Grow or shrink: Aged care leaders can no longer sit on the fence

Aged care boards often succumb to an accountability problem. While they’re focused on managing the complex issues of compliance, workforce, and finance, they often don’t ask the harder questions, like: what is our role in the structural problem facing the sector?

Wayne Belcher OAM sets a direct challenge to boards in a time of great reform. 

“I would love to see every board sit down and do a capital investment workshop where they’re actually considering: what is our place in this sector? Are we in it to stay, or are we in it just for ourselves at this point in time?”

The answers can be the difference between survival and thriving.

Providers are facing a choice

Organisations that stay static in a growth-deficit environment don’t stay stable: they decline. As the provider market contracts, the organisations left standing will be those that made a deliberate choice to expand. Which isn’t an argument against small providers – it’s an argument for intentionality. 

“If we’re in it to stay, as tough as it is, we have a choice,” Belcher offers. “We can either stay the size we are and we will almost certainly dwindle out of existence, or we can be part of the solution and grow our business, so that we are providing additional places.”

If providers are, in fact, in it for the long haul, a practical first step is to invest in a capital investment workshop.

What a capital investment workshop looks like

In his own research, Belcher suggests a powerful framework that aged care boards can use to run a diagnostic. Designed around six key lenses, it offers strategic guidance for capital that factors in compliance as well as the lifecycle of assets.

1. Strategy: Know which of your buildings will be obsolete within 20 years, and whether your current operating model can actually afford to replace them.
2. Risk: Understand your RAD exposure, whether your village contracts can survive a redevelopment cycle, and when your older buildings last had a serious safety audit.
3. Control: Make sure your capital plan, asset register, and registration conditions are one integrated document – not three that only get reconciled when a board paper is due.
4. Culture: If management is describing ageing buildings as “established” or “trusted,” your board may be the last to know they’re at end of life.
5. Conformance: Every major capital decision should be tested against your Aged Care Act 2024 obligations and your ACNC governance standards, not assumed to be compliant.
6. Performance: Know where you sit against the StewartBrown benchmark, and have a pre-agreed trigger – written into your strategic plan – for when underperformance forces a decision to recapitalise, divest, or find a partner.

Take proactive action

Much like providers, aged care peak bodies have their limits. In the past, they’ve tended to be too diplomatic with the government to force the capital conversation. This is where providers can act collectively to amplify the conversation.

“To do nothing I think fails our own clients and our organisation,” Belcher confessed. “Every provider, with others, as collegiate support, can do a great deal – with or without the peak bodies.”

There’s more at stake than just organisational survival. We must ensure that the current generation of aged care leaders can actually leave the sector in better shape than they found it. And this is where boards can offer hope and support. 

What should a CEO or board chair do in the next 30 days? 

Put the capital conversation on the next board agenda: commission the numbers and make the decision. The solutions to aged care’s biggest challenges have to come from somewhere and they’re more likely to come from the providers who are willing to speak up.

“Every provider can do something,” Belcher encourages, “and the larger the provider is, the more noise they can make. We need to consider changes that are going to surpass the ability of some of the peak bodies at the moment.”