Counteracting the Context: Practical Strategies for Retention

Retaining a happy, healthy, and skilled aged care workforce is essential to meeting the growing demands of an ageing population and its increasingly complex care needs. Yet workforce retention does not occur in isolation; it is embedded within a highly complex care system shaped by a web of interrelated factors at the individual, organisational, and societal levels.

To develop effective retention strategies, aged care providers must use a combination of systems and processes to gather meaningful workforce data, understand the specific needs of workers, respond to organisational pressures (such as compliance requirements or geographic constraints), and account for broader sector influences, such as public perception. While no single strategy can address all these contributing factors, a comprehensive, integrated approach is essential - one that recognises the interconnected nature of these influences and responds holistically.

Contextual factors

Context is critical. When considering how to retain staff, the challenges providers face in supporting their workforce - especially during times of widespread shortage - must be taken into account. One major issue is the impact that existing workforce shortages have on providers’ ability to deliver high-quality services. According to leaders providing aged care, labour shortages are already having significant and far-reaching effects on delivery, including:

• Increased pressure on the workforce, leading to heavier workloads for existing staff - a trend expected to worsen in coming years.
• Ongoing high costs associated with attracting and retaining staff, placing financial strain on organisations.
• Long-term impacts on care quality and service capacity, as workforce shortages limit the ability to take on new clients and maintain standards.
• Greater reliance on agency staff and increased overtime payments, used as short-term measures to fill staffing gaps. [1]

As a result, many providers may be forced to adopt cost-reduction strategies, such as lowering staff-to-client ratios, limiting new client admissions, or scaling back service levels. [1] Labour shortages in the aged care sector have wide-ranging consequences, affecting not just providers and workers but also families, older people, and the broader health and care system. These shortages can lead to reduced access to care, increased pressure on acute health services, rising costs, poorer health outcomes for older people, and additional strain on families and carers. [1]

To understand what is needed to build and retain a skilled, supported, and stable workforce, it is essential to examine the current realities facing those working in aged care. The following sections explore key challenges such as inadequate training, limited career development, barriers to inclusion, and sector reform. Together, they provide a clearer picture of the conditions shaping workforce retention - and where change is most urgently needed.

For more information: 

• Explore the latest open access research on aged care workforce shortages across Australia’s diverse geographic settings in the article by Morris et al.
• New to aged care or have an idea to develop? Try our free online training related to broader aged care contexts
• Discover our curated collection of workforce retention resources - designed to offer valuable insights for those navigating aged care sector challenges.
• Looking for up-to-date evidence on workforce retention? Access our live PubMed search at the bottom of the page for the latest research.

While some aged care workforce retention challenges are beyond the control of any one individual or group, collective efforts should consider a range of factors and adopt tailored strategies. Research shows there is no 'one-size-fits-all' approach; what motivates one person to stay may differ greatly from another. Gathering meaningful data requires drawing on existing systems and software, such as workforce, human resources, learning, and performance management systems. In addition, staff engagement surveys, stay interviews, and other feedback methods can help identify common themes. Together, these insights support the development of effective retention strategies and solutions.

For more information: Workforce Management and Planning.

Some possible solutions and strategies are:

Population and workforce ageing

• Increasing complexity in consumer care needs demands a workforce equipped with the right skills and competencies. Workforce planning and rostering should incorporate strategies that ensure an appropriate skill mix, provide staff with the necessary knowledge and management support, and align workforce capability with service requirements and compliance obligations.
• Mature workers may benefit from strategies such as work redesign, mentoring roles, and retirement planning support, which can help them feel more secure and valued in the later stages of their careers - and enable them to remain in the workforce longer, if they choose.
• Younger workers may be more likely to stay when supported by strategies that promote career development, offer health and wellbeing incentives (such as gym memberships), and foster a workplace culture where they feel a strong sense of belonging and purpose.

For more information: 

1. Trace: Challenges and Opportunities in Australian Aged Care Operations
2. Hello leaders: Tips for attracting and leading Gen Z in the aged care workforce
3. At work Australia: How to Recruit & Retain Older Workers

Workforce demographics

• Strategies that raise awareness and challenge gender myths about careers in aged care can help attract more male workers and address gender imbalance. For those already in the sector, pairing male staff with male consumers may reduce barriers to providing personal care and counter perceptions of aged care as predominantly ‘women’s work’.
• Training strategies that emphasise cross-cultural communication can help ensure all staff and consumers feel safe, respected, and understood. Organisations should establish diversity champions and support networks for CALD and First Nations workers, and embed cultural safety across all policies and practices.
• During onboarding, gather information about each migrant employee’s cultural practices and preferences to inform inclusive and supportive strategies. Training that helps new migrant workers understand Australian workplace norms and customs can build confidence, ease the transition, and support successful integration into the workforce.

