The Aged Care We Dreamed Of?

This week, I wanted to share some compelling insights from Natalie Siegel-Brown, the Inspector-General of Aged Care for the Australian Government, following her keynote at the ACA Conference in Christchurch, New Zealand, in October 2025.

She opened with two simple but profound questions:

If you were unable to care for yourself independently as you aged:

• What would you most want?
• What would scare you the most about being dependent?
  
  These questions invite us to reflect deeply on what aged care should truly provide. They frame the heart of Australia’s new Aged Care Act—a shift toward a more holistic, person-centred approach.
  
  

Siegel-Brown addressed the practical realities of implementing reform in a sector grappling with funding pressures and workforce shortages. Below are some of her key themes. While this article focuses on the Australian context, it also draws inspiration from the Māori concept of Wairua.

True reform cannot be achieved through superficial tweaks or by targeting the "low-hanging fruit"—those easy fixes that often become the enemy of meaningful change. Instead, holistic aged care demands legislation with teeth: mechanisms that enforce accountability and drive transformation at the core.

While quick policy adjustments may offer short-term relief, lasting change requires embedding the Royal Commission’s findings into law. For professionals navigating this evolving landscape, the directive is clear: shift from procedure-focused to outcomes-focused care.

We must spend less time asking, “How do you feel?” and more time understanding and meeting the fundamental needs of older people. Current funding models often misalign priorities, rewarding compliance over care. Inspired by international models—from Singapore’s 2025 reforms to practices in Scandinavia and Japan—Australia must invest in keeping elders active, connected, and engaged in their communities for longer.

A major barrier to holistic care is the divide between clinical services and personal well-being. Government funding currently covers clinical needs, while essential daily supports—like showers—often fall to personal contributions.

More critically, emotional, personal, and spiritual dimensions are excluded from funding frameworks. Yet these elements are central to a person’s identity, dignity, and resilience. A truly holistic model must embrace the full spectrum of human needs.

To define and integrate these non-clinical dimensions, we can look to the Māori concept of Wairua—spiritual health and resilience. Recognised as the fourth pillar in the Te Whare Tapa Whā model of health, Wairua is essential to well-being.

It refers to the non-physical essence of a person—the source of emotion, character, and soul. It’s not necessarily religious, but rather a deep sense of connection: to self, others, nature, and the world. Encouraging Wairua helps individuals build identity, find purpose, and foster contentment.

Spiritual health strengthens psychological resilience, enabling people to navigate adversity, deepen relationships, and live more fully. Common themes of spirituality that should be embedded in aged care include:

By nurturing Wairua, we build resilience—not just for individuals, but for families (whānau) and communities. When elders struggle to recover from adversity, the ripple effects are felt by all.

To make holistic care a reality, policy must align financial incentives with desired outcomes. Funding drives behaviour—and reform must harness that power.

A proactive, preventative funding model is essential:

1. Preventive Care Savings: Investing early in dental, hearing, and infection prevention keeps elders out of hospitals and reduces long-term costs. This supports both better health outcomes and fiscal sustainability.

2. Incentivising Autonomy: Policies that support elders to remain at home longer reduce reliance on high-cost facilities and promote independence.

Ultimately, the success of reform depends on societal demand. A critical mass of voices calling for outcome-focused, comprehensive care is what compels political action.

The new Aged Care Act must be more than symbolic. It must be the engine of real change—funding the whole person, not just the clinical chart. It must prioritise what elders value most, even when that challenges procedural convenience.