Policy analysis disclaimer: This article presents evidence-based analysis of Australia's aged care workforce crisis and related policy responses. It does not constitute legal or professional advice. All statistics cited reflect published government and research sources. Policy positions represent analysis by Coalition for Better Health contributors.
Introduction
Australia's aged care sector is confronting a workforce crisis that predates the COVID-19 pandemic but has been sharply accelerated by it. The combination of an ageing population, elevated care acuity in residential facilities, chronic underpayment of the direct care workforce, and competing demand from other health and social services sectors has produced a shortfall that no single policy lever can close. Understanding the depth of this shortage — and why it differs meaningfully from the broader Australian health workforce challenge — is a prerequisite for coherent reform.
The 2021 Final Report of the Royal Commission into Aged Care Quality and Safety placed workforce at the centre of the sector's dysfunction. Commissioners Tony Pagone and Lynelle Briggs did not characterise staffing problems as incidental to the system's failures; they identified them as structural and causative. Low pay, inadequate training requirements, high turnover, and a culture of task-based rather than person-centred care were identified as compounding factors that would persist unless addressed through regulation, wage reform, and sustained workforce planning investment.
This analysis examines what the Royal Commission found, how the subsequent legislative and funding responses have performed, where the workforce gap persists and why, and what policy architecture is required to close it.
Royal Commission Findings on Workforce
The Royal Commission into Aged Care Quality and Safety ran from 2018 to 2021, receiving submissions and testimony from more than 10,000 individuals and organisations. Its Final Report identified workforce shortcomings as one of the primary systemic failures in the sector.
Staffing Levels and Skill Mix
The Commission found that residential aged care facilities routinely operated below safe staffing thresholds. Many facilities had no registered nurse on site for significant portions of the day or overnight, relying instead on enrolled nurses or personal care workers for clinical decisions that exceeded their scope of practice. The Commission's commissioned modelling estimated that residents were receiving, on average, significantly fewer minutes of direct care per day than evidence-based standards recommended.
The recommended benchmark — derived from international research and adopted by the Commission — was a minimum of 200 minutes of direct care per resident per day, including at least 40 minutes from a registered nurse. At the time of the report, many facilities fell well short of this standard, and no regulatory requirement existed to enforce minimum time-based staffing levels.
Workforce Culture and Conditions
Beyond raw numbers, the Commission identified a workforce culture shaped by chronic underfunding. Personal care workers — who constitute the largest component of the direct care workforce — were typically paid at Award rates that left them among the lowest-paid workers in the health and social services sector. High casual employment rates meant many workers held multiple jobs across different providers, creating continuity-of-care problems and limiting attachment to individual facilities and residents.
Training requirements for personal care workers were, in the Commission's assessment, inadequate. The Certificate III in Individual Support remained the baseline qualification despite the increasing clinical complexity of residents in both residential and home care settings. Workforce planning was fragmented, with no national body holding responsibility for projecting and managing supply and demand across the sector.
The 2022 Aged Care Act Reforms
The Australian Government's legislative response to the Royal Commission produced two major pieces of legislation: the Aged Care and Other Legislation Amendment (Royal Commission Response) Act 2022, and the broader Aged Care Act 2024, which replaced the 1997 Aged Care Act entirely. The 2022 amendments addressed the most urgent operational issues; the 2024 Act restructured the rights and governance framework.
The 24/7 Registered Nurse Requirement
The most contested workforce reform was the requirement for a registered nurse to be on-site at residential aged care facilities at all times — 24 hours a day, seven days a week — from 1 July 2023. This requirement had been explicitly recommended by the Royal Commission and was strongly resisted by peak provider bodies, who argued that the available RN workforce was insufficient to meet it, particularly in rural and regional areas.
The 24/7 RN mandate was legislated and took effect as scheduled. The Department of Health and Aged Care established an exemption framework for facilities that could demonstrate genuine workforce unavailability, particularly in thin labour markets. In practice, the majority of metropolitan facilities achieved compliance; rural compliance rates were more variable, and the exemption framework was used in a subset of cases. The Australian Aged Care Quality and Safety Commission assumed responsibility for compliance monitoring.
