It described a system “capable of supporting people to age how they want, founded on rights and self-determination and delivered high quality, person-centred care, capable of preserving the wellbeing of older people and ensuring dignity and quality of life for all Australians as they age.” Key recommendations included:
The report emphasises that achieving this vision required “an overhaul of established legislation, policies and programs” with “genuine consultation, co-design and information exchange.” Yet, it concludes, “This has not occurred.”
The biggest deviation: Co-payments over tax levy
The Royal Commission’s report, aptly titled Neglect, exposed a system failing older Australians, particularly the most vulnerable. It is therefore mind-blowing that the government’s most significant deviation from its recommendations – rejecting a tax levy for means-tested co-payments under the Support at Home program – will exacerbate this neglect.
The Commission argued that a levy would ensure equitable, sustainable funding, aligning with the principle of universal entitlement and avoiding individual financial burdens. Instead, the government’s Aged Care Taskforce claimed a levy would exacerbate intergenerational inequity, asserting that older Australians with means should contribute more.
This argument is fundamentally flawed. The overwhelming majority of taxpayers contributing to a levy will eventually require aged care services, meaning they would be investing in their own future care, not just subsidising others.
A levy would distribute costs across society, ensuring access regardless of wealth, consistent with the Royal Commission’s vision.
Inspector-General Natalie Siegel-Brown expressed “genuine fears” that co-payments will push vulnerable people to forgo care, stating, “Co-payments will result in the Act ‘establishing, if not outright endorsing, a system where continuity of care is increasingly tied to one’s ability to cover out-of-pocket costs’.”
Economists, senior aged care figures and older Australians echo this concern, warning that co-payments will disproportionately harm those least able to afford them, such as full pensioners, people with cognitive decline, or those without family support.
The report highlights that “fewer people receiving the care they need is likely to be one of the outcomes of the introduction of co-payments for non-clinical services.” This risks forcing vulnerable individuals into costlier residential care, which “would come at a greater cost to the system and therefore the taxpayer,” undermining the government’s aim to contain costs and support ageing in place.
The policy creates a two-tiered system where access to essential services depends on financial means, directly contradicting the Royal Commission’s call for equitable care. The report warns, “It is not clear that the difficulty people are likely to encounter in navigating the hardship provisions has been considered,” noting that complex bureaucratic processes will likely exclude those most in need.
This perpetuates the neglect highlighted by the Royal Commission, as vulnerable older Australians may forgo critical services like showering or food preparation due to cost, leading to poorer health outcomes and increased system costs.
Harmful Distinction
The government’s funding model distinguishes between clinical and non-clinical care, with clinical care (e.g., nursing, allied health, medical services) fully funded, while non-clinical care (e.g., showering, food preparation, accommodation) is subject to co-payments for those with means.
The report criticises this as “inconsistent with high-quality care,” particularly the classification of showering as non-clinical. The Inspector-General warns, “Personal hygiene has a clear clinical dimension if not in its delivery, then certainly in its absence. This has implications for a person’s dignity, and ultimately their hygiene and safety, in particular if continence is an issue.”
Showering is essential for preventing infections, skin conditions, and falls, which can lead to hospitalisations and increased costs. For individuals with mobility issues or continence problems, forgoing regular showering due to cost could have severe clinical consequences.
The report states, “If, for example, a full pensioner cannot afford to make a co-payment each day for showering, the likely consequence is that they will forgo its regularity.” This compromises dignity and increases health risks, particularly for vulnerable groups. Similarly, classifying food preparation as non-clinical overlooks its role in supporting nutrition, critical for health outcomes like fall prevention, especially for culturally and linguistically diverse groups.
The report cites concerns about “substandard quality of… food and nutrition,” with one stakeholder noting, “Food delivery is an issue that’s important where people can’t get out of their rooms and they might wait quite a distance for food to be delivered to them. And it’s not necessarily warm or even partly warm.”
This arbitrary distinction risks creating inequities, as access to essential services becomes tied to financial means, further entrenching the neglect the Royal Commission sought to address. The policy fails to recognise the interconnectedness of clinical and non-clinical care in maintaining health and dignity, undermining the goal of person-centred care.
Neglect of Aboriginal and Torres Strait Islander elders
The report is scathing about the government’s failure to implement the Aboriginal and Torres Strait Islander Care Pathway, opting instead to mainstream Aboriginal Community-Controlled Organisations (ACCOs) for at least four years.
