Aged care CEO pens a scathing open letter to ACQSC

This article is brought to you by an anonymous aged care leader. Anonymous Leader could be your CEO, your mentor, or the person you sit next to at an industry dinner. We’ll never tell. What they do share are the candid, sometimes cheeky reflections of life at the top in aged care.

I began my career in the aged care sector as a Facility Manager and Registered Nurse. Over a few decades (more than I care to count), I climbed the ranks to become the CEO of a large provider. It was an honour. As my career evolved, so did the sector I dedicated my professional life to. While aged care has never been perfect, things had been getting progressively worse, until recent years when they took a turn for the bizarre.

What was once a system with at least some teeth has become a stage for performative theatre, a good-cop, bad-cop routine between providers and regulators. The lead actor in this bad movie is the Aged Care Quality and Safety Commission. Touted as a watchdog enforcing minimum care standards, it’s really a toothless tiger, more an advisory service obsessed with optics than resident welfare. Occasionally, it sacrifices a small provider and or single home of the big players for added realism, the big corporates deemed too big to fail, generally skate free.

There’s no contingency plan for the thousands of residents who’d be displaced if a major provider collapsed. Where would they go? This fear fuels a regulatory farce that leaves our elderly vulnerable.

The Royal Commission promised reform, but what we got was a watered-down system prioritising “collaboration” over accountability. Gone are the days when serious risk findings led to swift non-compliance notices or sanctions like funding cuts or licence revocations. Now, the Commission leans on enforceable undertakings, performance improvement notices, and monitoring, dressing up inaction as progress. This delays intervention, especially for politically connected or large providers, leaving residents in risky facilities exposed while the system pats itself on the back for “working together.”

Take St Charbel’s Care Centre in Punchbowl, NSW. A 2024 audit found failures across all eight Aged Care Quality Standards: shoddy clinical care, chemical restraints used without alternatives, unmonitored blood glucose levels, staff clueless about residents’ needs, foreign objects in meals, and poor family communication.

Residents were at serious risk, yet the Commission’s response was a masterclass in leniency: no accreditation revocation, just a tweaked accreditation expiring May 2025, with 39 corrective actions like updating care plans and cutting agency staff. By May 2025, another assessment showed ongoing monitoring but no sanctions or Notice to Agree.

And then we have Carinya of Bicton (Perth, WA) with a site audit conducted from 7 January to 9 January 2025 and reaccredited on 19 January 2025, to 11 June 2026. However, reports indicate that in May 2025, there were serious failure across all eight Quality standards. The Commission is monitoring. Then Bupa, an organisation that had the gall to claim in court they “never promised to meet minimum care standards,” in response to an ongoing class action against them.  That’s not just cheek; it’s a two-finger salute to regulators, taxpayers, and residents. And yet, if a small provider tried that, they’d likely be shut down before the ink dried.

The double standard exists because big providers are untouchable; the system can’t handle the fallout if they fail.

Audits are another act in this circus. Unannounced visits, once the backbone of real quality checks, have been swapped for predictable short-notice or remote assessments. Providers now get a heads-up to spruce up the place. Insiders, including ex-Commission staff, say visits are so expected that facilities can hide their flaws. A former colleague was asked to complete an internal audit of their nursing home, after a Commission green light and found significant issues with infection control, resident security and safety, and a range of other matters that with appropriate evidence-based risk assessment would have found the residents to be at potential serious risk. That’s not oversight; it’s negligence masquerading as compliance. Remote assessments, a hangover from COVID, are a joke. You can’t measure care quality over Zoom. Real checks need eyes on the ground: observing, interviewing staff and residents, checking records in real time. Anything less is just ticking boxes to keep the show running.

Media, not Standards, drives action. Exposés by the ABC are what spark quick responses, often before proper investigations, while quieter failures like St Charbel’s as but one example get “monitored” into oblivion. This headline-chasing betrays the Commission’s true priority: keeping the system’s image clean, regardless of the impact on residents.

Aged care isn’t a sexy portfolio, so political will is flimsy. The Commission’s own spin, from Regulatory Bulletin RB2024-26, claims enforceable undertakings “support sustainable compliance outcomes while reducing disruption to residents.” Disruption? Try telling that to residents stuck in substandard care because regulators won’t act. It’s a pathetic cop-out.

Smaller providers, especially in rural and regional areas, get the raw end of the deal.

Regulations like the 24/7 registered nurse rule or upcoming medication administration requirements crush them. They can’t afford agency nurses charging approximately $1200 to $1500 a day plus travel, a cost big providers swallow easily. This squeezes out standalone operators, leaving the sector to corporate giants. Even governance rules, like mandating independent board directors, can be a sham. Providers just appoint mates – doctors or nurses – who nod along, gutting the spirit of accountability. It’s straight out of Yes Minister, a performance where compliance is faked, not enforced.

Then there’s the scam of additional services. Some providers charge for things like wine or newspapers, even when residents can’t derive a benefit, as the law requires. A stroke survivor who can’t drink or communicate shouldn’t be billed or offered to opt out, but who checks. Self-reporting, like SIRS, is another weak link. Providers can choose or not choose to report effectively marking their own homework, so issues may go underreported. I helped an enrolled nurse falsely accused of abuse, reported five months late. The Commission’s response? A letter, no interviews, no site visit. If real abuse had happened, residents could’ve suffered for months.

So, how do we fix this mess? Bring back unannounced visits, the heart of real quality control, done cyclically with no warning. Lay out Aged Care Act expectations clearly, with penalties enforced consistently, no matter the provider’s size or clout. Revamp re-accreditation for genuine, real-time quality assurance, not staged shows. Providers need to monitor systems 24/7, not just when the Commission knocks. And keep regulators independent. Residents need a real advocate, not a system chummy with the industry it is meant to be policing.

The aged care sector is full of dedicated staff who care deeply, but they’re let down by a regulatory setup that puts politics before people. Most providers mean well, but good intentions don’t cut it when oversight is a charade. Our elderly deserve better than a system that polishes its image while leaving them at risk. It’s time to drop the curtain on this farce and demand real accountability, before another tragedy reminds us what’s at stake.