“It’s just a harsh reality, isn’t it?” Russell Egan doesn’t wait to be asked before he says the thing most aged care leaders won’t. As CEO of family owned operator Superior Care Group, Egan’s view is blunt: not everyone pays for, or gets, the same thing, and the sector needs to stop being outraged by something that has always been true of aged care, and of life generally.
“I really am a bit dismayed at this whole idea that aged care should be a one size fits all, and that everyone should get everything,” he says. “It’s a real problem with public services, where the expectation is that the level of service should be the highest, gold plated level of service for everyone, when the taxpayer should not be on the hook for that.”
That tension is real and well documented. When some residents can pay for extras like premium meal choices, pay TV or alcohol under Higher Everyday Living Fees (HELF) and others can’t, staff are often the ones left to explain the difference, day after day, to residents who see each other across the dining room. It’s a significant part of why some lifestyle and care staff have walked away from the sector altogether in recent months, unable to reconcile the job of caring for people with the job of telling some people “no.”
Egan doesn’t dismiss that discomfort. But he argues it comes from staff, and the public, being asked to absorb a truth that leadership rarely says plainly: aged care was never actually equal, HELF has just made the inequality visible for the first time.
Before HELF, many providers ran bundled packages rather than itemised ones. “We had a suite, what we call the superior package,” Egan explains. “There was a range of services on essentially a brochure, a sheet that says these are all the things that are included. The cost was $30 a day, and you get it all. Food choices, drinks, internet.”
On the surface, that looked fairer than today’s opt in, opt out model. Everyone in the package got the same list, no itemising, no tick sheet. But Egan points out the flaw that rarely gets discussed: those flat fees didn’t move with a resident’s actual capacity to use what they were paying for.
A resident who signed up at 85, sharp and social, ordering the good coffee and the gourmet dinner option, kept paying the same premium rate years later even as cognitive decline meant she could no longer read a menu, hold a conversation over drinks, or register that the turkey dinner was any different from the standard one.
The have and have not problem wasn’t solved by the old model. It was simply invisible, buried inside a single number on an invoice instead of itemised on a form.
The itemised version, Egan admits, is more honest, but it’s also more work. “You’ve then got to have documentation to say, well, resident A is having A, B, and C, and resident B is having D, E, and F,” he says. “You gotta have the documentation, and it’s changing all the time. It is a moving feast of complexity.” In roughly half his homes, he estimates, residents are on HELF or a grandfathered version of the old additional services packages, which gives some sense of how much day-to-day administration that complexity now involves.
In that sense, HELF hasn’t invented a class system in aged care. It’s made a pre-existing one legible, which is a different problem, and arguably a more honest one.
Egan’s argument starts with a simple claim: hotel services, the food, laundry, cleaning and day-to-day running of a home, already run at a loss under the basic daily fee, even with the government’s hoteling supplement factored in.
“Providers are running a massive deficit on the hotel service equation,” he says, pointing to the sector’s own financial benchmarking data as evidence that the gap between what providers are funded to deliver and what it actually costs is longstanding and structural, not something individual operators have engineered.
By his estimate, the hoteling supplement currently sits at around $22 a day, while a HELF package might add another $35 on top for residents who opt in.
“If the basic daily fee doesn’t cover hotel costs for the bare minimum, then how could those customers possibly be serviced at the premium level?” he asks. “Then they would need to add on the $35 a day that I charge. So if they increased the hotel fee to $67 a day, everyone could get additional services. But the government’s never going to do that.”
Egan is blunt about what that funding actually pays for. “This is how the bills get paid,” he says. “This is how new buildings get built. This is finance. This is commerce.” He also points to the sector’s recent pay rises as evidence providers aren’t the ones benefiting from new funding.
“We’ve got this narrative in the industry now that we’ve spent twenty billion dollars extra in aged care, but every cracker of that went to workers,” he says. “There was no money that went to providers.”
Egan is upfront that the alternative, a single, identical, no extras standard for every resident, sounds fairer on paper. But he pushes back hard on the idea that it’s realistic. “We’ve got a lot of capital on the line, and we’re just not earning a reasonable return at the moment,” he says. “To expect everyone to fly business class, only paying economy class, it’s not realistic. It would impose obligations on providers which are just not sustainable.”
He’s candid that basic care, as opposed to hotel extras, is identical for every resident regardless of what they’ve opted into. “HELF has got nothing to do with care,” he says. “Every person receives identical quality of care in an aged care home.” The extras, in his view, are meant to feel like genuine value rather than an obligation.
“I want the residents and the families saying HELF is a good deal,” he says. “I’m glad I’ve got it. I don’t want them to be saying, oh, begrudgingly, I had to pay this fee.”
He points to small, low cost additions his homes have made on top of the core package, like a choice of pillow firmness or upgraded paper products, as examples of the kind of thing he tells his managers to say yes to. “If there’s any other reasonable request that a HELF payer wants, let’s try and make it happen,” he says.
Seen through a lens of scarcity, he argues, the job feels like constant refusal. Seen through a lens of what the sector is actually able to sustainably deliver, it looks more like additional choice for those who can afford it, without reducing what everyone else already receives, and without the wages and beds that fund it disappearing altogether.
Part of what makes HELF hard to administer is the law itself. Providers are required to let residents opt in and out of individual services rather than offering the kind of simple bundled package that used to be standard, adding a layer of ongoing administrative complexity most homes are still working through.
It’s a rule designed to give residents more genuine choice and to stop bundling from being used to squeeze people into paying for things they don’t want. In practice, though, it does little to address the underlying issue driving staff distress: the funding shortfall that makes some kind of differentiation necessary in the first place.
Tightening the process around how HELF is offered doesn’t change whether it needs to exist at all.
None of this makes the discomfort staff are describing any less real, and Egan doesn’t dispute that it’s a genuinely difficult part of the job. But his broader point is that the outrage aimed at HELF is, more often than not, aimed at the wrong target.
“There’s no margin provided for these providers who have everything on the line, twenty-four seven,” he says. “The government has outsourced their risk to providers and will not give them a profit. It’s obscene, really. So this is why there is this pressure on these other revenue streams.”
The uncomfortable version of that argument is the one Egan is willing to say, and most of his peers aren’t: aged care is a class system, quietly, and always has been. The homes people could afford, the packages they could opt into, the standard of room they were given, all of it has tracked what people could pay long before HELF gave it a name and a tick box.
What’s changed isn’t the existence of tiers. It’s that they’re now itemised in front of everyone, instead of buried in a single flat fee nobody thought to question.
Whether that’s a step backwards or, as Egan would argue, simply the sector being honest for the first time about how it has always worked, is a judgement call for the reader.
What’s harder to argue with is his conclusion: until government funding for hotel services closes the gap he describes, HELF isn’t going anywhere, and neither is the discomfort that comes with administering it.
The sector can keep being outraged by that, or it can start being honest about it. It probably can’t do both.
