A Working Paper

Andrew Paul Klein & Sera Elizabeth Klein

Abstract

The Royal Commission into Aged Care Quality and Safety titled its interim report Neglect. Its final report, handed down in 2021, found a system in crisis and made 148 recommendations. Five years later, the Commonwealth has legislated a new rights-based Aged Care Act, replaced Home Care Packages with Support at Home, and committed $3.7 billion in the 2026–27 Budget to additional beds, dementia care, and free personal care. This paper examines the gap between that reform architecture and the outcomes the evidence records: over 3,600 patients stranded in hospitals awaiting aged care placement, almost 154,000 people waiting for a Support at Home package at their assessed level, a classification algorithm that a specialist in funding design has described as “fatally flawed” and that underwent no live trial before launch, and a workforce in which 96.43 per cent of surveyed staff experienced or witnessed violence or aggression in the past year. It argues that neglect has not ended; it has been re-architected — relocated from the ward to the algorithm, from the staffing roster to the waitlist, and from the provider to the procurement process. It examines the Minister for Health and Ageing’s public responses, identifies a five-part pattern of euphemistic framing, and argues that the absence of a live trial for the algorithm cannot be justified on the government’s own stated standard.

1. Introduction: The Word the Commission Chose

The Royal Commission into Aged Care Quality and Safety was established in 2018. Its interim report, delivered in 2019, was titled Neglect — a single word, chosen deliberately, that described a system in which older Australians were being failed not by accident but by the cumulative effect of underfunding, indifference, and poor leadership. Its final report, delivered in March 2021, made 148 recommendations and found that the system was in crisis. The Commission’s research estimated that 39 per cent of aged care residents experienced some form of neglect.

The Commonwealth’s public position is that it is implementing the Commission’s recommendations. The Aged Care Act 2024 commenced on 1 November 2025, establishing a rights-based framework with a Statement of Rights, streamlined obligations, and strengthened Quality Standards. Support at Home replaced Home Care Packages as the in-home care system, with a single assessment framework intended to allocate funding according to need. The 2026–27 Budget committed $3.7 billion to additional beds, dementia care units, and free personal care services.

This paper asks a single question: do the outcomes that the reforms were meant to deliver match the outcomes the evidence records? The answer, on the public record, is no. And the structure of the failure is not accidental. It is architectural.

2. The Reform Architecture: What Was Promised

2.1 The Aged Care Act 2024

The Aged Care Act 2024 (Cth) commenced on 1 November 2025. Its stated purpose is to place older people at the centre of the aged care system. It establishes:

· A Statement of Rights, replacing the previous Charter of Aged Care Rights, which sets out what older people can expect from providers and workers;

· Strengthened Aged Care Quality Standards, which apply to registered providers and set the standard for safety and quality;

· A new provider registration model, administered by the Aged Care Quality and Safety Commission;

· New complaints arrangements, including protection from reprisal for people who raise issues about provider conduct;

· A new compensation pathway where serious injury or illness results from a breach of the registered provider duty.

The Minister has described the reforms as “the biggest aged care reforms in a generation”.

2.2 Support at Home

Support at Home replaced the Home Care Packages program. Its stated aims are faster access, greater consistency, and a single assessment framework designed to allocate funding according to need. The Aged Care Act 2024 Wait Times Report, published on Budget night, records that the national median elapsed time from application to commencement of Support at Home services was approximately 12 months as of 31 March 2026.