This is described as a “highly retrograde step” that “risks undermining services’ ability to provide culturally appropriate and responsive care.” The decision violates the National Agreement on Closing the Gap, with the report noting, “The Office has continually heard that consultation with ACCOs regarding mainstreaming has been rushed and perceived as cursory.”
Interim First Nations Aged Care Commissioner Andrea Kelly states, “The aged care system was never designed with older Aboriginal and Torres Strait Islander people in mind. The system is still not providing culturally safe care and is poorly placed to meet projected growth in demand.”
The report highlights the trauma faced by Stolen Generations survivors, noting, “Aboriginal and Torres Strait Islander people entering the aged care system continue to face additional barriers and challenges. This is magnified for Stolen Generations survivors, for whom institutional care environments distressingly re-trigger past trauma.” Disconnection from Country causes “great personal and community distress, especially if they die off Country.”
Mainstreaming ACCOs, combined with co-payments, exacerbates these issues. Providers face a “cultural load,” forced to choose between refusing care to elders unable to pay or absorbing costs, which could deter them from the sector.
The report warns, “ACCOs may face having to refuse services to older people who cannot pay the co-contribution or absorb the cost of providing those services themselves.” This risks further marginalising Indigenous elders, perpetuating the systemic neglect the Royal Commission exposed.
Persistent waiting lists and rationed care
The government rejected the Royal Commission’s call for universal entitlement, retaining a capped funding model. The report states, “The government has not delivered a universal entitlement to aged care,” perpetuating waiting lists.
The Royal Commission’s one-month wait time target remains unmet, with the report noting, “The current approach cements a rationed system. This continues the decision of previous governments to refuse to accept this recommendation.”
The new single assessment system, introduced in December 2024, has failed to reduce delays, with stakeholders reporting that “the new single assessment system has not alleviated delays in accessing assessments, nor simplified assessment processes for older people and their families and carers.”
Restrictive practices and human rights
Restrictive practices remain prevalent, with the report noting that “the use of restrictive practices remains high,” with only a modest decline from 22.7% to 18.5% of residents restrained between 2021–22 and 2023–24.
Chemical restraints, particularly antipsychotics, are unaddressed, with the government rejecting restrictions due to “substantial risks of unintended consequences.” The consent model, relying on substituted decision-makers, undermines supported decision-making, constituting “a fundamental breach of human rights.”
Health system integration and NDIS inequity
The report highlights a lack of progress in integrating aged care with health systems, stating, “Successive Australian Governments have implemented only piecemeal responses.”
Older people remain “stuck” in hospitals due to poor discharge processes, and the Seniors Dental Benefits Scheme has not been implemented, despite “declining oral health among older Australians.”
Equity with the NDIS remains elusive, with “tangible differences” in support levels. The $15,000 cap on home modifications and assistive technology risks forcing individuals into residential care, breaching “Australia’s international human rights obligations.”
Recommendations for Reform
The Inspector-General proposes urgent actions:
Ending neglect: A mandate for equitable and culturally safe care
The 2025 Inspector-General’s Progress Report lays bare the Government’s failure to deliver the transformative aged care system envisioned by the Royal Commission, aptly titled Neglect.
By rejecting a tax levy for means-tested co-payments, the government has created a system where vulnerable Australians, particularly those on low incomes, may forgo essential services like showering due to cost, perpetuating the very neglect the Commission sought to eradicate.
The arbitrary classification of showering and food preparation as non-clinical undermines dignity and health, while the mainstreaming of Aboriginal Community-Controlled Organisations threatens culturally safe care for Indigenous elders.
As the Inspector-General warns, “There remains considerable scope to move the aged care system closer to the model recommended by the Royal Commission.” Urgent action is needed to reverse these harmful policies, restore equity, and ensure a rights-based system that truly ends neglect for all older Australians.
The inspector generals report is excellent however falls shot in addressing the impact on the homeless, an increasing marginal group, with limited ability to negotiate the complexity of copayments and as a result will forego services , particularly showering, food assistance, both clinical necessity and social work support, if the community hope for any assistance for them to transit to safer circumstances .
I don’t understand, as a part pensioner at the assessed lowest end of the co-payment assessment scale, why with having only one service, twice a week, from allied health, I pay $220 per month co-contribution. If I get other services from my new provider (left former August 2025), will this figure rise? I can’t afford this rise and barely last a month as it is.