Aged care overhaul criticised as First Nations Elders face new barriers

Aboriginal and Torres Strait Islander aged care leaders are warning that recent reforms are deepening pressure on Elders and on the community-controlled providers many families trust most. The concerns have sharpened around the Support at Home program, which began alongside the new Aged Care Act in November last year, and around the continuing interim status of the First Nations Aged Care Commissioner role.

The Queensland Aboriginal and Islander Health Council has urged governments to move quickly, arguing the current arrangements are not adequately designed around the lived realities of older First Nations people. Its concerns focus particularly on co-payments, financial barriers, and the risk that reforms framed as modernisation may end up widening existing inequities instead of reducing them.

QAIHC acting chief executive Paula Arnol said, “The current reforms are not addressing the realities faced by many Aboriginal and Torres Strait Islander Elders.” The organisation says those realities include lower rates of home ownership, limited superannuation, heavier reliance on income support, and the need for culturally safe services that many large mainstream providers are not set up to deliver.

The broader policy context makes the warning harder to dismiss. The federal government’s own material states the Interim First Nations Aged Care Commissioner role was created in response to recommendation 49 of the Royal Commission into Aged Care Quality and Safety, and that part of the role is to help design an independent permanent statutory commissioner in partnership with Aboriginal and Torres Strait Islander people. Andrea Kelly remains in the interim role, with the government indicating the appointment runs until June 2026.

That continuing interim arrangement has itself become part of the criticism. Sector leaders say it sends an uneasy message about how seriously reform is being taken, especially when the commissioner’s formal brief includes advocating for system-wide change that embeds cultural safety. In practical terms, providers say the system is still not matching rhetoric with funding certainty, flexibility, or the kind of local authority needed for genuine self-determination in care.

Another key concern is the effect on community-controlled services. QAIHC and allied providers say these organisations are carrying heavier administrative and compliance burdens while trying to preserve low-barrier, preventative supports that help Elders remain independent and connected to community. They argue that as smaller providers are squeezed, larger for-profit operators are better placed to absorb reform costs, potentially shifting the market away from culturally grounded care.

What is at stake is bigger than program design. The argument from the First Nations sector is that aged care reform will only succeed if it is built around cultural safety, proper partnership and stable support for Indigenous-led delivery. Without that, a system intended to improve care may instead make it harder for Elders to stay connected to Country, family and community in later life.