“No bed, no exit”: SA’s aged care bottleneck forces hospitals to get creative

As aged care bed shortages continue to paralyse hospitals across the country, South Australia has taken the unusual step of opening a “bridging ward” at Hampstead Rehabilitation Centre and repurposing hotel rooms to house elderly patients with nowhere else to go.

It’s a stark measure, and one that underscores the growing cracks in Australia’s aged care system.

Right now, hundreds of older South Australians remain stuck in public hospital wards, despite being medically cleared for discharge. Many wait weeks, even months, for a place in residential aged care. And South Australia leads the country on this metric, with a median wait time of 253 days from approval to placement, nearly double the national average of 136 days.

Hotel rooms over hospital wards

In a move that blends necessity with innovation, the state government has converted part of the Pullman Adelaide hotel into a temporary care facility for long-stay patients. Medically stable but unable to return home or enter aged care, these patients receive supervised care while they wait for a permanent placement. So far, more than 80 people have used the service, freeing up dozens of hospital beds.

Health Minister Chris Picton says the pilot offers a “more dignified, cost-effective alternative” to long hospital stays, which are both expensive and detrimental to patient wellbeing. “This is the reality of an aged care system in crisis,” he told the media this week.

A national symptom, with state-led solutions

The move comes as part of a broader state response, including 55 new beds at Hampstead Rehabilitation Centre, targeting older people who are in hospital limbo. The new Care of the Older Person and Community Transition (CO-ACT) service will include 50 beds for patients awaiting aged care placement and a further 20 for those with dementia or memory support needs. 

But these beds barely scratch the surface of what’s needed.

In 2022–23, older Australians occupied more than 438,000 hospital bed days nationally while awaiting residential aged care according to the AMA, Hospital Exit Block Report. Queensland, New South Wales and South Australia were the hardest hit. In SA alone, the figure exceeded 58,000 bed days — a staggering use of hospital resources for patients who should have been discharged long ago.

The bigger problem: aged care capacity is falling behind

Behind the hospital gridlock is a deeper issue: in 2024 alone 10 aged care homes closed, results in the loss of nearly 800 places, and new builds are not keeping pace with demand. Occupancy in the remaining homes sits above 90%, leaving little room for urgent admissions.

South Australia’s government has committed nearly $60 million to transitional services and aged care initiatives, including $42.9 million jointly funded with the Commonwealth.

But many argue it’s not enough.

In response, federal funding has started to flow. The 2024–25 Budget included:

• $610 million for states to reduce hospital discharge delays
  
• $270 million to expand Transition Care Programs
  
• 24,100 additional Home Care Packages 

The Albanese Government is also preparing to launch the Support at Home reform in 2025, aiming to consolidate home care programs and improve access to in-home support, potentially easing pressure on residential aged care places in the long term.

Still, the reality on the ground remains stark.

“These are people, not bed blockers.”

Hospitals are designed for acute care, not long-term stays. Yet for too many older Australians, they’ve become holding pens, sometimes for months, simply because no aged care bed is available.

The Australian Medical Association estimates that this issue costs health systems up to $2 billion annually in wasted hospital resources.

As COTA Australia and other advocacy groups continue to push for investment in aged care infrastructure and workforce capacity, South Australia’s stop-gap solutions offer a glimpse of what may be required nationwide: more flexibility, more collaboration, and bold thinking to prevent a system-wide breakdown.

Because for every hospital bed that’s blocked, there is a person waiting, and a system struggling to keep up.