The mandate represented a significant shift in the regulatory philosophy governing aged care. Prior to this reform, staffing requirements were expressed in terms of qualifications held by staff rather than their physical presence. The 24/7 requirement created, for the first time, a presence-based minimum standard with enforcement consequences.
Care Minutes Requirements
Alongside the RN mandate, the government introduced legislated care minutes requirements — the 200 minutes per resident per day benchmark, including 40 minutes of RN time, phased in from October 2023. These requirements were informed directly by the Royal Commission's modelling. Facilities are required to report actual care minutes against targets, and the Star Ratings system — also introduced in the post-Commission reform period — includes care minutes compliance as a publicly visible component.
Wage Reform: Fair Work Commission Decisions
Workforce shortage in aged care cannot be addressed solely through regulation of facility staffing without addressing the compensation that makes the workforce sustainable. The Fair Work Commission's consideration of the Aged Care Work Value Case produced two significant decisions that reshaped the sector's wage structure.
In November 2022, the Fair Work Commission handed down its Stage 1 decision, granting a 15 per cent pay increase for direct care workers covered by the Aged Care Award — personal care workers, enrolled nurses, and home care workers. This was the largest single increase to aged care Award rates in the Commission's history, and it followed a Work Value case argued by the Health Services Union and other unions on the basis that the work's value had been systematically underestimated due to gender-based undervaluation.
A Stage 2 decision in August 2023 applied a further increase of between 14.4 and 28.5 per cent across relevant Award classifications, depending on grade. The combined effect of the two decisions lifted the base rate for personal care workers substantially over the two-year period.
The Commonwealth Government funded the increased cost through the AN-ACC (Australian National Aged Care Classification) funding model, with a supplement paid directly to providers on the condition that the wage increases were passed through to workers. This pass-through funding model aimed to ensure providers did not absorb the wage supplement as margin.
The wage increases were widely regarded as overdue and necessary. Their impact on recruitment and retention has been positive in metropolitan labour markets, reducing attrition and improving the sector's competitive position against other employers in health and social assistance. The shortage persists, but the wage floor has shifted.
The Persistent Shortage: Carers Versus Registered Nurses
Despite the wage reform and care minutes requirements, significant shortfalls persist. The nature of the shortage differs across workforce categories.
Personal Care Workers
The personal care worker shortage is characterised by high turnover, geographic maldistribution, and competition from the NDIS sector. The NDIS has drawn substantially from the same pool of workers who previously staffed aged care, offering comparable or higher rates and often more flexible working arrangements. The aged care sector's higher clinical intensity — particularly in residential care — has not always translated into commensurate pay differentiation between personal care work in aged care versus disability support.
The Australian Institute of Health and Welfare's aged care workforce data consistently shows that turnover among direct care workers remains elevated relative to other health and community service sectors. Casual employment remains prevalent, and the path from Certificate III to higher qualifications and more secure employment is not well-defined or well-resourced across most providers.
Registered Nurses
The RN shortage in aged care is structurally distinct from the personal care worker shortage. Registered nurses who graduate from Australian universities have a range of employment options — hospitals, primary care, community health, specialist services — that typically offer higher pay, better career progression, and higher social status than residential aged care. The aged care sector has historically struggled to attract and retain RNs because it has not competed effectively on any of these dimensions.
The 24/7 mandate increased demand for RNs in aged care without immediately increasing supply. The result, particularly in regional and rural areas, has been upward pressure on agency rates for RNs willing to fill compliance gaps — a cost absorbed by providers and ultimately by the Commonwealth through funding supplements. The structural pipeline problem — insufficient RN graduates with interest in, or preparation for, aged care practice — has not been resolved by the mandate alone.
Migration Pathways
Australia's migration system has been used as a partial response to health and aged care workforce gaps. Several migration pathways are relevant to the aged care context.
Skills in Demand Visa (Subclass 482)
The Skills in Demand visa replaced the Temporary Skill Shortage visa in late 2023. It includes a Specialist Skills pathway and an Essential Skills pathway, with the latter specifically designed for lower-wage occupations in sectors experiencing genuine shortages. Aged care workers — including personal care workers under certain conditions — have been identified as eligible occupations in shortage lists administered through Jobs and Skills Australia.
