Delivering aged care in remote Australia: From policy design to lived dignity
Goorambah Bigi. I begin by acknowledging the Traditional Custodians of the lands on which we meet today – the Yuggerah Turrabal people, and I pay my respects to Elders past and present. I extend that respect to the First Nations Elders joining us here, whose authority, wisdom and cultural leadership have long set the standard for how Elders should be respected, and whose teachings we must be far more deliberate in carrying forward.
Like all of you here, I do not regard aged care in remote Australia as some 'marginal issue'. And unlike some of the messaging might tacitly convey from time to time, it is not something to be dealt with once the 'main system' is working properly.
If a system cannot deliver dignity, safety and culturally fulfilling care in the most challenging contexts, then it is not yet a system that deserves the confidence we place in it.
Many of you here don’t need me to tell you that remote aged care is difficult. You live it. You’ve built services around realities that policy too often treats as edge‑cases.
So rather than restating what you already know, I want to frame today around 3 propositions that go to the heart of where I see aged care reforms, and how it will hold in remote Australia.
First: Ageing in place is not sentiment, it is strategy.
If we want a sustainable system, we must fund support earlier and closer to home. Because when aged care services in the community are thin, the system defaults to hospital or residential care – often far from culture, kin and community – and that is both harmful and expensive.
Keeping people well and connected for longer is the most fiscally intelligent thing the system can do, as well as the most humane.
Second: The Remote Accord exists for a reason, and the reforms now rolling out should be judged against that origin story.
The Accord wasn’t formed as a networking group. It was formed because the system itself – and the workforce strategy that helped give rise to this Accord – recognised that remote and very remote communities require different design, not a metropolitan model stretched over distance.
The practical test we need to wrestle with is: Do the new reforms meet the needs that gave rise to the Accord in the first place?
Third: Remote aged care is being held together by you, and the system depends on unseen work it rarely names.
You are often the only stable service presence, the relationship‑keepers, the navigators, the cultural translators, and in many communities, part of the social infrastructure.
Policy can promise rights, dignity and choice, but in remote Australia those promises live or die in the daily reality you manage.
Those are my 3 messages:
- Investing in keeping people in the community is both a rights and economic strategy
- Reforms must be judged against the Accord’s founding rationale
- The system must recognise the centrality of your work.
Many of you aren’t operating in what policy documents call 'markets'. You are operating in places. Places where you know your clients by name. Where you see them at the shop, at community events, at funerals and ceremonies. Where your staff are not just workers, but neighbours, relatives, and trusted faces.
Many of you deliver services remotely, coordinating care across hundreds of kilometres, flying in and out when you can, relying on phone calls that drop out, internet that fails, and staff who stretch themselves well beyond what metropolitan service models ever anticipate.
Before I go any further, I want to say this plainly: In many remote communities, aged care services are not peripheral to community life. They are part of the fabric that allows people to age in place at all.
And for much of what you do – the unseen hours, the improvisation, the relationship work, the community responsibility – I want to thank you.
In my role as Inspector‑General of Aged Care, I oversee the Government’s administration of the aged care system – from policy right through to implementation. I look not only at what the system intends to do, but at how it actually operates – across different contexts, cultures and communities.
The limits of our aged care system become most visible wherever people do not neatly fit the assumptions the system was designed around.
The Remote Area Accord exists because the system was told – explicitly – that remote aged care requires deliberate workforce strategy and deliberate system design, not after‑the‑fact adjustments.
From my own work, 3 realities are unavoidable, and are well known to you:
- Service availability drops sharply with remoteness
- Waiting times grow longer, not shorter, as need increases
- The consequences fall disproportionately on Aboriginal and Torres Strait Islander older people.
When services that address everyday need are thin on the ground, the system does not pause. It defaults. And the default, far too often, is hospital – or residential care – miles and miles away from culture, community and kin.
For the older person, this is not simply a change of setting. It is unsafe. It is disorienting. And it is profoundly demoralising.
We know this intuitively, and we see it repeatedly: people decline faster when they are removed from the relationships, routines and places that give their lives meaning.
