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While the policy of the aged care reforms absolutely has the right intent, a “perverse mismatch between legislative and policy intent and its administrative implementation” is appearing, says New South Wales Trustee and Guardian chief executive officer Brian Woods.
Speaking on the second day of the Ageing Australia NSW/ACT conference 2026 in Sydney on 14 August, Mr Woods echoed sentiments expressed in former Inspector-General of Aged Care Natalie Siegel Brown’s National Press Club address – that a distinction needs to be made between intent and action.
“We’re doing the right thing for the right reason – it’s the choice of how we do it that needs a far greater focus of attention,” he said.
This is what makes supported decision-making such an important part of the reform.
As an example of why, Mr Woods shared a story involving an older woman living with dementia who was approved to receive in-home aged care and whose husband was caring for her. Meanwhile, her adult son tried to make arrangements with providers and also looked to be appointed as a support person to engage with My Aged Care.
However, when the adult son was advised that his mum had 28 days to engage with a service provider or lose her funding, both the husband and son were left unsure of what to do because the waitlist was more than three months.
This is where reform meets real life, Mr Woods said. This example has the legislative authority for resolution without the need for formal substitute decision-making, but the way the legislation is being interpreted and administered is causing a blockage and leading to adverse outcomes, he added.
“For many people, rights are relatively easy to exercise. For others, they are not,” he told delegates. “One size does not fit all, and that’s a theme that’s been reflected over the last couple of days, and this is where the real test begins.”
People cannot always advocate for themselves
When discussing reform, consideration must always be given to the most vulnerable, including people:
- living with dementia
- with cognitive impairment
- without family support
- moving between aged care, hospital and other services
- who are subject to guardianship and financial management arrangements
- who are involved in family conflict
- who have experienced trauma.
“The reality is, it’s these people who can’t easily advocate for themselves,” said Mr Woods. “They cannot easily navigate out, and they often struggle to access the supports needed to exercise the very rights the reforms seek to protect.
“If reform only works well for people with capacity, resources, family support and … digital confidence, then we have not fully succeeded. Systems developed for the administrative ease of the system administrator – whether that’s a government agency or a service provider – without considering the needs of the breadth and depth of the users of the system, will always lead to perverse outcomes and the greatest impact will be on the most vulnerable.”
Reform will be judged by its treatment of the most vulnerable
While the numbers for the 10-year period up to 30 June 2026 are not yet published, Mr Woods shared with conference delegates that in NSW there has been a 153 per cent increase in guardianship. Mr Woods also flagged that the number of older people under guardianship in NSW is increasing rapidly.
In 2024-25, there were 1,871 NSW Trustee and Guardian customers over 65 under guardianship, and 54 per cent of them lived in residential aged care.
“Demand is increasing, complexity is increasing, decision-making needs are increasing, and they are increasing faster than many of the supporting systems around them,” he said.
But the rising number of older Australians under guardianship is representative of missed opportunities to implement systems that deliver on the legislative and policy objectives, said Mr Woods.
Mr Woods emphasised that “one size does not fit all” and that the sector needs to come together and reflect on how to ensure implementation is not leaving those who are vulnerable behind.
“We cannot use a tool to look at a homogenous group of people because people aren’t homogenous,” he said. “And if we do that, even if we break it down into smaller segments, it’s often the people at the really, really pointy end who are left out and the worst outcomes are for those people. And they’re the people that end up with trustee and guardian.”
“The promise of reform is greater than choice, dignity and rights,” he said.
“That is absolutely the right ambition, but reform will ultimately be judged not by legislation, standards or policy papers; it will be judged by what happens to the older person with dementia, the older person without family, the older person facing abuse and neglect, the older person moving between multiple systems, the older person who has the least power, because that is where reform meets real life and that is where our shared work matters most.”
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