For more information:

1. Moskos: ‘The wrong sex’? Understanding men’s representation in the Australian aged care sector
2. Centre for cultural diversity in ageing: Empowering and supporting a culturally diverse workforce
3. City to country project: The right fit – attracting and retaining newcomers in regional towns

Perceptions of the industry

• Develop and promote a clear Employee Value Proposition (EVP) for both prospective and current staff, highlighting key aspects such as compensation and benefits, career development opportunities, workplace culture, work–life balance, and recognition and reward programs.
• Partner with universities and TAFEs - particularly nursing programs - to promote aged care as a long-term career path and offer supported placement opportunities for undergraduate students.
• Develop and promote positive messaging about aged care work and the sector through public campaigns and internal recognition programs. Use strategies that highlight the value of staff contributions and clearly communicate the supports available to help manage the emotional demands of the role.

For more information:

1. AIHR: Employee Value Proposition (EVP): All You Need to Know in 2025
2. APNA: APNA’s Aged Care Student Nurse Placement Program
3. ACWIC: Bring your thing

Forms of discrimination

• Develop strategies and policies that actively address ageism in the workplace. Provide training to help staff recognise and reflect on personal ageist attitudes and their impact on workplace relationships. Ensure inclusion policies safeguard older workers from discrimination in everyday practices and organisational procedures.
• Establish clear policies and procedures for reporting discrimination, outlining how incidents will be addressed and ensuring timely follow-through. Provide staff with training on best practices and organisational policies - related to discrimination. Offer additional support and remediation strategies for diverse staff who experience discrimination from consumers.

For more information:

1. Centre for cultural diversity in ageing: Empowering and supporting a culturally diverse workforce
2. Australian seniors: Ageing in the workforce – A virtual roundtable
3. MCCI: Diverse workforce – A guide to supporting inclusive workplaces in Aged Care

Sector complexity

• Retention strategies should be tailored to local and environmental contexts, aligning with specific business needs. In rural areas, this includes considering how workers can live and integrate into the community - addressing factors such as housing, schools, and lifestyle amenities - and providing early support to help them access local services and community resources.
• Ensure training strategies cover various models of care delivery, including person-centred and consumer-directed approaches. Support home care workers by creating opportunities for regular connection with colleagues to encourage communication, collaborative care planning, and a sense of camaraderie.

For more information:

1. UTS: Rural Australia delivers quality aged care
2. Aged Care Quality Commission: Rural health workforce
3. AAG: Addressing aged care workforce issues in rural and remote Australia

Reform and the aged care system

• Involve frontline staff in the co-design of compliance-related strategies to ensure reforms are practical and grounded in real-world care delivery. Aim to balance care quality with compliance requirements, and implement approaches that allow workers appropriate autonomy within clearly defined and safe risk parameters.
• Provide clear guidance, policies, and procedures related to compliance expectations, and develop strategies that commit to continuous improvement.
• Ensure staff have access to psychological support services and clear channels for providing feedback on role demands. Recognise that ongoing change can contribute to fatigue, burnout, and attrition, and develop strategies that actively mitigate the mental health impacts of continuous reform.

For more information:

1. Ideagen: Why aged care providers need to build a compliance culture
2. Australian Institute of Company Directors: Governing for quality aged care - A director’s guide
3. Future Work Institute: Designing SMARTer work to reduce psychosocial risks: Evaluating the effectiveness of a participatory work-redesign intervention in aged care

Technology, skills and training

• Develop strategies to enhance the interoperability of technical systems and processes. Identify digital literacy gaps among staff and provide tailored training programs to build confidence and improve digital skills across the workforce.
• Assess and map workforce skills to develop clear career pathway models for individual roles. Link professional development opportunities to staff preferences and objective skill assessments. Provide tools to help employees understand potential career progression, including required qualifications, skills, and associated pay rate levels.
• Implement buddying or mentoring programs for new staff during their first year to support them in managing the initial demands of the role. Maintain an open-door policy to encourage regular check-ins and foster a supportive work environment.

For more information:

1. Altura: Why do we need to conduct a training needs analysis?
2. Resthaven: Aged Care clinical mentor model of change – six steps to better practice
3. Department of Health and Aged Care: New Aged Care Act -Provider Digital Readiness Checklist
4. ARIIA: Retention strategies: What helps aged care workers stay in their jobs

Why context matters in workforce retention

Effective workforce retention strategies depend on understanding the broader context in which aged care operates. Factors such as provider size and location, service demand, workforce composition, compliance requirements, and public perceptions all shape the challenges and opportunities for retaining staff.

Retention is not one-size-fits-all. A comprehensive, systems approach is needed,  recognising the interconnected influence of sector, organisational, and individual factors.

Key points:

• Retention strategies must be tailored to provider size, location, and community needs.
• Workforce shortages, high workloads, and reliance on agency staff can erode service quality.
• Compliance demands, funding models, and reforms directly affect workforce stability.
• Demographic shifts - including an ageing workforce and changing migration patterns - influence recruitment and retention.
• Addressing stigma and negative perceptions is essential to attracting and keeping staff.
• Technology adoption brings both opportunities and challenges for training, workload, and service delivery.

