Outgoing aged care watchdog delivers final warning: “We are designing our way into the problem”

Australia’s outgoing aged care watchdog has delivered a sharp final critique of the Government’s reform agenda, warning that the implementation of the new aged care system risks accelerating decline among older Australians rather than supporting independence.

Speaking at the National Press Club this week, Inspector-General of Aged Care Natalie Siegel-Brown argued that while the principles behind the Albanese Government’s reforms were sound, the current design and delivery of the system are creating unintended consequences for older people, providers and taxpayers.

Her comments come just weeks before she leaves the role, having served as Australia’s inaugural Inspector-General of Aged Care since January 2025.

While acknowledging the ambition behind the new Aged Care Act, which commenced on 1 November 2025, Siegel-Brown said there remained a significant gap between legislative intent and what was occurring in practice.

“A promise on paper is not the same as a promise realised,” she said.

“As Inspector-General of Aged Care, I cannot see how our system is geared to deliver that promise.”

Support at Home facing renewed criticism

The strongest criticism from Siegel-Brown centred around the rollout of Support at Home and the introduction of consumer contributions for some services.

She argued the reforms were built around a reasonable principle: that Australians with the financial capacity to contribute towards their care should do so.

However, she said the current model has created a situation where those requiring the most support may face the greatest financial burden.

“At the heart of the aged care reforms is a very defensible idea: those who can afford to contribute should,” she said.

“But that is not the system we have built.”

For aged care providers delivering home support services, the concerns raised by Siegel-Brown highlight ongoing challenges around service uptake, client decision-making and whether older Australians are delaying essential supports because of cost concerns.

She warned that services such as transport, domestic assistance, meal preparation and social participation are not peripheral supports, but critical interventions that help maintain independence and prevent further deterioration.

Her concern is that when these services become harder to access, the system ultimately faces greater pressure as people enter residential aged care with higher needs.

The cost of delayed support

Siegel-Brown argued that long wait times and limited access to home care are creating a false economy.

More than 200,000 Australians remain waiting for aged care support, and she said delays are not simply an administrative issue.

“Waiting is not free. Decline is not free,” she said.

According to Siegel-Brown, people who remain unsupported for extended periods are more likely to experience declining health, increased hospital presentations and earlier entry into residential aged care.

She contrasted the cost of supporting people at home with the significantly higher cost of residential care, arguing that inadequate investment in early intervention ultimately shifts costs elsewhere in the system.

“If we are effectively pricing people out of the very care that is designed to keep them independent at home, we are likely pushing them towards something far more expensive to the taxpayer: residential care.”

The argument reflects one of her broader criticisms of the current reform approach: that governments continue to respond to aged care demand by expanding residential capacity rather than reducing the number of people needing that level of care.

“Building our way out” is the wrong approach, watchdog says

Federal Government representatives have repeatedly highlighted the need for more residential aged care beds as Australia’s population ages.

But Siegel-Brown challenged this approach, arguing the sector should instead focus on preventing avoidable transitions into residential care.

“I see us keep trying to build our way out of a problem we are designing our way into,” she said.

She pointed to international examples, including Denmark, where greater emphasis has been placed on prevention, community-based support and maintaining independence.

She also argued Australia already has evidence that earlier intervention works.

“When people are properly supported to stay at home for longer, it roughly halves the rate of entry to residential aged care,” she said.

For providers, the comments highlight a broader policy debate about whether future aged care investment should prioritise infrastructure growth or strengthening the community care system that supports people before they reach crisis point.

A system problem, not simply a funding problem

Throughout her tenure, Siegel-Brown has repeatedly argued that aged care’s challenges cannot be solved through funding increases alone.

Her latest address reinforced that view.

“The real issue is not that we’re short of funding. It’s we’re short of value,” she said.

She pointed to examples where administrative complexity and inefficient processes have resulted in significant expenditure while delaying simple supports.

One example she provided involved an older person requiring approximately $50 worth of crutches, but instead undergoing a lengthy occupational therapy assessment process before receiving assistance months later.

For Siegel-Brown, the example demonstrates a broader issue within aged care reform: a system that can sometimes prioritise process over timely intervention.

She argued governments need to focus less on reforms that are easier to announce and more on changes that deliver practical improvements for older Australians.

Concerns extend beyond Support at Home

Siegel-Brown’s criticism has not been limited to consumer contributions.

During her time as Inspector-General, her office has raised concerns about the accessibility and complexity of My Aged Care, assessment processes and whether reforms are achieving their intended outcomes.

Her office’s review of My Aged Care found many older Australians continued to struggle navigating the system and accessing support.

She has also previously warned that implementation risks undermining the rights-based vision outlined in the new Aged Care Act.

The concern is that while the legislation establishes stronger expectations around dignity, choice and independence, the systems supporting that legislation must be capable of delivering those outcomes.

Government defends aged care reforms

The Federal Government has rejected the suggestion that its reforms are making aged care worse.

Aged Care Minister Sam Rae said Labor had expanded access to home care, placed older Australians’ rights at the centre of the system and was continuing to improve implementation.

He pointed to the significant growth in home care participation and said the reforms had placed aged care on a more sustainable footing.

“While we know there’s much more to do, our aged care system is on a stronger, more sustainable footing as a result of our reforms and we’ll continue to work to strengthen it as our generational reforms bed down,” he said.

The Government has already adjusted elements of Support at Home following concerns raised by consumers and the sector, including moving some personal care services into fully funded clinical supports.

However, Siegel-Brown argued broader questions around co-contributions, waiting times and system design remain unresolved.

A significant final intervention

Siegel-Brown’s departure on 31 July marks the end of a short but influential tenure as Australia’s first Inspector-General of Aged Care.

Her final message was not a rejection of reform itself, but a warning that successful aged care transformation depends on how policy operates in practice.

For providers navigating the complexity of the new system, her comments reinforce a concern that has been raised repeatedly across the sector: that implementation challenges risk undermining the very goals the reforms were designed to achieve.

The Government has positioned the new Aged Care Act as a generational reform built around rights, dignity and choice.

Siegel-Brown’s final assessment is that achieving those ambitions will require more than legislation. It will require a fundamental rethink of how Australia funds, delivers and prioritises aged care.