2.3 The 2026–27 Budget Package

The Budget, handed down on 12 May 2026, allocated $3.7 billion to aged care measures. The figure of $3 billion, announced by the Minister at the National Press Club on 22 April 2026, is the pre-announced package; the Budget line is larger because it includes measures announced subsequently. The primary breakdown, from budget.gov.au and Budget Paper No. 2:

· $1.7 billion to incentivise construction of up to 5,000 additional aged care beds each year, comprising:

· $606.5 million for new capital subsidies (up to $30 per supported resident per day for new builds, for up to 25 years; up to $15 per day for expanded homes, for up to 15 years), room-price flexibility, and dementia supports — including up to 20 Specialist Dementia Care Program units and expansion of the Hospital to Aged Care Dementia Support Program from 11 to 20 locations;

· $1.1 billion provisioned in the Contingency Reserve for future spending to increase and restructure the Accommodation Supplement, and to introduce an additional payment for homes with more than 60 per cent low-means residents;

· $1 billion to fully subsidise and remove co-contributions for personal care — showering, dressing, and continence — through Support at Home;

· $565.1 million for sector quality, safety and viability;

· $389.8 million over four years from 2026–27 to accelerate Support at Home packages, extend the end-of-life pathway, make the program fairer and more affordable, and review the Integrated Assessment Tool and the algorithm.

The government also committed to returning the private health insurance rebate to its original design, removing the age-based loading, with the savings — approximately $3 billion over four years — redirected into aged care.

The Minister’s framing of the funding case is consistent: Commonwealth aged care spending has risen from $24 billion to $44 billion in four years — an additional $20 billion — and “we still know we need much, much more”.

3. The Evidence: What the Record Shows

3.1 Bed block: thousands stranded in hospitals

As of mid-2026, over 3,600 patients were stranded in state hospitals across Australia, medically fit to leave but unable to access a Commonwealth aged care placement. The national number had risen from over 2,700 in mid-2025. The state breakdown:

· Queensland: 1,272 (up from 1,076)

· New South Wales: 1,027 (up from 750)

· South Australia: 476 (up from 245)

· Western Australia: 423 (up from 230)

· Victoria: 302 (up from 226)

The NSW Minister for Health, Ryan Park, described the prevalence of bed block as “accelerating and is far beyond sustainable“. The South Australian Minister for Health, Blair Boyer, stated the national need plainly: “Nationally, we need an additional 10,000 aged care beds each year — last year we had just 800“. The sector body Ageing Australia has made the same assessment: Australia needs closer to 10,000 additional beds every year over the next two decades to keep up with demand, and only 800 were delivered in 2024–25.

The Commonwealth’s commitment of 5,000 beds a year is therefore half the assessed need, and the gap between the promise and the need is the space in which bed block persists.

3.2 The Support at Home waitlist: almost 154,000 people

The government’s official figure, as of 31 March 2026, is that 100,191 people were waiting in the Support at Home priority system for an ongoing place at their assessed level, with a further 98,606 waiting for an aged care assessment. The government’s own Wait Times Report records an average wait of 12 months for a Support at Home package, and the ABC reports a median wait between applying for aged care and receiving it of 10 months (297 days).

The official figure understates the position. The ABC’s Four Corners investigation, reported by Anne Connolly on 22–23 August 2026, found that the number of people waiting for full aged care funding at home stands at almost 154,000 — not 100,000 as officially reported. The discrepancy arises because the Department of Health changed how it calculates the waitlist after the reforms commenced in November 2025, removing people receiving interim funding from the count. Calculated on the pre-reform method, the figure would be higher by 53,718 people, bringing the total waiting for their full approved level of funding to 153,909. The Minister for Aged Care and Seniors, Sam Rae, denied any change, saying the waitlist “has always been manufactured, or calculated the way it currently is”.

The government’s stated goal is to reduce average wait times to three months by 1 July 2027. On the current numbers, that target requires a pace of change the system has not yet demonstrated.

The Inspector-General of Aged Care, Natalie Siegel-Brown, has described the human cost directly: “delayed access to care can be conceived as both a rights failure and an economic failure… Delays in access may seem to manage budget pressures in the short term, but over time they can make the system more expensive and harder to sustain”. She has noted that 3–6 months for an initial assessment is “not uncommon,” and that more than 200,000 people are effectively held in the system awaiting assessment or a package.

