Aged care reform after the Royal Commission: what's actually changed?

Five years have passed since the Royal Commission into Aged Care Quality and Safety delivered its damning final report in February 2021, branding Australia's aged care system a "shocking tale of neglect." The question on every family's mind is simple: what has actually changed?

The answer is complicated. While some progress has been made, many of the fundamental problems that led to preventable deaths and systemic neglect remain unresolved.

The promises vs the reality

The Royal Commission made 148 recommendations, calling for a complete overhaul of how we care for older Australians. The Morrison Government initially committed $17.7 billion over four years, followed by additional funding from successive governments. By 2026, total additional investment has reached approximately $25 billion.

But here's what families are still experiencing:

• Average wait times for home care packages remain at 12-18 months for higher-level care
• Nursing home staffing ratios, while improved, still fall short of the mandated minimums in many facilities
• Out-of-pocket costs for aged care have increased by 23% since 2021, according to the latest ACFA reports
• Rural and remote areas continue to face critical shortages of both residential and home care services

What has actually improved?

To be fair, some significant changes have occurred:

Staffing standards: New mandatory minimum staffing requirements came into effect in 2024, requiring facilities to provide 200 minutes of care per resident per day, including 40 minutes with a registered nurse. Early data suggests this has reduced preventable hospital admissions by 15%.

Quality oversight: The Aged Care Quality and Safety Commission has been given stronger powers and additional funding, conducting 30% more unannounced visits than in 2021.

Worker conditions: A dedicated aged care worker supplement has increased wages by approximately $3.50 per hour, helping to address the workforce crisis that saw 35% annual turnover rates pre-pandemic.

Technology integration: The introduction of a single aged care portal has streamlined applications, reducing paperwork delays that previously added months to the assessment process.

Where the system is still failing

Home care chaos: Despite being the preferred option for 89% of older Australians, the home care system remains a postcode lottery. While the government has released an additional 80,000 home care packages since 2021, demand has grown even faster. The result? Over 180,000 people are still waiting for appropriate care levels.

Financial transparency: Families report ongoing confusion about aged care costs. The new pricing structure, while supposedly simpler, still sees residents paying vastly different amounts for similar care depending on when they entered the system and their financial circumstances.

Regional inequality: Metropolitan areas have seen modest improvements in service availability, but regional centres continue to struggle. Towns with populations under 50,000 have actually seen a net decrease in aged care beds since 2022, as smaller operators exit the market.

The human cost of slow reform

Behind every statistic is a family struggling to navigate an system that remains Byzantine in its complexity. Margaret from Ballarat waited 14 months for a Level 4 home care package for her husband with dementia. "The assessment happened quickly," she told us, "but then nothing. No communication, no timeline, just endless waiting while his condition deteriorated."

Similar stories emerge from families across the country who find themselves caught between inadequate home care and unaffordable residential options that can cost upwards of $80,000 annually in major cities.

Why direct democracy matters for aged care

Here's the uncomfortable truth: aged care reform moves slowly because older Australians and their families lack political power when it matters most. Major policy decisions are made in party rooms and cabinet meetings, influenced by industry lobbying and electoral calculations rather than the lived experiences of those navigating the system.

Imagine if the people actually using aged care services had direct input into policy priorities:

• Would we prioritise expensive new bureaucratic structures or direct funding for more care workers?
• Would families choose complex means-testing arrangements or simplified, universal access?
• Would communities support redirecting infrastructure spending toward regional aged care facilities?

Direct democracy ensures that those most affected by policy decisions have a genuine voice in shaping them. Rather than waiting for politicians to respond to royal commissions and media cycles, we could have ongoing, responsive policy development driven by real community needs.

The aged care crisis didn't emerge overnight, and it won't be solved by traditional politics that treats major reform as a once-per-decade event driven by scandal rather than systematic improvement.

Ready to give families and communities a real voice in aged care policy? [Take our policy quiz](https://directdemocracy.com.au/quiz) to see how direct democracy could transform not just aged care, but every area of policy that affects your life.