What is framed administratively as '“accessing care' is, in lived terms, often loss: loss of control, of identity, and of connection.
I want to pause here to make an important clarification. It is sometimes assumed – incorrectly – that Aboriginal and Torres Strait Islander people predominantly live in remote Australia. In fact, around 85% of Aboriginal and Torres Strait Islander people live in urban and regional Australia. Only around 15% live in remote and very remote areas.
But – this is the critical point – the impact of remoteness is disproportionately borne by Aboriginal and Torres Strait Islander people. In very remote Australia, almost half of the population is Aboriginal or Torres Strait Islander.
So, when aged care fails in remote contexts, it is not a geographically neutral failure. It falls most heavily on First Nations Elders.
Therefore, to speak honestly about aged care in remote Australia is therefore to speak honestly about First Nations ageing – not because most First Nations people live remotely, but because system failure in remote contexts disproportionately affects them.
For First Nations Elders, removal from Country, community and kin does not simply reduce quality of life. It actively undermines wellbeing and hastens decline.
A system that cannot deliver support where people live forces choices that are neither safe nor efficient. And when that happens, there is a devastating cost to the individual and to kin and community.
And - as I will describe in a moment – there is also a fiscal cost.
This is not an abstract issue for me. Earlier in my career, I lived in the Kimberley. I worked for an Aboriginal Medical Service, supporting social and emotional wellbeing care delivery across vast distances – in communities where services are sparse, workforces are thin, and relationships matter more than any formal service boundary.
I saw first‑hand how services are not simply providers. They are part of the community fabric. And I saw how Elders sit at the centre of that fabric in a way that, frankly, we have lost in ‘mainstream society’.
When services fail them, it wasn’t just an individual who suffered. The whole community feels it.
That experience continues to inform how I approach my role today.
I know that, for many First Nations Elders, engagement with government systems carries deep historical trauma-stemming from:
- forced removals
- institutionalisation
- loss of Country
- decades of discriminatory service design.
This harks back to the Royal Commission and a reminder of what we may have lost sight of in the current reforms to the aged care system.
The Royal Commission did not describe quality aged care as a narrow clinical concept. Nor did it describe dignity as something delivered by legislation alone. It described a system where people can age with connection, self‑determination, and safety – and where services are delivered in ways that meet people where they are.
In my 2025 Progress Report, I described the risk of reforms being 'disparate and disconnected', and warned about unintended consequences that could push people prematurely into residential care, undermining ageing in place.
Remote Australia is where those consequences appear fastest.
So the question becomes: what do we need to do to bring reform back into alignment – not just with the Act’s language, but with the Accord’s founding rationale?
The struggles in delivering CHSP is one of the clearest manifestations of where the rubber hits the road here. In many remote and very remote locations, CHSP is not an entry‑level service sitting alongside other options. It is the only service provider. There is no alternative market.
No spare workforce. No capacity to absorb disruption.
And yet communities and providers are being asked to live with profound uncertainty about what happens after July 2027.
For communities, this uncertainty translates into fear: fear of losing the only service that allows Elders to remain at home.
For staff, it translates into insecurity: wondering whether the work they do, and the relationships they have built, will still be supported.
A transition that destabilises CHSP in these contexts does not simply reform a program. It risks removing care altogether.
Recently I spoke out about the fact that the Commonwealth does not currently hold – or at least cannot clearly articulate – reliable data on unmet need in CHSP, particularly by geography.
What we do know, from consistent and overwhelming evidence, is that demand exceeds supply, and that providers in regional and remote areas are routinely turning away people who have already been assessed as needing care.
Extended delays in access to basic supports – help with meals, transport, personal care, social connection – increase the risk of rapid deterioration and premature entry into higher‑level care, or worse, no care at all.
In remote areas, those risks are amplified by distance, workforce shortages, infrastructure constraints and thin provider markets.
The refrain – or defence – I hear all the time in response to delivering better funding and prioritisation of the very programs that deliver on the Government’s beautiful promise of dignified aged care that prioritises connection to country, community, culture and even pets – such as that delivered by CHSP, is:
“The problem is that we have a largely static aged care budget, demand is growing as our population ages, and the tax base that funds it is under pressure.”