3.3 The algorithm: the new ward

The most consequential controversy of 2026 concerns the Support at Home classification algorithm. The distinction that the government has blurred is critical, and it is stated plainly in the ABC’s analysis: “Conflating the two — the questionnaire and the algorithm — has been a common tactic of the government and the Department of Health.”

· The Integrated Assessment Tool (IAT) is the questionnaire completed by a clinician. It was recommended by the Royal Commission, tested on 22,000 people, developed with input from three clinical working groups, and has a publicly available development and trial report.

· The algorithm is a separate, secretive formula that scores people for funding. It was never recommended by the Royal Commission, underwent no live trial before launch, and the Department of Health has been unable to name any clinicians who signed off on it. There is no detailed public report explaining how it was developed and tested.

Provenance. Through Senate estimates questioning by the Coalition, the Greens, and Senator David Pocock, it has been established that a prototype of the algorithm — believed to have been designed by a consultancy — was taken in-house by public servants, modified and validated by them, and launched on 1 November 2025. Public servants have given evidence that they used data from 200,000 assessments to test and verify the algorithm at the back end, but there was no live trial. The government has refused a formal Order for the Production of Documents, releasing nothing beyond publicly available Department of Health material.

What the algorithm does. Professor Kathy Eagar, who led the development of the Australian National Aged Care Classification used to fund residential aged care, reverse-engineered the Support at Home algorithm for Four Corners. Her findings:

· Of the more than 500 questions in the IAT, “the vast majority do not feed into the algorithm”;

· The detailed clinical notes recorded in more than 100 text boxes cannot be read by the algorithm;

· Frailty, cognitive problems, mental health issues, and carer fatigue “come into the equation far too late” to affect funding;

· A one-point difference at a particular juncture in the algorithm equates to almost $40,000 a year lost or gained in funding. In one example, two people with otherwise identical needs but functional scores of 24 and 25 were allocated to funding levels eight and five respectively — a 51 per cent difference in funding.

Eagar’s conclusion, delivered to a Senate inquiry on 24 August 2026, was blunt: “the algorithm is fatally flawed, and its continued use can’t be justified”. She raised a legal question: “I don’t think it’s compatible at all with what the Royal Commission recommended, and I also don’t think it’s compatible with the Act… I personally believe that the rules are illegal and are not consistent with the Act”.

The July 2026 change. In July 2026, 13 of the 33 items previously used to calculate the functional score were removed and three introduced. Eagar’s evidence is that this change was made quietly, and her conclusion is decisive: “even if it was [validated], the algorithm has now changed so substantially in July that the version that is now the national rule has certainly not been validated.”

The review-rate exchange. In its first five months, more than 1,000 people asked to have the algorithm’s decision reviewed — six times the number from the entire financial year before its implementation. The government says this is still less than 1 per cent of all assessments, indicating that it is not a real problem. Eagar disagrees: “The reason that it’s a very small percentage is because it’s too hard and complex to appeal and also people are giving up… They know that if they appeal, the appeal is being considered by the very department that developed the system.”

Institutional consequences. The Senate has voted for the algorithm to be ditched. The Commonwealth Ombudsman is investigating after 800 complaints. The government has committed $18 million to reviewing both the IAT and the algorithm, within the $389.8 million Support at Home measure. As of September 2026, the three-month review had missed its deadline. Freedom of Information documents show that ministers were warned three days before the Act commenced that assessors had no legal discretion to override the algorithm.

The human case that crystallised the controversy is that of Audrey Staniland, 96, who is blind and lives alone. After her first reassessment in more than a decade, the algorithm decided she should remain on the same level of funding she had received nearly 12 years earlier, despite her conditions and her age. When pressed on her case, the Minister responded: “I don’t accept your description of this as a computer system”.

3.4 The absence of a live trial: can it be justified?

This is the question the paper’s argument turns on, and it deserves a cold answer rather than an outraged one. The best defence available to the government should be stated first, and then tested.