Contextual factors 

Workforce pressures - Shortages, high workloads, and cost pressures challenge retention

Many providers face difficulty recruiting and retaining staff, leading to higher workloads and greater reliance on agency staff. This can increase costs, reduce continuity of care, and place strain on existing teams, impacting service quality and staff morale.

Demographic challenges - An ageing workforce and limited younger recruitment affect long-term sustainability

The sector is seeing a higher proportion of older workers, with fewer younger entrants. Cultural diversity and migration patterns also influence workforce composition, requiring tailored recruitment and retention strategies.

Stigma and public perception - Negative perceptions undermine recruitment and retention

Aged care roles are often undervalued compared to other health professions. Stigma can deter new entrants and affect job satisfaction. Addressing this requires proactive sector promotion, recognition of professional skills, and positive public narratives.

Sector complexity - Multiple service models and funding streams require adaptable approaches

The diversity of aged care - spanning residential care, home care, and community-based models - means no single retention strategy fits all. Providers must navigate varied regulatory frameworks, care models, and geographic contexts.

Reform environment - Policy changes directly impact workforce planning and retention

The Aged Care Act 2024, commencing 1 November 2025, and the Strengthened Quality Standards introduce new compliance requirements, including workforce planning obligations. Providers need proactive strategies to prepare for these changes.

Technology and training - Digital systems can enhance care and support

Technology adoption in aged care can streamline processes, improve care quality, and support compliance. However, digital literacy gaps, training needs, and change fatigue can limit benefits unless addressed through targeted workforce development.

Why this matters

Understanding these contextual factors enables providers to design realistic, targeted retention strategies. Without this context, initiatives risk missing the root causes of workforce instability.

Want to know more? Click on the + below for full research evidence into the contextual themes related to retention.

Australia’s population is ageing due to increased life expectancy and lower birth rates, resulting in older adults making up a growing share of the population. In 2021, approximately 4.2 million people - around one in six Australians - were aged 65 or older. By 2066, this figure is projected to rise to nearly one in four. [2]

While longer life brings many benefits, including extended time with family and greater opportunities for social, community, and economic contribution, it also presents significant challenges - particularly in aged care. As the number of people needing care grows, the demands on families, aged care services, and workers continue to increase. [3]

One direct consequence of this demographic shift is a shrinking proportion of people in the working-age population. As a result, current staffing models and workforce approaches will not be sufficient to meet future demand. [4]

A significant and growing challenge in the aged care sector is the increasing complexity - often referred to as acuity - of care needs. This shift is largely due to people entering aged care later in life, typically between the ages of 80 and 85, and often presenting with higher levels of dependency and multiple chronic conditions. [2, 4, 5, 6, 7]

For Aboriginal and Torres Strait Islander (First Nations) people, the average age of entry into residential aged care was approximately 73 years in 2017 - considerably younger than the general population. [8] First Nations people often have more complex needs linked to intergenerational trauma and disadvantage, which may be misunderstood or inaccurately assessed by non-Indigenous staff. [9]

The increase in care complexity is also reflected in historical data: in 2009, only 13% of aged care residents were rated as having complex health care needs. By 2016, this had surged to 61%. [10] This increasing acuity places substantial physical, emotional, and professional pressure on an already ageing workforce, contributing to high levels of stress and staff burnout. [3] These pressures make it increasingly difficult to sustain high-quality, person-centred care in a sector that is already under-resourced.

As care needs continue to intensify, services will be required to maintain higher staff-to-resident ratios and ensure a diverse mix of staff skills to provide safe and effective care. [11] At the same time, workforce shortages and escalating care complexity are heightening the physical demands of aged care work, increasing the risk of workplace injuries. [12]

To meet these challenges, employers - and the sector as a whole - must ensure the workforce is adequately trained and equipped, particularly in a context marked by high staff turnover, low engagement, significant capability gaps, and a misalignment between workers’ skills and the requirements of their roles. [10]

The age profile of the care workforce itself is advancing. [4, 13] While the average age of care and support workers declined from 44 years to around 42 years between 2015 and 2021, workers in the direct care category had an average age of 55 years in 2021, with approximately 102,000 expected to retire within the next decade. [14] Attracting and retaining younger workers remains a persistent challenge, [6] and despite growth in the 15–44 year age group between 2015 and 2021, [14] recruitment in the 15–25 year age range continues to lag behind older cohorts. [13]

Want more information on the aged care workforce in Australia? Visit the online data resource at AIHW GEN-ACDATA.