Permanent Residence Pathways
Personal care workers and enrolled nurses who have worked in aged care on a temporary visa have access to streamlined permanent residence pathways under several programs, including employer-sponsored permanent residence streams and the Aged Care Industry Labour Agreement — a formal mechanism administered by the Department of Home Affairs that enables employers to sponsor workers in occupations not typically eligible under standard employer-sponsored visa frameworks.
Limitations of the Migration Response
Migration has alleviated some pressure but has not substituted for domestic workforce development. Internationally qualified nurses must complete assessment through the Australian Health Practitioner Regulation Agency before they can practise — a pathway with historically long processing times. The ethical dimensions of drawing healthcare workers from countries that are themselves experiencing shortages, particularly in Southeast Asia and the Pacific, also require acknowledgment in any sustainable migration strategy.
Distinguishing the Aged Care Shortage from Broader Health Workforce Gaps
Australia's health workforce shortage affects general practice, nursing, allied health, and aged care simultaneously. The causes and appropriate policy responses differ significantly between sectors.
The GP workforce crisis (examined in our GP workforce analysis) stems from the income differential between GPs and specialists, practice ownership burden, and geographic maldistribution. The policy levers relevant to GP supply — training pipeline expansion, scope of practice reform, rural incentive programs — are largely orthogonal to aged care.
Rural and remote health access (analysed in our rural health policy piece) shares geography challenges with aged care, but the rural aged care workforce problem has additional features: older regional age profiles that raise the ratio of aged care need to working-age population, and the fixed-cost structure of rural residential facilities that the current funding model does not always adequately support.
The aged care shortage is also distinct in its gender dimensions. The direct care workforce is overwhelmingly female, and the Fair Work Commission explicitly linked wage suppression to the feminisation of the occupation — making the Work Value Case as much an equity matter as a market correction.
Outstanding Policy Gaps
The legislative and funding reforms since 2022 have addressed the most urgent identified shortfalls. Significant gaps remain.
Workforce planning authority. Australia still lacks a national aged care workforce planning body with the mandate and data infrastructure to project supply and demand over a 10- to 20-year horizon and coordinate responses across training, migration, and regulation. Jobs and Skills Australia has a relevant mandate but is not sector-specific.
Training pipeline investment. The transition from Certificate III to higher qualifications — particularly enrolled nursing — requires funded pathways, including paid study leave, fee support, and employer incentives for backfilling roles during training. These pathways exist in outline but are not resourced at the scale the sector requires.
Rural facility sustainability. Rural residential providers operating below full occupancy face financial sustainability pressures that limit their capacity to offer competitive wages and career development. A rural viability supplement — distinct from the current AN-ACC base funding — would address the fixed-cost reality of thin-market providers.
RN career pathway in aged care. Developing a clinical specialist and nurse practitioner pathway within aged care — analogous to those in hospital and community health settings — would improve the sector's ability to attract and retain RNs with career aspirations beyond basic compliance roles.
Pass-through monitoring. The Commonwealth's wage supplement is conditional on pass-through to workers, but monitoring mechanisms rely substantially on self-reporting. An independent audit function — with powers to recover supplements from providers who fail to pass them through — would strengthen the integrity of the wage reform.
Conclusion
Australia's aged care workforce shortage is not a single problem but a layered one: inadequate pay for direct care workers, an insufficient RN pipeline, geographic maldistribution, competition from the NDIS, and a migration system that supplements but cannot substitute for domestic supply. The Royal Commission's findings catalysed significant reform — the 24/7 RN mandate, care minutes requirements, Fair Work wage decisions, and the new Aged Care Act framework — but these reforms have not closed the gap.
Closing it requires sustained investment in domestic training pipelines, a workforce planning authority with real data and real authority, rural sustainability funding that reflects the economics of thin-market provision, and continued monitoring of wage pass-through to ensure Award gains translate into improved conditions at the facility level. The sector's structural challenges — demographic pressure, a feminised and historically undervalued workforce, and geographic thinness in regional areas — mean that workforce adequacy in aged care will require ongoing policy attention rather than a single reform moment.
For related analysis, see our assessments of aged care reform priorities and Royal Commission implementation, Australia's GP workforce crisis, and rural and remote health access policy.
Coalition for Better Health advocates for evidence-based health policy reform in Australia. This analysis is produced independently and does not represent the position of any government agency or political party.