The defence. A trilemma: a live trial would have delayed reform; the old system was itself indefensible; and the algorithm was validated against 200,000 assessments at the back end. On that view, the choice was between an imperfect new system and a known-bad old one, and the government chose the imperfect new one while committing to review. This is a serious argument, and it is the only one available that engages the substance rather than the process.

Why it fails, on the government’s own standard.

First, back-end validation is not a trial. Testing a model against 200,000 historical assessments answers the question “does the model reproduce the patterns in the data?” It does not answer “does the model produce correct funding decisions for people?” The historical data were generated under the old system, by the old assessment processes. There is no independent clinical counterfactual in that dataset. A live trial — the thing that was refused — would have compared algorithm outputs to clinician judgements prospectively, in real cases, with the ability to override. That is precisely the design that would have caught the first-branch flaw Eagar identified.

Second, the algorithm was changed quietly in July 2026. Eagar’s Senate evidence is that 13 of the 33 functional-score items were removed and three introduced. Whatever validation was done at the back end does not apply to the version now in force. The fallback defence is therefore destroyed by the government’s own subsequent action.

Third, the refusals are not separate failures. They are one decision, repeated. The government refused a live trial. It refused to name the clinicians who signed off. It refused an Order for the Production of Documents. It voted down a Senate amendment to allow human override. Each refusal removes a mechanism by which the algorithm could be shown to be wrong. That is the architecture of unfalsifiability — and an unfalsifiable funding system is not a neutral instrument. It is a system in which error cannot be attributed to anyone: not to the clinician (who cannot override), not to the public servant (who validated it in-house), not to the consultant (whose prototype was modified beyond recognition), not to the Minister (who says he does not accept the description of it as a computer system). This is Bandura’s displacement of responsibility, built into the procurement process rather than into a speech.

Fourth, the international comparison shifts the burden. Eagar told the Senate that she knows of no country using an algorithm of this kind to determine a person’s overall aged care budget. “Many countries have tried it, and they’ve all abandoned it… It does not work because no one tool, no one algorithm, can be all things to all people.” The question is no longer “why didn’t you trial it?” but “what evidence do you have that the countries that abandoned this were wrong?” There is none, because there was no trial. The government is not following international best practice; it is the outlier, and it has declined every mechanism that would test whether the outlier is right.

Fifth, the escalation pathway is not a remedy. The government’s September 2026 amendment (debated 17 September, Aged Care Legislation Amendment Bill) enables escalation of home support assessment decisions “in extenuating circumstances.” Rebekha Sharkie’s assessment in the House: “This is a bandaid patch-up. I don’t even think it’s going to work.” Eagar’s assessment: “If the purpose is to give people the wrong funding faster, then that’s a good idea to do that.” The pathway operates after the decision, places the burden on the older person or their family to appeal, and is administered by the department that built the system. It cannot generate the evidence a trial would have generated.

The honest conclusion. The absence of a live trial cannot be justified on the government’s own stated standard — needs-based, person-centred care, as recommended by the Royal Commission. It can only be justified on a different standard: administrative convenience, fiscal urgency, and the political cost of delay. The government has never stated that standard out loud. That is the euphemism at the centre of the paper. The Minister says the IAT “didn’t drop from the sky” and was “a very important recommendation of the Royal Commission.” Both statements are true of the questionnaire. Neither is true of the algorithm. The gap between the two is where the justification lives, and it is empty.

3.5 The workforce: understaffing and violence

The Australian Nursing and Midwifery Federation’s 2026 Aged Care Pulse Check surveyed more than 3,550 frontline nurses and care workers between October and December 2025. The findings:

· 49.03 per cent of staff had insufficient time to deliver care, rising to 55.75 per cent among staff at for-profit providers;

· 96.43 per cent experienced or observed one or more instances of violence and aggression in the workplace in the past 12 months, including verbal aggression, physical violence, racism, and sexual harassment;

· Cost-cutting is impacting resident care, with workers reporting unfilled sick shifts, limited use of agency staff, and rationing of essential supplies.