Gender

In 2020, women made up over half (53%) of Australians aged 65 years and over - approximately 2.2 million women compared to 2.0 million men. [2] Reflecting longer life expectancy, more women than men entered aged care in 2023: 59% of those entering residential care and 65% of those accessing home support or home care were women. [2]

In 2019, women made up 71% of First Nations care and support workers. [14] Among non–First Nations workers, women comprised 79% of the care and support workforce, with the highest concentration in registered nurse roles - 89% in 2021. [14]

Overall, women make up the vast majority of workers in the broader care and support sector, with 77% of personal care and support workers identifying as female. [14] However, the proportion of men in the workforce is gradually increasing. Between 2015 and 2021, the number of male personal care and support workers rose by 67% - a growth rate 40% higher than that of women during the same period. This growth, however, appears to be more prominent within the disability support sector (NDIS) rather than in aged care specifically.

Aged care is often characterised as a “highly feminised” profession, reinforcing perceptions of care as inherently “women’s work.” [13] Such gendered framing can contribute to the broader marginalisation and devaluation of care work, [15] as well as raise doubts about men’s competence or suitability for roles in the sector. [13]

These gendered dynamics can also have implications for pay and conditions. Although men tend to earn more than women across most occupations, [14] 64% of male workers in the care and support sector are employed in roles classified at lower skill levels (3 or 4), compared to 59% of female workers. [14] In residential aged care, the workforce is also demographically distinct by gender: 50% of female workers are aged over 45, whereas 55% of male workers are under 45. [14]

To address workforce shortages and build a more sustainable sector, it will be important to attract and retain a more diverse workforce, including increased participation from men and individuals from underrepresented backgrounds. [16]

Cultural Diversity

The aged care workforce and its consumers are increasingly culturally diverse, [4] with predictions that by 2026, about one-quarter of older adults in residential care will be culturally and linguistically diverse (CALD). [17] This diversity brings unique perspectives and care expectations that must be supported in both delivery and employment, requiring workers with appropriate skills to respond effectively. [13] This highlights the need for culturally responsive care that supports inclusive communication, honours cultural traditions, and ensures staff and clients experience culturally safe, linguistically appropriate services - critical in an increasingly diverse sector.

As of 2020, culturally and linguistically diverse individuals made up 28% of home care clients, 20% of residential care clients, and 20% of those in respite or transition care. [2] In 2022, 14% of Aboriginal and Torres Strait Islander peoples aged 50 years and above received home support, 3.6% accessed home care, and 1.3% used residential aged care either permanently or temporarily. [18]

The aged care workforce is culturally and linguistically diverse, with 40% (approx. 183,000 workers) born overseas. [14] In 2018, 2.2% (approx. 8,000 workers) within the broader care and support workforce identified as being from an Aboriginal and Torres Strait Islander background. [14] By 2020, 19.3% (2,876 workers) of the Aboriginal and Torres Strait Islander health workforce were employed in aged care and disability support roles. [19]

Migrant Workers

Well-designed migration pathways can play a valuable role in supplementing the domestic aged care workforce and have historically served as a successful model of permanent skilled migration in Australia. [16] Initiatives such as the Aged Care Industry Labour Agreement (ACILA) - which requires providers to enter into a memorandum of understanding (MoU) with the relevant industry union - and schemes like the Pacific Australia Labour Mobility (PALM) scheme help address workforce shortages in domestic supply. In 2023, ACILA-type agreements issued 2,649 visas. [20]

However, these migration-specific routes account for only a portion of the migrant workforce in aged care. Many migrant workers already reside permanently in Australia before entering the sector. Census data shows that the proportion of personal care assistants born overseas in residential aged care rose from 43.7% in 2011 to 50.2% in 2016, and from 33% to 37% in home-based care over the same period. [21]

Although many workers entering through migration programs are highly qualified, [21] their retention is influenced by several factors: the casual nature of employment, irregular hours, lower pay than non-migrant peers, and the type or duration of visa. [21] Research consistently highlights that poor job quality - including low pay, inadequate working conditions, and insufficient time to provide quality care - acts as a deterrent to both attracting and retaining migrant workers. [21]

Migrant workers are also more likely to work part-time, hold multiple jobs, and report a desire for more hours compared to their non-migrant colleagues. [21] These combined challenges often leave migrant workers - most of whom are women - without access to stable income, structured training, or adequate support for their broader family unit. When highly skilled migrants are employed in roles below their qualification level, this mismatch can negatively affect their wellbeing [21] and contribute to attrition, as workers leave for better-paid, more stable roles aligned with their knowledge, skills, and education.

Want more information on migrant workers perceptions of working in residential Aged Care? Visit this open access article, Adebayo et al.

Perceptions of the aged care sector matter in understanding why individuals enter, remain in, or exit the industry. These perspectives may come from society broadly, professionals, or the general public - including older adults and their families. Whether these perceptions are positive or negative depends on a range of historical, stereotypical, and personal viewpoints. Taken together, they shape an overall perception of what aged care represents, which may or may not reflect the reality of the sector.

