In one of the strongest public criticisms yet of the Albanese Government’s aged care reforms, outgoing Inspector-General of Aged Care Natalie Siegel-Brown has warned that the system designed to keep older Australians living independently is instead pushing many into residential aged care sooner than necessary.
Just two weeks before stepping down from the role, Siegel-Brown used her National Press Club address to argue that key elements of the Government’s reforms are causing harm to older Australians while also driving up long-term costs for taxpayers.
Her remarks carry particular weight. As Australia’s inaugural Inspector-General of Aged Care, Siegel-Brown has spent the past 18 months independently scrutinising the administration of the nation’s aged care system.
While she praised the principles underpinning the new Aged Care Act, which came into effect on 1 November 2025, she said the reality has fallen well short of the promise.
“The way aged care reform is being implemented is causing harm,” she said.
Siegel-Brown acknowledged the Albanese Government deserved credit for introducing a rights-based Aged Care Act built around dignity, respect and independence.
But she said those principles are being undermined by the way reforms actually operate in practice.
“A promise on paper is not the same as a promise realised,” she said. “As Inspector-General of Aged Care, I cannot see how our system is geared to deliver that promise.”
Rather than encouraging older Australians to remain at home, she argued the Support at Home program is discouraging participation through a combination of co-payments, long waiting lists and increasing complexity.
“We say we want people to age in place. Yet we discourage people from accessing Support at Home.”
Perhaps Siegel-Brown’s strongest criticism centred on the new co-payment arrangements introduced under Support at Home.
While she agreed that Australians who can afford to contribute towards their care should do so, she argued the current model has been designed around how much care someone requires, rather than simply their financial capacity.
The result, she said, is that people with the greatest care needs often pay the most.
“At the heart of the aged care reforms is a very defensible idea: those who can afford to contribute should,” she said.
“But that is not the system we have built.”
She warned that many part pensioners and full pensioners are now reducing or declining services such as cleaning, transport, meal preparation and social support because of the additional costs.
Those supports, she argued, are not optional extras.
“They are the very services that keep people living independently.”
The Government has already made minor amendments to the program after widespread criticism, including moving showering, dressing and continence care into fully funded clinical services.
However, Siegel-Brown said the broader design problem remains unresolved.
One of the Inspector-General’s central arguments was that Australia’s aged care system continues to treat waiting as though it has no financial consequence, even though it clearly does.
With more than 200,000 Australians waiting for appropriate home care, she argued that many people deteriorate while sitting on waiting lists.
“Waiting is not free. Decline is not free.” As health worsens, older Australians become more likely to require hospital care or permanent residential aged care, dramatically increasing costs to the government.
Residential aged care costs taxpayers around $123,000 per person each year, compared with approximately $30,000 annually for home care.
“If we are effectively pricing people out of the very care designed to keep them independent at home, we are likely pushing them towards something far more expensive to the taxpayer.”
It is a point Siegel-Brown has raised repeatedly during the rollout of Support at Home and was echoed by many aged care experts. Unfortunately, the warnings fell on deaf ears.
In June, during her final Senate committee appearance, she warned the reforms were accelerating decline rather than preventing it.
“The current design and administration of Support at Home appears not to be achieving this intended purpose. Indeed, in key respects, it may be undermining that,” she told senators.
Siegel-Brown also challenged one of the Government’s most consistent messages around aged care planning.
Federal ministers have frequently highlighted the need for significantly more residential aged care beds to meet Australia’s ageing population. But the Inspector-General argued the country is asking the wrong question.”I see us keep trying to build our way out of a problem we are designing our way into,” she said.
Instead of expanding residential aged care capacity, she said governments should focus on preventing people from needing it in the first place.
She pointed to Denmark as an example of a country that has successfully invested in early intervention and community support to reduce demand for residential care.
Australia, she argued, already has evidence that supporting people earlier delays entry into permanent care.
“The most important lesson here is that better outcomes do not come from bigger budgets. They come from spending the money more intelligently.”
One of Siegel-Brown’s recurring themes throughout her tenure has been that Australia’s aged care system is not suffering from a lack of funding, but from poor allocation of existing resources. “The real issue is not that we’re short of funding. It’s we’re short of value,” she insisted.
She illustrated the point with an example of an older Australian who required approximately $50 worth of crutches but instead underwent an occupational therapy assessment costing around $1,800 before receiving assistance months later. By the time support arrived, the person’s risk of falls had significantly increased.
Her broader argument is that administrative complexity is often generating unnecessary costs while delaying simple interventions that could prevent decline.
These criticisms are not new. Since taking office in January 2025, Siegel-Brown has consistently questioned whether the reforms are achieving their stated objective of helping people remain independent for longer.
Her office’s review of My Aged Care found many older Australians still struggle to navigate the system.
At June’s Senate inquiry she conceded the problems had become more significant than even her office anticipated.
“While my office predicted many of these unintended consequences in our 2025 progress report, we simply did not foresee them on the scale we are now witnessing.”
Aged Care Minister Sam Rae defended the Government’s approach, saying Labor had significantly expanded access to home care and placed older people’s rights at the centre of the system.
He pointed to the substantial increase in home care participation over recent years and said reforms would continue to evolve.
“While we know there’s much more to do, our aged care system is on a stronger, more sustainable footing as a result of our reforms and we’ll continue to work to strengthen it as our generational reforms bed down.”
At this juncture, the Albanese Government continues to stand behind the reforms that Natalie Siegel-Brown has previously described as ‘cruel.’
Whether it is prepared to revisit broader concerns around means testing, waiting times and system design remains to be seen.
Siegel-Brown steps down on 31 July after less than two years as Inspector-General. Her farewell message was less about criticising reform itself than warning against assuming legislation alone delivers better care.
The Aged Care Act promised a system centred on rights, dignity and independence. Her assessment is that unless implementation changes, those promises risk remaining largely aspirational.
For a Government that campaigned on fixing aged care, this is a damning verdict from the very watchdog created to measure whether those reforms are actually working.