The ANMF’s assessment is that “reforms may have led to some welcome improvements (such as RN 24/7), but they certainly haven’t gone far enough to fix a broken system”. The Federation is calling for mandated staffing ratios to replace care minutes, risk assessments to manage violence, and greater transparency over how providers spend taxpayer funding.

3.6 Rights and abuse

The Australian Human Rights Commission’s 2026 assessment records “important but uneven advances“. On the positive side, the National Plan to End the Abuse and Mistreatment of Older People 2026–2036 was launched in March 2026, and the aged care reforms have introduced a Statement of Rights and strengthened standards.

But significant protection gaps remain:

· The absence of nationally consistent enduring power of attorney laws, adult safeguarding laws, and safeguarding agencies across jurisdictions;

· Limited enforceability of rights in aged care;

· Persistent age-based discrimination in the workplace.

The Commission notes that the rights set out in the Act “are not directly enforceable“. The 2021 National Elder Abuse Prevalence Study found that one in six older Australians (15 per cent) experienced abuse in the previous year, and that two-thirds (61 per cent) did not seek help. The study surveyed community-dwelling older people and did not cover residential care settings or people with cognitive impairment, so the figure is likely to understate prevalence among the population most exposed to the risk.

4. The Minister’s Responses: The Five-Part Pattern

Minister Butler’s public defences of the reforms follow a consistent structure. The structure is worth naming because it is the same structure identified in the analysis of the NDIS and the extraction economy: the mechanisms by which a system that is failing can continue to describe itself as reforming.

First, appeal to the Royal Commission’s authority. The reforms are framed as the implementation of recommendations the Commission made, which places critics in the position of opposing the Commission itself. The Minister’s statement on the algorithm: “The idea of an Independent Assessment Tool didn’t drop from the sky, we didn’t come up with it. It was a very important recommendation of the Royal Commission into Aged Care”. The problem, as the ABC analysis documents, is that this conflates the IAT (recommended) with the algorithm (not recommended) — a conflation that has been “a common tactic of the government and the Department of Health”.

Second, concede the principle while disputing the characterisation. “I’ve been pretty frank and honest about the fact that we need more aged care supply”. “I don’t accept your description of this as a computer system“. The concession is real — the government does acknowledge the supply problem — but it is paired with a refusal of the specific characterisation that would make the problem legible. The Minister points instead to the review rate: “The number of reviews that have happened through the IAT, the new system which has assessed well over 200,000 people, is pretty small, it’s less than half a percent”. The implication is that a low review rate is evidence the system is working. It is equally consistent with a system in which people do not know they can seek review, or cannot navigate the process — and the existence of 1,000 review requests in five months (six times the prior year), 800 Ombudsman complaints, and a Senate vote against the algorithm suggests the review rate is not a reliable measure of satisfaction.

Third, point to process and review. “We’re doing everything that we can to make sure this tool delivers the sort of predictability and consistency that the Royal Commission recommended”. A three-month review, an $18 million commitment, a consultation process, a proposed escalation pathway. The response is procedural rather than substantive, and the procedure is always in the future tense. As of September 2026, the review had missed its deadline, and legislation to enact the escalation option had not been introduced.

Fourth, deflect to commentary. When asked directly about the flaws Eagar identified, the Minister for Aged Care and Seniors, Sam Rae, declined to engage the substance: “I’ll leave it for the commentators to commentate.” The formulation is worth recording because it is the purest specimen of the pattern — the question is not answered, not disputed, and not acknowledged. It is reassigned to a category (commentary) in which it need not be met.

Fifth, blame the Senate when legislation stalls. On the private health rebate bill: “The Senate’s responsibility today is the same as yesterday, and that is to do its job and debate bills, not just discharge them from the paper”. The $3 billion saving, the Minister argues, is needed to fund the expansion regardless. The framing directs attention to the procedural conduct of the Senate rather than to the substance of the measure or the adequacy of the funding it is meant to support.

