A new national survey shows for-profit providers scoring worse on staffing, ratios and care time than their not-for-profit and public counterparts, and the union representing aged care workers says the answer is structural, not just more funding.
Australia’s aged care sector has spent three decades moving towards privatisation. For-profit providers now operate around 38% of residential aged care facilities nationally. A new survey from the Australian Nursing and Midwifery Federation (ANMF) argues that shift has come at a direct cost to residents and staff, and is calling for it to be reversed.
The union’s Pulse Check of the Aged Care Sector report, drawing on responses from more than 3,550 frontline workers, doesn’t just allege that for-profit providers cut corners. It quantifies the gap.
Across nearly every staffing metric measured in the survey, for-profit providers scored worse than public and not-for-profit facilities.
Workers in for-profit facilities were far more likely to report having insufficient time to deliver care: 55.75% said so, compared with 47.53% in not-for-profit facilities and 40.13% in public/government-run services.
The pattern held for nursing ratios. Over half of respondents in for-profit facilities (52.09%) rated the ratio of nursing to care staff as inadequate, against 45.19% in not-for-profit facilities and 46.20% in public providers.
It also held for overall staffing levels (43.47% rated “poor” or “very poor” in for-profit facilities, versus 36.83% in not-for-profit and 42.77% in public settings), for enrolled nurse numbers (48.20% rated inadequate in for-profit facilities), and for time spent on paperwork and administration, where for-profit facilities again recorded the highest dissatisfaction at 52.10%.
Workers in for-profit facilities were also considerably more likely to report being shifted into “universal worker” models, where care staff are expected to take on hotel, food and domestic duties alongside clinical work: 71.98% reported this shift, compared with 50.16% in public facilities.
Beyond the statistics, workers’ written responses point to specific cost-control measures they believe are affecting resident care directly.
Multiple respondents described being discouraged from ordering adequate wound care supplies. “The RNs at work have been told they are spending too much on dressings. We had a few residents with complicated wound care requiring daily dressings. The other RN was so scared to ask for stock that we ended up running out altogether,” one NSW registered nurse in a not-for-profit facility said, though similar accounts of supply rationing came from for-profit settings too.
Others described management’s reluctance to backfill sick leave with qualified staff as a deliberate cost-saving measure. “When someone calls in sick, management usually doesn’t arrange a replacement, which puts even more pressure on the remaining staff,” said one South Australian registered nurse working in a for-profit facility.
One NSW registered nurse working in a for-profit facility put the perceived trade-off plainly: “I think there’s enough funding, but the facility wants to maximise profits.” An enrolled nurse in Queensland, also in a for-profit setting, went further: “Due to the facility being for profit, funding is not channelled towards providing residents’ services, but towards purchasing more facilities.”
Where many aged care reports stop at calling for “more transparency” or “more funding,” the ANMF’s recommendations go considerably further. The union is calling for a staged national de-privatisation strategy, aimed at reducing for-profit ownership of aged care services to below 20% market share over ten years, with public providers managing at least 50% of beds in high-need areas.
The proposed mechanism includes targeted buybacks of underperforming for-profit facilities, concessional loans and priority bed allocations to support not-for-profit expansion, and regulatory caps on new for-profit licences.
Alongside this, the ANMF wants mandatory, standardised public reporting of provider-level financial performance, covering expenditure on direct care, staffing, administration and profit, reviewed by an independent aged care financial auditor. It’s also calling for the Aged Care Quality and Safety Commission to be given stronger enforcement powers, including the ability to revoke provider registration for repeated or serious non-compliance.
The union frames the case in comparative terms, pointing to broader international evidence that healthcare quality and outcomes tend to be worse under private ownership, and arguing the Australian aged care sector’s reliance on market competition has not delivered the quality gains it was meant to.
It’s worth stressing that these are sector-wide averages, not a verdict on every individual operator. The survey doesn’t identify or single out specific providers, and plenty of for-profit facilities are staffed, run and resourced well, with committed teams delivering genuinely high-quality care to residents.
The ANMF’s argument isn’t that private ownership guarantees poor care, but that the for-profit model, on average and at scale, appears to create financial incentives that make cost-cutting more likely. Individual providers bucking that trend would presumably have little to fear from the increased financial transparency and reporting the union is calling for, and may even stand to benefit from it, as it would make it easier for families and regulators to distinguish well-run operators from those cutting corners.
Unlike calls for higher funding, which providers across the sector broadly support, a de-privatisation target is likely to draw direct pushback from industry bodies representing for-profit operators, who may dispute both the causal link between ownership structure and the survey’s findings, and the practicality of a mandated market-share cap.
That tension, and the ANMF’s willingness to name a specific number, is likely to be the story here: not simply “for-profit providers are struggling to meet standards”, but a peak union putting a concrete structural target on the table for how much of the sector should be allowed to operate for profit at all.
