Aged care’s quiet exclusion: When the system rewards those who say “no”

There’s a quiet crisis unfolding behind the doors of Australia’s aged care homes, and it’s not new.
A recent report has confirmed what many leaders already know but few are willing to say publicly: homes are increasingly screening out residents with high behavioural and psychological support needs. It’s a symptom of a system that rewards the simple and penalises the complex.

For those inside the sector, this isn’t “cherry-picking”; it’s survival. But it’s also a moral reckoning.

The uncomfortable truth

Funding still hasn’t caught up with the true cost of caring for people living with severe dementia, mental health challenges, or trauma-related behaviours. These residents need higher staff ratios, skilled teams, and robust behaviour support programs, all of which demand time, training, and resources.

When those supports aren’t available, leaders are forced into a brutal calculation:
Do we accept someone whose needs we can’t properly meet, risking distress to other residents, burnout among staff, and complaints from families? Or do we quietly decline and protect the home’s stability?

Let’s not pretend this is about discrimination. It’s about design.

The clash of two realities

In today’s market, many facilities operate like small businesses rather than public services. Some residents pay six-figure accommodation bonds for a “premium” experience, including boutique dining, wellness lounges, and quiet surroundings. When those same homes are asked to admit residents who may shout, wander, or lash out, the inevitable happens: complaints rise, families demand action, and high-paying residents threaten to leave.

So the sector self-selects. Homes balance their resident mix carefully, avoiding anyone who could disrupt the experience of those who can afford more. It’s an economic decision disguised as a clinical one. And while leaders can rationalise it by saying “we’re not equipped”, “it’s unsafe”, or “we can’t get staff”, the result is the same: those with the most complex needs are left waiting, often in hospital beds, because there’s nowhere else for them to go.

We have, unintentionally, created a market that rewards exclusion.

When “choice and control” becomes selective compassion

The language of aged care reform has been built around choice and control. But choice, when filtered through economic constraints, becomes privilege. Those with money have options. Those without, or with “behaviours”, are left behind.

This is where the rhetoric of consumer-directed care collides with the reality of underfunding. Behavioural complexity doesn’t fit neatly into a cost-weighted model. Yet leadership teams are measured on occupancy, satisfaction, and compliance, not on who they turn away.

In effect, we’ve created a system that measures success by how efficiently it can say no.

What leaders can do and why it matters

If aged care leaders don’t take ownership of this issue, it will be decided for them by media scrutiny, regulatory intervention, or tragedy.
Here’s where leadership counts:

• Start with transparency. Acknowledge this is happening. Many providers already “pre-screen” applications informally, but few record or report who is turned away and why.
• Push for funding realism. Behavioural complexity costs more. Until that’s recognised through a distinct funding stream or supplement, this pattern will persist.
• Rethink the cohort model. Mixed cohorts work only when staffing levels and environments are suited to them. Dedicated wings or partnerships with behaviour-specialist teams could help ease tensions between premium and high-needs residents.
• Protect your workforce. Staff burnout is the silent casualty of this issue. Without adequate support, even the most compassionate teams are set up to fail.
• Use your influence. Boards and CEOs have more leverage than they think. When united, the sector’s voice can shift the conversation from blame to design failure and push policymakers to act.

The bigger picture

The problem isn’t that aged care homes don’t care. It’s that they’re being asked to meet incompatible expectations: to be a hospital, a hotel, and a home, all within the same funding envelope.

If we continue to penalise facilities for accepting residents with the highest needs, turning people away will remain the rational choice. But if we recognise and properly fund behavioural complexity as a specialist skill, not a liability, we can begin to reverse the trend.

This isn’t just about budgets. It’s about fairness, trust, and leadership integrity.

Because when a system starts rewarding those who say “no”, we all lose faith in what care is meant to stand for.