The gap between these responses and the sector’s account is stark. Ageing Australia’s CEO, Tom Symondson, said: “It is heartbreaking to watch older people crying out for support they so desperately need and deserve“. Anglicare Australia’s executive director, Kasy Chambers, described the system as “rationing support and leaving older Australians waiting months for help,” and added: “An algorithm cannot solve a shortage of care. It cannot create more home care places, and it cannot make months of waiting acceptable”.

5. The Architecture of Neglect

The reforms are real. The legislative architecture — the Aged Care Act, the Statement of Rights, the strengthened standards, the registration model — is a genuine advance on what preceded it, and the government has spent money at a scale that is documented. The Minister’s figure of $44 billion in Commonwealth aged care spending this year, up from $24 billion four years ago, is not disputed.

But the outcomes the reforms were meant to deliver are not arriving at the pace or scale the evidence demands. The hospital stranded figures are rising. The waitlist is almost 154,000 on the ABC’s documented count. The algorithm has produced a funding system that a specialist in classification design says does not capture the things that matter most, that she believes may be unlawful, and that was substantially changed in July 2026 without revalidation. The workforce is understaffed and exposed to violence at rates that would be a scandal in any other industry. The rights framework is real on paper but limited in enforceability, and the abuse prevalence has not changed.

The pattern is not one of simple failure. It is one of relocation. The neglect the Royal Commission identified was visible: maggots in wounds, malnourishment, understaffing, indifference. The neglect that the 2026 record documents is architectural: it is built into the algorithm that scores need, the waitlist that rations access, the procurement process that purchases the platform, and the review mechanism that substitutes procedure for remedy. The ward has not been fixed. The ward has been replaced by a system in which the same population is sorted, scored, and delayed — and in which the sorting is described as consistency, the delay as prioritisation, and the score as needs-based assessment.

What holds the architecture together is unfalsifiability. The system has been designed, or has evolved, such that its errors cannot be attributed and its judgements cannot be tested. There was no live trial. The clinicians who signed off cannot be named. The documents cannot be released. The clinician cannot override. The algorithm was changed without revalidation. The appeal is heard by the department that built the system. The escalation pathway operates after the decision and places the burden on the older person. Each of these is defensible in isolation; together they form a structure in which the question “is this working?” has no institutional answer. That is not an accident of implementation. It is the property that allows a failing system to continue to describe itself as reforming.

The Royal Commission’s one-word verdict was neglect. The 2026 record does not show that neglect has ended. It shows that neglect has been re-architected — moved from the ward to the algorithm, from the staffing roster to the waitlist, from the provider to the procurement process, and from the visible failure to the unfalsifiable one.

6. Conclusion: The Question the Record Puts

The aged care system in Australia in 2026 is not failing because the people running it are indifferent. It is failing because the architecture of the reform has been designed to measure what can be counted, and to count what can be measured, while the things that cannot be counted — the time a carer spends sitting with a resident, the judgement a clinician makes about frailty, the difference between a person who is managing and a person who is not — are pushed to the margins of the apparatus or excluded from it altogether.

The Minister’s responses are not dishonest in the ordinary sense. They are euphemistic in the technical sense: the reframing of the algorithm as the IAT, the appeal to a Royal Commission recommendation the algorithm never received, the proceduralism that substitutes a review for a remedy, the deflection to commentary, and the concession of the principle while disputing the description. These are the mechanisms by which a system that is failing can continue to describe itself as reforming. They are the same mechanisms that Bandura identified in moral disengagement: moral justification, euphemistic labelling, displacement of responsibility onto the algorithm, and the diffusion of responsibility across a review process that is always about to report.

The question this paper puts to the institutions is narrow. Do you know what you are holding? Because a funding formula is not a needs assessment. A score is not a judgement. A review is not a remedy. And a system that cannot be shown to be wrong is not a system that has been shown to be right.