Over time, that observation hardens into a kind of fatalism – the idea that the budget will never be enough, and that this is, ultimately, an unsolvable problem.
But I see the ‘problem’ very differently. What we have is a funding distribution issue. How do we use the $40bn to keep people connected, happy and able for longer?
Because when we reconceive the system this way, something important happens: more people get access to support earlier, at lower intensity; decline is slowed; pressure on residential entry eases; and the system is no longer forced to respond primarily at the point of crisis.
Fewer people need beds, sooner – and the budget works harder, for longer, for more people.
When we fail to provide timely, community‑based support that keeps people at home and connected for longer, we do not save money. We shift cost. And we shift it into a much more expensive place – downstream – into hospitals, into residential care, and into crisis responses that are far more expensive and far less effective at prevention.
The evidence is clear, and it aligns with what we know from public health more broadly: Supporting people earlier, at lower intensity, slows decline and reduces the need for high‑cost care later.
Delaying entry into residential care – even by months – reduces cumulative public expenditure, lowers hospital use, and results in shorter, less acute residential stays.
Keeping people well, connected and supported at home for longer is not sentiment. It is economic strategy.
We have decades of evidence – across health, disability, and ageing – that timely, low‑level support, social connection, appropriate housing and environments, continuity of relationships, and support that adapts as people change delays the need for high‑cost, high‑intensity care.
And yet our aged care budget remains structurally weighted toward: late‑stage intervention, clinical task funding, and crisis responses.
There is $40bn going to aged care. We haven’t modelled how spending it upstream in this way, would increase the number of people the system could serve, reduce wait times and importantly lead to a fulfilled ageing journey.
And at the same time I hear the Government constantly decrying the lack of ‘beds’ in residential aged care. People are not beds. Ageing should not mean ‘repairing’ the shell that the holds the human.
My dream is that we de-institutionalise aged care. But, until then, the proportionately small amount it would cost to keep people connected and ageing in place – instead of resorting to residential aged care off country or literally anywhere that ‘has a vacancy’ – could vastly reduce the demand for the current institutional system.
This brings me to the trauma layer we cannot ignore.
For many Aboriginal Elders, particularly members of the Stolen Generations and others who were institutionalised as children, residential aged care can reopen wounds. Being placed off Country, in settings that are not community controlled, can echo earlier experiences of removal, surveillance and loss of autonomy. The routines, the rules, the uniforms, the locked doors can feel uncomfortably familiar.
These environments can trigger fear rather than safety, compliance rather than trust. This is compounded by the very front door to the system: My Aged Care.
In my review of My Aged Care, I found that access barriers for people living in remote and very remote communities are not marginal; they are structural. The system assumes digital access, English fluency, service availability and trust in government processes that simply do not exist in many remote contexts.
These barriers are significantly compounded for Aboriginal and Torres Strait Islander people, particularly those with lived experience of trauma and institutional harm, who may delay engagement or avoid the system altogether for fear of being removed from family, community and Country.
As a result, people often enter care late, in crisis, and with higher needs – not because they did not seek support earlier, but because the system was never designed to meet them where they are.
It is clear we have never designed a ‘theory of change for our aged care system, let alone how to deliver the rights promised by the new Aged Care Act for people in remote communities.
If we say older people have rights, those rights cannot be divided by distance, culture and history.
If we continue to design aged care as if distance, trauma and culture are secondary considerations, then the system will keep defaulting – to hospitals, to residential care, and to harm.
Reform in remote Australia demands a different centre of gravity: power anchored in place; funding that reflects reality, not theory; and Aboriginal Community Controlled Organisations recognised as leaders, not exceptions.
It requires cultural safety that is enforced, not assumed, and support that is delivered in person, not through systems people cannot or will not access.
None of this sits outside the reform agenda. It sits squarely within it. These were clear, deliberate recommendations of the Royal Commission – and until they are properly implemented, we will keep calling something 'reform' that too often feels, on the ground, like retreat.
Thank you.