Aged care, for example, can be perceived as ‘dirty work’ [22, 23] due to challenges associated with the physical nature of the role (such as bathing or toileting), societal attitudes toward older people (including age discrimination), or moral issues related to end-of-life care, restraint, or compliance versus person-centred care. This poor reputation and negative image can significantly affect the attraction and retention of workers. [12, 23]

Public Perceptions

Historically, persistent quality issues in aged care have attracted sustained media scrutiny and public criticism. This attention has led to multiple public inquiries - most notably the Royal Commission into Aged Care Quality and Safety (established in 2018) - aimed at reforming the system and addressing widespread systemic issues. The resulting regulatory and system reforms, broadly welcomed by both the public and the sector, are designed to improve care quality but have also led to heightened scrutiny. From the perspective of workers, however, this increased scrutiny can have unintended consequences. Families may feel hesitant about using aged care services, and workers may experience a growing sense of shame or stigma surrounding their roles. [24]

Negative perceptions of aged care - shaped by media coverage, public attitudes, and professional discourse - can contribute to stigma: a harmful social label that devalues both care work and those who receive it. This stigma often operates subtly, conveyed through language, tone, and underlying assumptions, yet its effects are profoundly felt. When staff internalise these negative views, it can result in feelings of shame, diminished self-worth, and psychological distress, including stress, anxiety, and depressive symptoms. [25] These outcomes are closely linked to reduced psychological wellbeing, lower job satisfaction, and higher staff turnover. [26]

This internalisation also reinforces the broader narrative that aged care is a sector in crisis - portrayed as broken, in need of repair, or inferior to other areas of health and social care. [27] However, research highlights the importance of fostering positive perceptions through reinforcement, advocacy, and reframing. [24] When workers view their roles as socially meaningful and impactful, their job satisfaction improves, and they are more likely to remain in the sector. [28]

Professional Perceptions

For workers - particularly nurses - the stigma associated with aged care, shaped by poor public and professional perceptions, can make roles in the sector appear less desirable compared to those in acute settings. [29] Aged care nursing is often viewed as offering limited career progression, with additional responsibilities such as managing non-nursing staff, high workloads, low staffing ratios, and generally poor working conditions. [12] For example, registered nurses working in acute care settings earn approximately 10% more than those in aged care. [30]

Personal care work is also commonly perceived as low-skilled, low-status, and low-paid. [31] These perceptions can hamper recruitment and retention efforts and further compound concerns about the sector’s capacity and capability. [31]

These factors - especially when combined with low wages and disparities in resourcing - reinforce the perception that aged care work is both socially and economically undervalued. [30] The result is a feedback loop in which stigma and negative perceptions erode the sector’s public image and directly undermine efforts to attract and retain a stable, skilled, and committed workforce. [12]

Want to know more about younger people's perceptions of the aged care workforce? Visit this webpage from Whiddon.

Age Discrimination

Another subtle but contributing factor to perceptions of aged care is age discrimination, also known as ageism. Ageism, as a form of stigma, is created through negative stereotypical perceptions related to age. [32] This message - or bias - can be perpetuated by the media or through word of mouth and can be found in both public and professional systems. It impacts not only how we think, but also the actions we take toward particular groups or individuals.

Ageist attitudes toward older adults - whether they are working in or receiving care - can manifest in how they are spoken to, how their capacity is perceived, how their value is assumed, and how their needs are positioned as a lower priority compared to younger people. [33]

For workers delivering care, ageism can appear in two key ways: through the perceptions of others, if the worker is themselves considered older; and through how workers of all ages perceive and interact with older consumers. This may include workers feeling they should leave the profession at a certain age, or employers holding the view that older workers are less capable or productive than younger ones - for example, in adopting new technologies or undertaking unfamiliar tasks. [34] These assumptions contribute to what has been referred to as a ‘grey ceiling’, [35] limiting perceptions of older workers' productivity.

Public attitudes and discriminatory perceptions about ageing can also be internalised by those working in the sector, reinforcing harmful stereotypes about both consumers and the quality of care provided. These may include beliefs about older adults being inherently vulnerable, assumptions about poor staff competence, and perceptions of low care quality. [36] The overall value of care work is also often perceived as ‘soft’ and ‘feminine’, further reinforcing the notion that it is undervalued by society. [27] In turn, this contributes to the view that aged care is inferior to other services or professions, making the field appear unattractive and of limited social worth to prospective or current workers.

Racial Discrimination

Australia’s aged care system reflects the diversity of its population, with both clients and staff coming from a wide range of cultural and ethnic backgrounds. Many individuals are born overseas and speak English as a second language, mirroring the broader multicultural makeup of Australian society. For over a century, Australia has welcomed migrants from around the world. However, as in broader society, discrimination can still occur within aged care settings - affecting individuals based on aspects of their cultural or diverse identities, including race, religion, disability, gender identity, or sexual orientation.

