OPINION: A uniform national pricing or regulatory model of aged care won’t fit in regional and rural settings.
Regional Western Australia will determine whether national aged care reform can deliver what it promises.
While the policy intent is universal coverage, the conditions under which regional providers operate – thin labour markets, limited housing, ageing assets and higher costs – require different settings to achieve the same outcomes.
What works in metropolitan settings will not automatically translate outside them; a reality the aged care sector has been clear on for more than a decade.
Demand in many regional communities is rising faster than in metropolitan areas and, like the cities, the economics underpinning aged care are moving in the opposite direction.
The cost of building an aged care bed in regional WA now exceeds $600,000 and sector-wide operating deficits continue to deepen. Even efficient, well-managed providers struggle to make a viable case for expansion or large scale refurbishment under current capital and operating structures.
We know capital only flows to environments with predictable returns. Currently, regional aged care does not offer that predictability (and has never really done so). Without structural change, the gap between what communities need and what providers can sustainably deliver will continue to widen.
Delivering care outside metropolitan areas requires a policy framework that reflects a different commercial and operational reality.
Workforce remains central to this challenge, but the constraint in regional WA is both labour availability and housing availability. Providers can recruit staff but cannot retain them without suitable accommodation.
Many regional towns have little or no additional housing stock and the existing supply is often unsuitable or unaffordable for care workers.
Workforce planning in regional areas must be tied directly to housing policy. While there has been some government investment in staff accommodation in recent years, it falls short of the long term, dedicated capital stream needed to support a stable workforce pipeline.
The condition of aged care infrastructure in regional WA is another significant challenge. Providers are expected to deliver increasingly complex clinical and regulatory outcomes with infrastructure that was never designed for modern care models.
Many facilities were originally built as low care hostels decades ago and lack the configuration needed for today’s higher acuity residents. Retrofitting older buildings to contemporary standards is frequently inefficient or unviable.
However, closing outdated beds without replacing them reduces access for local families and places further strain on the health system.
Ensuring Aboriginal elders can access appropriate services close to home is essential to equity.
The Yokai memorandum of understanding (signed by aged care organisations MercyCare, Bethanie, and Hall and Prior with Aboriginal community controlled organisation and Stolen Generations advocate, Yokai) signifies a commitment from those providers to improve culturally appropriate services for Aboriginal customers.
But goodwill is not enough. Delivering culturally safe care in regional and remote areas depends on stable staffing, flexible funding and policy settings that recognise the additional capability and resources needed to deliver this work well in dispersed communities.
The broader system impacts of regional aged care shortfalls are becoming harder to ignore. Limited residential and home care capacity means regional hospitals often become the de-facto providers of aged care.
Hospitals are no place for older people who are not actually sick. Economically, this is also inefficient, costly, and ultimately unsustainable. The health system cannot absorb the long-term consequences of under resourced aged care, particularly in communities where distance magnifies the impact of every systemic gap.
The challenge for policymakers is that regional WA cannot be treated as a scaled down version of metropolitan aged care. The operating conditions are fundamentally different: workforce markets are thin, housing is scarce, construction costs are higher and infrastructure is older.
A uniform national pricing or regulatory model will always fall short in these environments because it is built around metropolitan assumptions that do not apply beyond the city. Regional providers need settings calibrated to the realities in which they operate.
Reform that overlooks this will deliver inconsistent outcomes and entrench the very inequities it seeks to resolve.
Strengthening aged care in regional WA, therefore, requires a policy response built around place: capital settings that reflect real construction costs, long term investment in workforce housing, pricing that accounts for regional complexity and durable funding models that support culturally safe care for Aboriginal elders.
If reform can work in regional WA, it can work anywhere.
• Amber Crosthwaite is a commercial lawyer specialising in seniors living.
