What does it say about us that we needed a billion dollars to make a shower free?

Mark Butler’s $3 billion aged care package is being welcomed across the sector. But look closely, and it’s also an admission about how far we’ve let things slide.

Somewhere in Australia last year, an older person chose not to shower.

Not because they couldn’t physically manage it. Not because they didn’t want to. But because the bill had arrived — a co-payment for personal care under the new Support at Home program. After doing the maths, they chose to eat instead.

Inspector-General of Aged Care Natalie Siegel-Brown has heard these stories firsthand. Since co-payments were introduced in November, her office has collected accounts of people having to choose between a shower and a meal, and of people skipping continence supplies because they couldn’t afford them, leaving them feeling embarrassed and humiliated when they went out in public.

These aren’t edge cases. Three quarters of people receiving home care and paying co-contributions are full or part pensioners. The people bearing the greatest burden of these charges are the ones who can afford it least.

On Wednesday, Health Minister Mark Butler stood at the National Press Club and announced that from October, showering, dressing and continence care will be reclassified as clinical care: free, fully covered, no co-payment. The announcement drew immediate and genuine applause from advocates, peak bodies and provider groups across the country.

It should. Because people shouldn’t have to choose between a shower and a meal.

But it’s worth sitting with the discomfort of that sentence for a moment. Not to score political points, but because it tells us something important about where aged care has been, and what we’re really measuring when we call this progress.

A wave we saw coming

Mark Butler opened his National Press Club address with a personal story. His grandfathers came home from the Second World War in their twenties, found jobs, found partners, and had children. “Lots and lots of kids,” he said, “including my mum and my dad.”

Those babies are now turning 80. And they’re doing it in unprecedented numbers.

In the four years from 2012, the net increase in Australians aged 80 and over was 70,000. In the next four years, that number will exceed 300,000 — four times the growth we saw just over a decade ago.

Butler put it plainly: Australia needs to open a new aged care facility every three days for the next 20 years. Right now, we are nowhere close. In 2024-25, the sector delivered 800 additional beds against a need of 10,000 new ones per year.

We knew this was coming. The demographic data has never been a secret. Yet here we are.

What $3 billion buys, and what it reveals

The package Butler announced is substantial. Three billion dollars across: 5,000 additional residential beds per year through new capital subsidies and accommodation supplement increases; $1 billion to remove co-payments for showering, dressing and continence care under Support at Home; more than $200 million for 20 new Specialist Dementia Care Program units and an expansion of the Hospital to Aged Care Dementia Support Program; and accelerated access to more Support at Home packages, with full details to follow in the May Budget.

“Just as we invest in opportunity for younger Australians,” Butler said, “we must invest in dignity for older Australians.”

That framing — dignity — ran like a thread through everything he said. And it is the right word. But it also raises the question: if dignity is what we’re investing in now, what exactly were we doing before?

Siegel-Brown answered that, quietly and clearly. In her response to the announcement, she welcomed the decision but noted that Australia already spends around $40 billion a year on aged care, and argued that the budget is currently being “consumed at the wrong end of the system.” If people enter residential care earlier than necessary, if they stay longer than they need to, if small supports at home go unfunded until they become crises, then the most expensive setting in the system is doing work that cheaper, earlier intervention could have prevented.

“A system that supports independence rather than dependency, intervenes early rather than late, and invests in connection rather than crisis,” she said, “would serve more people, with shorter wait times, and fewer emergency escalations.”

It’s a provocation worth absorbing. We are spending more to fix what earlier spending could have prevented.

The trade-off nobody wanted to make

To fund part of the package, Butler announced the scrapping of the higher private health insurance rebate for Australians over 65, a Howard-era measure that has paid older Australians a larger subsidy than younger people on the same income.

“I don’t want to take them,” Butler said of hard decisions. “But we have to take these hard decisions.”

Private Healthcare Australia’s CEO, Dr Rachel David, warned the move would affect more than 1.4 million older Australians, with premiums potentially rising by up to $640 a year. She acknowledged, though, that this cohort is largely unlikely to drop their cover — and her organisation has previously called for this cohort’s rebate to be redirected toward lower-income Australians.

Butler called it intergenerational equity. Others will call it a cost shift. What it is, practically, is a government saying: we can’t keep paying a premium for private health cover for older Australians while older Australians are choosing between showers and meals.

The sector response: welcome, but watch closely

The chorus of welcome across the sector has been real, but so has the caution.

COTA Australia’s Acting CEO Corey Irlam described it as “a positive and much-needed investment” while flagging that strong safeguards are needed to ensure aged care homes aren’t exclusively taking residents with the greatest capacity to pay. “All providers benefiting from public funding should be contributing to the care of residents with low means,” he said.

The Older Persons Advocacy Network welcomed the showering announcement but noted it doesn’t address long wait times for assessment or the need for price caps under Support at Home. The Australian College of Nursing was direct: “Each of those beds requires nurses. We must invest strongly in workforce planning.”

Dementia Australia welcomed the $200 million investment and noted that 446,500 Australians are currently living with dementia, with the number projected to exceed one million by 2065. With two in three people living with dementia residing in the community, accessible personal care isn’t a nice-to-have.

The question leaders should be asking

There is a version of this story that is simply good news. Three billion dollars. More beds. Free showers. Dementia care expanded. A government listening.

And in a sector that has spent years fighting for recognition, that version is worth acknowledging.

But the version that will matter most — for your organisation, for your residents and clients, for the people in your care — is the harder one. The one that asks: were the incentives right when we built 800 beds against a need for 10,000? Are they right now? Will the capital subsidies actually drive new beds, or refurbishment of existing ones? Will the most vulnerable, the supported residents, the pensioners, the people with dementia, be the ones who benefit, or will they be last in the queue?

COTA has already flagged that “incentives should be applied at the provider level, not the site level, to ensure each provider is genuinely building additional beds the system needs.” That’s not bureaucratic nitpicking. It’s the difference between a policy that works and one that looks good on paper.

The money is welcome. The admission inside it is important. And the work — for government, for the sector, and for leaders inside it — is far from done.