The Royal Commission chose the word neglect. The 2026 record shows that the word still applies. It has simply been given a new architecture — and the architecture’s defining feature is that it cannot be tested.

Claim – Status – Summary

# – Claim – Status – Source

1 – The Royal Commission’s interim report was titled Neglect – Established

2 – The final report made 148 recommendations – Established

3 – The Aged Care Act 2024 commenced 1 November 2025- Established

4 – The Act established a Statement of Rights and strengthened Quality Standards- Established

5 – The 2026–27 Budget allocated $3.7 billion to aged care- Established

6 – The package includes $1.7 billion for up to 5,000 beds a year- Established

7 – The $1.7bn comprises $606.5m for capital subsidies and dementia supports, and $1.1bn in the Contingency Reserve- Established

8- The package includes $1 billion for free personal care- Established

9 – The package includes $565.1 million for sector quality, safety and viability- Established

10 – The package includes $389.8 million for Support at Home acceleration, end-of-life pathway, fairness, and the IAT/algorithm review – Established

11 – Commonwealth aged care spending rose from $24bn to $44bn in four years- Established

12 – Over 3,600 patients were stranded in hospitals in mid-2026- Established

13- The number rose from over 2,700 in mid-2025- Established

14 – The official waitlist figure at 31 March 2026 was 100,191 – Established

15 – The ABC’s Four Corners investigation found almost 154,000 waiting- Established

16 – The pre-reform calculation would add 53,718 people – Established

17 – The median wait from application to receipt was 10 months – Established

18 – The government’s Wait Times Report records an average wait of 12 months- Established

19 – The IAT was recommended by the Royal Commission and tested on 22,000 people- Established

20 – The algorithm was never recommended by the Royal Commission and had no live trial- Established

21- The algorithm prototype was designed by a consultancy and taken in-house by public servants- Established (via Senate estimates)

22- The government refused a formal Order for the Production of Documents – Established

23 – The Department could not name clinicians who signed off on the algorithm- Established

24- Of 500+ IAT questions, the vast majority do not feed into the algorithm – Established

25 – A one-point difference can mean almost $40,000 a year in funding- Established

26 – Eagar described the algorithm as “fatally flawed” – Established

27 – Eagar believes the rules may be illegal and inconsistent with the Act – Established (as her evidence)

28 – 13 of 33 functional-score items were removed and three introduced in July 2026- Established (via Senate evidence)

29 – The current version of the algorithm has not been validated – Established (as Eagar’s evidence)

30- More than 1,000 review requests were lodged in the first five months – Established

31 – The government says this is less than 1 per cent of assessments- Established

32 – The Senate voted for the algorithm to be ditched – Established

33 – The Ombudsman is investigating after 800 complaints – Established

34 – The government committed $18 million to a review – Established

35 – The review missed its three-month deadline- Established

36 – Ministers were warned assessors could not override the algorithm – Established

37 – Eagar knows of no country using an algorithm of this kind for overall budgets- Established (as her evidence)

38 – The September 2026 amendment enables escalation “in extenuating circumstances” – Established

39 – Sharkie described it as “a bandaid patch-up”- Established

40 – 49.03 per cent of surveyed staff had insufficient time to deliver care – Established

41 – 96.43 per cent experienced or observed violence or aggression – Established

42 – The ANMF survey covered more than 3,550 workers – Established

43 – The AHRC recorded “limited enforceability of rights in aged care”- Established

44 – One in six older Australians experienced abuse in the previous year – Established

45- The Minister said “I don’t accept your description of this as a computer system”- Established

46 – The Minister said the review rate was “less than half a percent” – Established

47 – Sam Rae said “I’ll leave it for the commentators to commentate” – Established

48 – The Minister said “the Senate’s responsibility today is the same as yesterday” – Established