People arrive in Australia through various pathways, such as employment schemes (including those linked to aged care), family reunification, or other migration programs. Regardless of the pathway, migrants often undergo a rapid process of adapting to new cultural norms and expectations - one that is not without its challenges.

Cultural differences can shape how care is expected and delivered. Language barriers, cultural misunderstandings, and communication challenges - such as interpreting terminology, colloquialisms, and slang [37] - are common. [13] Individuals born outside Australia, or from diverse ethnic backgrounds, whether workers or service recipients, may face both overt and subtle forms of racism - intentional or otherwise. [13]

Aboriginal and Torres Strait Islander peoples (First Nations people) face additional, intersecting challenges, including racism, colonisation, and marginalisation. Systemic racism - experienced by both recipients and staff - is a recognised determinant of health and compounds broader sociocultural and intergenerational impacts rooted in historical and ongoing injustice. [38] Many instances of racism go unreported, as workers often believe that no meaningful action will be taken. [37, 39]

These experiences can affect people’s willingness to access aged care services and can also impact workforce participation and retention - particularly for First Nations people and those from migrant or ethnic backgrounds. Recognising and valuing the contributions of people from diverse identities - especially women, who often bring a deep sense of empathy and respect for older people rooted in cultural norms - is essential to building a culturally safe, inclusive, and responsive aged care system. [39, 13]

Want more information on how to tackle ageism in aged care? Visit the EveryAge counts campaign by Brisbane North PHN.

A Complex System

Aged care is a complex system [17, 40] and a dynamic sector [41], shaped by intersecting policy, legislative, and workforce dynamics. It is closely interconnected with other areas of care delivery, including primary health, mental health, disability, and housing - forming part of a broader, interdependent care and support system. Sector funding comes from a mix of sources, including federal and state government subsidies, capital grants, program funding, and means-tested consumer contributions. [42]

The aged care workforce is highly diverse, encompassing both formal and informal roles, and includes professional and non-professional staff delivering care through both direct and indirect roles. Employment arrangements span voluntary, agency, fixed-term, casual, subcontracted, independently contracted, and permanent positions. [43]

This work demands a high degree of both emotional and physical labour [44], requiring a workforce equipped with a broad set of skills. Roles include lifestyle coordinators, registered nurses, clinical leaders, care workers, and service managers - each contributing to care delivery in different but complementary ways.

Aged care workers provide a wide range of services [23], including direct care, lifestyle support, homemaking, food service, and hospitality, across various employment types (zero-hour, casual, part-time, and full-time) and shift patterns, including daytime, evening, and weekend work. These services are delivered across diverse geographical settings - from metropolitan to rural and remote areas.

Many individuals enter the aged care workforce by transitioning from other sectors such as hospitality, retail, or commercial cleaning. [45] In contrast, registered nurses often enter aged care either directly after completing their education and placements in aged care settings or after gaining experience in the acute sector. [13]

Aged care roles frequently compete with similar positions in other sectors [1, 43], where higher pay, better working conditions, and greater professional recognition attract potential workers. This competition is expected to intensify in the coming decades [13], particularly as global ageing trends and economic growth reduce the availability of migrant labour. [14] In this context, aged care employers will need to work harder to attract and retain staff amid rising service demand.

Models of Care

Care delivery in aged care is increasingly diverse, spanning a range of service types and models [4], including person-centred care, consumer-directed care, integrated care, and smaller-scale models shaped by accommodation size and design. Emerging trends include a move away from medical-style care towards wellness and enablement approaches [4], and a shift in staff support - from doing things ‘for’ older adults to doing things ‘with’ them - through a reablement approach. [46] 

The Australian aged care sector includes a mix of government-funded, not-for-profit, cooperative (member-owned), and privately owned providers. These organisations deliver services across three government-defined areas: residential aged care, in-home aged care, and short-term care. [47]

Service delivery and staffing needs vary considerably between settings. For instance, client needs in residential care may differ significantly from those in home care. In rural and remote areas, some providers offer multi-purpose services that integrate aged care into traditional health settings. Aboriginal Community Controlled Health Organisations (ACCHOs) also play a key role in delivering culturally appropriate care to Aboriginal and Torres Strait Islander communities, primarily through the National Aboriginal and Torres Strait Islander Flexible Aged Care Program. [43]

The diversity of care models results in a complex mix of funding streams, qualification requirements, workforce drivers, and service demands - all of which affect recruitment and retention strategies. For example, challenges in metropolitan areas differ from those in rural and remote regions, where staffing costs are often higher due to recruitment difficulties and additional expenses for accommodation, relocation, and travel. [48]

This complexity highlights the need for providers to develop tailored, locally informed workforce solutions that respond to specific staffing and consumer needs. Building the future aged care workforce is not just about increasing headcount; it requires a reimagining of staffing models and service delivery to reshape workforce structure and composition. [48] This is especially critical as existing infrastructure and aged care models are not equipped to meet rising demand or shifting consumer expectations. [49]

Consumer Expectations

Consumer expectations around ageing and aged care supports are constantly evolving. The preference to ‘age in place’ at home [44] remains strong, impacting demand for home care far more than for residential care - until individuals reach a threshold of need. Funding also dominates public discourse - raising questions about who pays for what in a system already grappling with how to deliver high-quality, appropriate, and sustainable services.

