Oct 31, 2019

“This cruel and harmful system must be changed”: interim report


The royal commission’s interim report provides a damning appraisal of Australia’s aged care sector and calls for a complete overhaul of the system.

Describing ageist attitudes, cruelty, neglect, poor leadership, confusing systems, fragmented services, and an absence of joy, the interim report, which is titled ‘Neglect’, reflects the thinking of the commissioners of the Royal Commission into Aged Care Quality and Safety up to September 2019.

The aged care system requires a “fundamental overhaul”, they write, and commit themselves to providing a framework for reform when they hand in their final report in November 2020.

“It is impossible to escape the melancholy conclusion that aged care services and the people who receive them have simply not been seen as a priority by successive Australian Governments,” the commissioners conclude.


The commissioners describe a system that neglects older people.

“We have found that the aged care system fails to meet the needs of our older, often very vulnerable, citizens. It does not deliver uniformly safe and quality care for older people. It is unkind and uncaring towards them. In too many instances, it simply neglects them.”

The delay thousands experience waiting for their correct level of home care is “shocking”, they say. The expectation they will manage while they wait is “unsafe”. “It is neglect,” the commissioners write.

Routine thoughtless acts – “the cup of coffee placed too far from the hand of a person with limited movement so that they cannot drink it, the call buzzer from someone left unanswered, the meal left uneaten with no effort to help” – become “unkindness and often cruelty. This is how ‘care’ becomes ‘neglect’,” the commissioners write.

‘An ageist mindset’

The report says ageist attitudes have enabled a dysfunctional system to evolve.

“As a nation, Australia has drifted into an ageist mindset that undervalues older people and limits their possibilities. Sadly, this failure to properly value and engage with older people as equal partners in our future has extended to our apparent indifference towards aged care services. 

“Left out of sight and out of mind, these important services are floundering. They are fragmented, unsupported and underfunded. With some admirable exceptions, they are poorly managed. All too often, they are unsafe and seemingly uncaring. This must change.”

My Aged Care ineffective

Rather than providing assistance to older people at a stressful time in their lives, My Aged Care is “frightening, confronting and confusing”, the commissioners write.

A lack of easily comparable information about aged care facilities makes the already difficult experience of moving into care even more alienating. People grieve when they move into aged care.

“We must find a way to ease these transitions and ensure that residential care services are made much more attractive and enjoyable for those in care,” the report states.

80% of revenue comes from the government

Aged care operators behave as though they are businesses, yet are mostly government funded and have little transparency or accountability.

“The aged care sector prides itself in being an ‘industry’ and it behaves like one,” the report states. “This masks the fact that 80% of its funding comes directly from Government coffers. 

“Australian taxpayers have every right to expect that a sector so heavily funded by them should be open and fully accountable to the public and seen as a ‘service’ to them.”

Despite the rhetoric, people using aged care services often have little choice available to them, and many are not able to make decisions about their care.

“The structure of the current system has been framed around the idea of a ‘market’ for aged care services where older people are described as ‘clients’ or ‘customers’ who are able to choose between competitively marketed services. 

“But many older people are not in a position to meaningfully negotiate prices, services or care standards with aged care providers. The notion that most care is ‘consumer-directed’ is just not true.”

Commissioners demand urgent action

Rather than wait until after completion of the royal commission in November 2020, the commissioners say a number of actions are needed immediately.

The commissioners are calling on the government:

  • to immediately provide more home care packages to reduce waiting lists, 
  • implement changes to the regulation of chemical restraints, 
  • accelerate the process of getting young people out of aged care, and 
  • stop the ‘pipeline’ of younger people with disability into nursing homes.

Increasing funding now not the answer

Despite repeated calls from within the sector for an immediate increase in funding, the commissioners say this would not fix the sector’s problems.

“These interventions are essentially variations on a theme which has haunted this area of government policy for far too long: short-term solutions which will at best temporarily stave off the worst problems and, at worst, produce another set of unintended outcomes requiring further inquiries and reviews and further injections of public funds without addressing the underlying causal factors. 

“These limited interventions are not enough to deliver an aged care system that meets the needs of older people,” they write.

Links to report are available here.

The commissioners are inviting the public to make submissions in response to the interim report.

Look out for our coverage of industry’s response tomorrow on HelloCare.


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  1. Can we also talk about “The Elephant In The Room?” Why the majority of staff from kitchen staff , AINs to CMs are all foureigners? I know of three intelligent wonderful Australian women who have applied for work at my place of employement who have had no success. What I have noticed over the years is they are accepting more foureign staff over Australian Citizens with life experiences and a better understanding of our elderly. Is it because Australians know their rights and will not put up with dreadful conditions? Or is it cheaper to hire foureigners that will not complain as most are on visas or have not become residents as yet? Or a combination? Have our Aged Care businesses made a pact with India and other countries to outsource Aged Care staff? I cannot understand how a foureigner that barely speaks understandable english would be better at communicating with our elderly than an Australian. Some of the progress notes are absolutely dreadful! Alot of it doesn’t make sense and the spelling and grammar looks like a 7 year old had put it together. There are family and friends getting jobs there but they aren’t Australian!

  2. Unfortunately there is no reasonable expectation of change in Aged Care unless our politicians, all of the major parties, change their cringing approach to reform.

    For example, after the Royal Commission into Child Abuse no government has removed taxation exceptions and funding from the major perpetrators of child abuse.

    Until all major parties get off their collective backsides, show some courage, and give bipartisan support to huge reform Neglect will continue.

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