49 – The government conflates the IAT with the algorithm – Established

50- The reform architecture constitutes a “re-architected neglect” Inference (authors’ construction) —

51 – The system is characterised by “unfalsifiability” Inference (authors’ analysis) —

52 – The five-part response pattern constitutes euphemistic framing in Bandura’s sense Inference- (authors’ analysis) —

53 The absence of a live trial cannot be justified on the government’s own standard Inference (authors’ argument) —

Method notes

Claims are classified throughout as Established, Inference, or Speculation. Established claims are sourced to primary documents or reputable secondary reporting and cited inline. Inferences are the authors’ analysis. Speculation is marked as such. The paper’s central analytical frame — the “re-architected neglect,” the “algorithm as the new ward,” and the “architecture of unfalsifiability” — is the authors’ construction and is not a claim made by any of the sources cited. The paper does not claim that the aged care system is deliberately designed to harm older people. It claims that the system’s documented outcomes, measured against its own stated objectives, constitute a continuation of the neglect the Royal Commission identified, in a new architectural form.

References

1. Aged Care Act 2024 (Cth), No. 104, 2024, commenced 1 November 2025. Federal Register of Legislation, C2025C00589.

2. Australian Government. (2026). Budget 2026–27: Care and opportunity. budget.gov.au.

3. Australian Government. (2026). Budget Paper No. 2: Budget Measures 2026–27. Commonwealth of Australia.

4. Australian Government Department of Health, Disability and Ageing. (2025, October 29). What the new Aged Care Act means for you.

5. Australian Government Department of Health, Disability and Ageing. (2026, April 22). More beds, more packages and better care for older Australians (Media release, Minister for Health and Ageing Mark Butler).

6. Australian Government Department of Health, Disability and Ageing. (2026, October 15). TV interview with Minister Butler, ABC Afternoon Briefing – 15 October 2026.

7. Australian Human Rights Commission. (2026, April 22). Older persons’ rights, aged care and discrimination: Australian Human Rights Assessment 2026.

8. Australian Institute of Family Studies. (2021, December). National Elder Abuse Prevalence Study: Summary report.

9. Australian Nursing and Midwifery Federation. (2026, August 11). ANMF calls for mandated staffing ratios to ‘finally fix’ aged care.

10. Australian Nursing and Midwifery Federation. (2026, August 11). National aged care survey reveals staffing shortages, escalating workplace violence and cost-cutting by providers.

11. Butler, M. (2026, April 22). More beds, more packages and better care for older Australians (Media release).

12. Connolly, A. (2026, August 22–23). While government reviews aged care algorithm, waitlists are growing and people are dying. ABC Investigations (analysis accompanying Four Corners, “The Waiting Game”, 17 August 2026).

13. Eagar, K. (2026, August 24). Evidence to Senate Community Affairs References Committee, as reported in Health Services Daily, “IAT ‘fatally flawed’, may defy Aged Care Act: Eagar”.

14. Inspector-General of Aged Care. (2026, April). Policy, accountability and the road ahead (Speech delivered by Natalie Siegel-Brown at the Support at Home Summit).

15. Labor resists widespread calls to ditch ‘cruel’ aged care funding algorithm. (2026, August 19). ABC News.

16. Mark Butler defends aged care reforms after Four Corners. (2026, August 19). The Weekly SOURCE.

17. NSW Government. (2026, September 4). Over 3,600 patients stranded in hospital waiting for aged care (Ministerial media release).

18. Peaks call for action on wait times. (2026, August 18). Australian Ageing Agenda.

19. 200,000 older Australians still waiting for aged care. (2026, May 31). The Weekly SOURCE.

20. Butler announces extra $3b for aged care. (2026, April 22). Australian Ageing Agenda.

21. ‘Why are they making it so damned hard?’: A blind 96yo vs the aged care algorithm. (2026, August 17). ABC News.

22. SA exposed: Ministers clash over proposed health changes. (2026, September 25). InDaily.