The “haves and have-nots” debate in aged care dining

The recent debate about so-called “two-tiered” offerings in aged care has struck a nerve across the sector. The idea that some residents might receive different dining options based on what they pay has been framed as controversial – even unacceptable.

But the reality is more nuanced than that.

For many working in aged care, this is not a new conversation. In fact, the sector has been grappling with this issue for more than a decade, ever since “additional services” were introduced in 2014. Those changes were designed to give residents more choice — including the option to pay for enhanced lifestyle and hospitality offerings.

Many of us remember vividly what those early rollouts looked like.

In some homes, the implementation was clumsy. I recall that, at mealtimes, a makeshift partition was pulled across the dining rooms to separate residents receiving additional services from those who were not. Residents paying for the enhanced offering might have access to extras such as a stocked fridge with snacks, sandwiches, and higher-quality biscuits to graze on throughout the day.

It didn’t always feel good.

Residents noticed the differences immediately. Some helped themselves to items they technically weren’t paying for. Arguments between co-residents weren’t uncommon. Staff were often left trying to manage rules that felt uncomfortable to enforce.

Those early experiences highlighted something important: the challenge isn’t necessarily the concept of different service levels – it’s how those differences are delivered in a place people call home.

A system designed around choice

Over the past decade, aged care policy has deliberately moved toward consumer choice and personalisation.

The system increasingly encourages residents to make decisions about their care and lifestyle. That includes the option to pay for additional services or enhanced experiences if they choose to.

When choice is built into a system, different levels of service inevitably follow.

We see tiered offerings everywhere else in society. Airlines have economy and business class. Hotels have standard rooms and suites. Restaurants offer different menus and price points. Even healthcare systems operate with public and private options.

The difference in aged care is that residents live together. They share dining rooms, lounges, and social spaces. Meals are social moments, not simply transactions.

And that’s where the tension lies.

Rising expectations from residents and families

Today’s residents are entering aged care with very different expectations to previous generations.

Many have travelled widely, dined out regularly, and enjoyed vibrant social lives. Families often expect aged care homes to deliver a dining experience closer to hospitality than institutional care.

At the same time, government funding primarily covers basic care and everyday living costs. Premium hospitality experiences – if residents want them – often require additional funding.

This creates a practical dilemma. Providers can either offer a single, basic standard for everyone, or they can offer additional choices that residents may choose to pay for.

Where the ethical line sits

The issue isn’t whether different offerings exist. It’s whether the standard offering remains dignified and good.

The ethical line is crossed when basic services are deliberately reduced to push residents toward paying for upgrades. Removing amenities, diminishing food quality, or presenting the standard option as inferior risks undermining the dignity of residents who simply choose not to pay for additional services.

Residents should still receive quality meals and meaningful choice within the core offering. Premium options should feel like enhancements – not necessities.

Equally important is the way these choices are communicated. Residents should never feel embarrassed about the option they choose or the budget they have.

Why dining rooms make this so complex

Unlike hotels or airlines, aged care is a shared living environment. Residents eat most of their meals together and dining rooms are often central to the social life of a home.

Seeing different meals served at neighbouring tables can feel uncomfortable, even if everyone understands the reasons.

That doesn’t mean enhanced options can’t exist. But it does mean the design of these offerings requires thought and sensitivity.

Some homes have explored ways to make dining feel more like a restaurant – allowing residents to occasionally purchase premium items, such as a special meal, dessert, or treat, rather than strictly dividing offerings by package. This approach allows choice while maintaining a sense of shared experience.

The role of frontline teams

One of the biggest lessons from past attempts at tiered offerings is that frontline staff play a critical role in how these models succeed or fail.

Nurses, hospitality teams, and lifestyle staff often feel deeply protective of residents. If they believe a model disadvantages residents, even unintentionally, their instinct is to step in.

When staff feel uncomfortable with a model, it can quickly unravel. Rules become blurred, explanations become inconsistent, and the experience for residents suffers.

For any new service model to work, staff need to understand the intent behind it and feel confident that the standard offering remains fair and respectful.

When cognitive impairment adds another layer

Another complexity often overlooked in this debate is how these models work for residents living with cognitive impairment.

Many aged care residents are no longer able to make financial decisions independently, which means frontline staff must balance offering choice with protecting the resident from unintended spending.

A resident may ask for a premium meal or an extra treat without fully understanding that it comes at an additional cost. Staff may find themselves in difficult situations — wanting to honour the resident’s request while also ensuring they are not making financial decisions they do not have the capacity to make.

Clear agreements with families or financial guardians about discretionary spending become essential. Homes need systems that guide staff on what can and cannot be purchased on a resident’s behalf, while still ensuring the resident never feels embarrassed or excluded.

As with many aspects of aged care, the answer lies not in removing choice altogether, but in designing processes that protect residents while preserving dignity.

A conversation the sector needs to have

The “haves and have-nots” narrative is uncomfortable, but it reflects a broader tension in the aged care system.

Residents want choice. Families increasingly expect higher standards. Providers are encouraged to innovate. Yet the sector must also preserve dignity, fairness, and community in a place residents call home.

The challenge isn’t whether different levels of service should exist. The real challenge is how to deliver choice in a way that never makes someone feel like they don’t belong at the table.