Direct budgets within consumer-directed care models allow individuals or their families to purchase services directly, offering greater choice and control. [13] However, these developments bring challenges, including administrative burden, inequities in knowledge, language and literacy barriers, and market limitations. They also shift certain risks to the individual or their proxy.

The rise of ‘gig economy’ care delivery - characterised by casual employment, zero-hour contracts, and limited oversight - has also affected the sector. In response, the Australian Government has asked the Fair Work Commission to investigate and establish minimum employment standards, fair pay, and protections for care workers operating in consumer-directed models.

Are you a middle manager looking to build a sustainable workforce? Visit this open access article by Radford and Meissner.

Want to know more about reablement? Visit ARIIA’s priority topic - Rehabilitation, reablement and restorative care.

Aged care is one of the fastest-growing parts of the care economy in Australia [28], and within it, a significant reform agenda is underway. [50] The federal government continues to build on recommendations made by the Royal Commission and subsequent associated inquiries by implementing legislative changes, including the introduction of the Aged Care Act 2024, set to commence in November 2025. This rights-based Act places older adults at the centre of both legislation and service delivery. It aims to drive continuous improvements in care quality and includes a Statement of Rights outlining what older adults should expect from aged care providers and services.

Legislative reform in aged care often triggers broader changes in how care is structured and delivered. This includes adjustments to funding and fee arrangements, assessment processes for new applications, regulatory responsibilities, quality assessment mechanisms, service types (such as the replacement of Home Care with the new Support at Home program), and provider obligations.

These reforms have significant implications for the workforce - impacting frontline workers, managers, and governing boards. In response to the Royal Commission, the Aged Care Code of Conduct was introduced. Reforms under the proposed new Aged Care Act have also led to revised worker screening requirements, and consultation is underway on a proposed national worker registration scheme.

The reform agenda also includes the (draft) Strengthened Aged Care Quality Standards- particularly Standard 2.8, which focuses on workforce planning - along with a new Statement of Principles (to sit alongside the existing Statement of Rights), and enhanced whistleblower protections. If you're a provider seeking to understand your obligations, you can find more information here.

While aged care is already one of the most highly regulated sectors in Australia, reform is broadly welcomed and seen as necessary. Workers themselves have expressed that reform is essential to better safeguard older people. [24] However, increased regulation can also place pressure on providers and staff, who must carefully balance high-quality care delivery with compliance obligations and financial sustainability.

The impacts of regulatory practice are two-fold. [51] On one hand, regulation provides staff with clear guidance and helps identify ongoing professional development needs. It promotes safety and quality for both residents and staff, improving job satisfaction and reducing turnover. On the other hand, regulatory demands can sometimes hinder person-centred care. A task-oriented, "tick-box" culture may emerge, shifting focus away from meaningful one-on-one interactions. [24] This can lead to moral distress among staff, as they struggle to balance regulatory expectations with professional judgement in delivering compassionate care - potentially contributing to burnout and staff turnover. [51]

The reforms introduced through the Aged Care Act 2024, alongside the expanded responsibilities of the Aged Care Quality and Safety Commission, represent a response to the Royal Commission and other inquiries. These changes aim to move the regulatory framework away from a compliance-based model toward one that prioritises outcomes, manages risks [52], and upholds the rights and well-being of older Australians. Understanding the dual impacts of these reforms - especially how they influence the support and representation of the sector and its workforce - is critical. Public and individual perceptions strongly influence who enters, stays, and feels valued within the aged care workforce, making this a key consideration for the sector’s future sustainability. [53]

Beyond regulatory reform, the federal government has taken additional steps to strengthen the aged care workforce, including an $11.3 billion investment to uplift wages through a 15% increase to the Aged Care Award. [43] As part of a broader professional framework, the government continues to invest in training and working conditions, foster workplace culture improvements, encourage innovation, expand career pathways, support workforce planning, build leadership capability, and strengthen the aged care evidence base. [54]

Residential aged care providers are now subject to mandatory care minute requirements - 215 minutes of direct care per resident per day, including at least 44 minutes delivered by a registered nurse, with RNs required to be on-site 24/7. [40] Non-compliance with these minimums results in automatic reductions to a provider’s Base Care Tariff (BCT) funding. [55]

However, as of June 2024, more than half of residential providers (59.5%) were falling short of these legally mandated minimums [40] - a challenge that is expected to persist given ongoing staff and skills shortages across the sector. Collectively, these government priorities aim to ensure the workforce is fit for purpose - capable of delivering high-quality, safe, and sustainable care - and ready to implement the once-in-a-generation reforms introduced under the Aged Care Act 2024. [56]

Need support with reform?

Policy changes drive the need for agile workforce responses. The LIFT Projects for Reform Program helps aged care professionals translate reform into practice - covering key changes like the Strengthened Aged Care Quality Standards, Support at Home program, and broader digital, data, and staffing reforms.

Program Snapshot:

• 6-week, approx.70-hour blended learning experience, combining self-directed modules and peer-led workshops, giving participants tools for knowledge translation, change management, and project planning.
• Leads to a ready-to-launch project plan and a polished project pitch for implementation in the participants’ workplace.
• Eligibility extends to all aged care workers - with 100% scholarships available for regional providers, those serving vulnerable communities, and smaller organisations.

Equip your team with the skills and strategies to meet aged care reform head-on. ARIIA LIFT: Turn reform into action

Want to know more how total care minutes impact older adults' needs in long-term care settings? Visit this open access article by Harrison et al.

Technology

The use of technology in the sector - particularly systems that support core functions such as human resources, staffing, and care planning - is increasingly improving service delivery and planning. In residential care, health information technology (HIT) systems also enhance quality, clinical support, and resident outcomes. [57] The uptake of technological systems and the advancement of artificial intelligence (AI) require providers, staff, and consumers to engage with new skills and integrate technology into everyday practice. Technological advances offer cost-effective and time-saving solutions in areas such as recordkeeping, although developments in robotics, for instance, still lag behind other key industries.

While the care and support industries are grounded in human connection - something no technology can replicate - technology offers both challenges and benefits. AI-powered systems are automating administrative tasks and analysing large quantities of data, increasing operational efficiency and reducing the administrative burden on staff, enabling them to focus more on quality care delivery. [58] These systems can also provide deeper insights into client needs and support more effective care planning and analysis. [59]

The impact on the workforce is mixed. Learning new technical skills is necessary for many, including mature workers (though assumptions that mature workers lack technological aptitude are increasingly challenged). Meanwhile, younger workers often expect modern technology to be already embedded in the sector. [59] Overall, limited findings suggest that the introduction of technology results in balanced rates of satisfaction and dissatisfaction, with minimal impact on staff attrition. [57]

The rate and pace of technological change require continuous learning for all staff and providers. However, implementation remains inconsistent and fragmented across the sector. [60] Challenges arise when time for training is limited - especially when combined with workforce shortages, burnout, and retention issues - creating a significant sustainability concern. [61] More broadly, interoperability across different systems and sectors (such as health and aged care) remains a challenge. Common data standards are needed to reduce complexity and build solid digital foundations for workforce planning and retention data collection. [62]
 

Skills, Qualifications, and Training

As noted earlier, aged care in Australia is delivered by a diverse workforce - including both Australian-born and migrant workers - with varying levels of qualifications (from Certificate III and IV to Diplomas and Degrees) and diverse training backgrounds. [63] Professionals such as nurses and allied health workers are registered with the Australian Health Practitioner Regulation Agency (Ahpra) and are required to complete a set number of continuing professional development (CPD) hours each year, specific to their role.

In contrast, personal care workers and nursing assistants are not currently registered with a national regulatory body and have no mandated CPD requirements. However, the Australian Government is consulting on the potential introduction of a national registration scheme for personal care workers in aged care. [64] If implemented, this reform would establish a minimum qualification requirement and formalise expectations for ongoing learning and development - helping to shape the future training landscape in the sector.

Concerns have been raised about the adequacy and consistency of training delivered by Registered Training Organisations (RTOs), particularly in preparing personal care workers for frontline roles. Providers have questioned the variability in course length and the practical relevance of training content. [12] Many workers also report feeling unsupported in developing clear career pathways. [65] Although professional development opportunities exist, they are often not tailored to the specific duties of personal care workers and may be poorly aligned with the workforce’s diverse educational and cultural backgrounds. As a result, training is often poorly attended, and the role is frequently seen as a temporary job rather than a long-term career. [23]

Shortcomings in training and development have direct implications for workforce retention. When workers feel undervalued, inadequately prepared, or uncertain about their career progression, they are significantly more likely to leave the sector. Research highlights that limited access to meaningful professional development and the absence of clear career pathways contribute to job dissatisfaction and high turnover - particularly among personal care workers. [66] Addressing these gaps through high-quality, targeted training and clearly defined career progression is critical - not only for workforce capability but also for retention and long-term workforce stability. This is especially important during the first year of employment, where structured induction programs and mentoring from experienced colleagues have been shown to support new workers and improve retention. [67]

Equip your team with the skills and strategies to meet aged care reform head-on.
ARIIA LIFT: Turn reform into action

Want to know more about the types of skills required in aged care? Visit this SkillsIQ report. 

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