The case for proactive aged care assessments

Proactive aged care assessments have the potential to reframe aging from a series of emergencies to a manageable life stage. Here’s how.

Australia’s aged care system appears stuck in crisis mode. Older people and their families often wait until a fall, fracture or sudden illness forces an emergency application, then endure months of waiting while health declines and costs balloon. Shifting to proactive, population-wide needs assessments at set age markers (for example, 70 and 75) would carry a large upfront price tag, but the long-term economics are compelling: earlier support keeps people safer at home longer, reduces expensive hospitalisations and delayed discharges, and gives governments a predictable pipeline for workforce and funding planning.¹

The scale of the problem: aging, waits and costs

Australia is aging rapidly. Around 4.84 million people were aged 65 and over as at June 2025, with the share of older Australians rising from 12.9% in 2005 to 17.5% in 2025. Around 30% of people over 65 experience at least one fall each year,² and for those 85 and over the hospitalisation rate from falls exceeds 10,000 per 100,000 population annually.³ Figures from the Australian Institute of Health and Welfare (AIHW) reveal that falls alone now account for more than 250,000 hospitalisations annually, costing the health system in excess of $5 billion in 2024–25.³

Yet access to aged care support remains slow and reactive. Recent data show more than 100,000 older Australians in the Support at Home Priority System waiting for a home care package at their approved level.⁴ Government figures also show the average wait from application to starting Support at Home services is around 10 months (306 days), and the average wait to start residential care is about a year.⁵ In 2024–25, more than 4800 people died while waiting for their approved aged care funding.⁶

Waiting for a crisis is a structural flaw

Under the current model, many older people only engage with aged care after a sudden health decline, often triggered by a fall, medication error, carer breakdown or acute illness. This creates a cascade of inefficiencies:

• Crisis-driven entry: Care is arranged after their health has already deteriorated, limiting their recovery potential and increasing the likelihood of permanent loss of independence.
• Long waits under pressure: With median waits of many months for home care and residential places, families must navigate complex decisions during emergencies — not the optimal time to be making far-reaching care choices.
• High-stress, low-choice decisions: Rushed entry into nursing homes often leads to poor matches, higher rates of transfer, and greater psychological distress for older people and families.
• System congestion: Thousands of hospital bed-days are consumed by patients who are medically ready for discharge but waiting for aged care placement, which contributes to overcrowding in our EDs and delays to elective surgery.
   

In short, the system is designed to respond to breakdowns rather than prevent them. While it’s clear there’s no silver bullet to these problems, realigning the system could deliver significant benefits to care outcomes and, in the longer term, health budgets.

The insurance logic of proactive assessments

Think of proactive aged care assessments like an insurance premium: you pay upfront to reduce the probability and severity of costly claims later. Insurers invest in risk assessment and prevention because it lowers payouts over time; governments could do the same for aged care.

A structured program of universal needs assessments at specific ages — for example, at 70 and again at 75 — would:

• Establish a baseline: Capture functional status, fall risk, medication complexity, carer capacity and home safety before a crisis occurs.
• Target prevention: Link people early to interventions known to reduce hospitalisations such as falls-prevention exercise programs, home modifications, medication reviews and carer support.
• Smooth demand: Give governments a forward-looking view of who will need what level of support and when, enabling better workforce planning and capital investment in beds and home care packages.
• Preserve choice: Allow families time to research options, visit facilities and plan finances calmly, rather than making urgent decisions in hospital corridors.
   

There may even be a case for a national preventative program for younger Australians, particularly around lifestyle-related chronic health conditions such as type-2 diabetes, cardiovascular disease and osteoarthritis. Behaviour changes when people are in their 50s can make a huge difference in avoiding or slowing the progression of such conditions, but there are currently no widespread public initiatives in this sphere.

Current government expenditure on prevention is only 2.3% of our health budget, less than half of the 5% target. But with the AIHW calculating that potentially preventable hospitalisations already cost the health system $7.7 billion a year and chronic conditions account for $3.5 billion of that total,⁷ the savings could be significant. There are other economic benefits too, with healthier people remaining in employment for longer, contributing to tax revenue and bolstering their retirement nest egg.

The long-term savings case

The potential savings channels are clear:

• Fewer fall-related hospitalisations: With one in four people over 65 falling each year and falls costing about $5 billion annually, even modest reductions in fall rates through early strength-and-balance programs and home modifications would yield large savings.
• Reduced residential care entry: Keeping people safely at home longer avoids or delays the $117,000-per-year residential care cost, replacing it with sub-$30,000 home support, as estimated by the Department of Health and Aged Care.⁸
• Shorter hospital stays and fewer ‘bed-block’ days: Better discharge planning and pre-arranged home care reduce the 8–10% of public hospital bed-days the Grattan Institute estimates are currently occupied by patients waiting for placement.⁹
• Lower acute care costs for older cohorts: Given that treating patients in their 70s and 80s costs hundreds of dollars more per hospital admission than younger adults, preventing avoidable admissions has outsized fiscal benefits.¹⁰
   

Yes, assessing the entire older population at set ages would require a substantial initial outlay of hundreds of millions, potentially billions, depending on design and coverage. But if even a fraction of the $5 billion in annual fall costs, the $7.7 billion in potentially preventable hospitalisations, and the multibillion-dollar gap between home and residential care costs can be avoided or deferred, the program could pay for itself within a decade while improving quality of life for millions of Australians.

Acknowledging the implementation gap

It must be acknowledged that Australia does not yet have the assessment workforce, digital infrastructure or integrated care pathways to provide universal proactive assessments at scale. Workforce shortages, fragmented data systems and the logistics of contacting and assessing millions of older people are legitimate barriers.

But these are design and funding challenges, not reasons to abandon the principle. A phased rollout starting with targeted cohorts (for example, 75+ in high-risk postcodes, or people with specific chronic conditions), coupled with major investment in assessor training, telehealth capacity and interoperable care records could build the system while delivering early wins.

Any proactive assessment model must also avoid the missteps of the Independent Assessment Tool, which should only ever be an addendum to a human-led process. Proven technology can be used to support a decision, but should never be the lone final arbiter. Assessors should always have veto power, allowing them to use their clinical judgment and experience to override recommendations from the algorithm, while the criteria for decisions should be transparent and clearly explained to applicants and their advocates.

A better deal for older Australians and the budget

Proactive aged care assessments have the potential to reframe aging from a series of emergencies to a manageable life stage. They align with how we already think about insurance: pay a known premium now to avoid catastrophic, unpredictable costs later. For older Australians, that means more time living well at home, greater autonomy and less angst for families. For governments, it means more predictable expenditure, reduced pressure on hospitals, and a healthier, more productive older population.

The upfront cost will be large. But so is the cost of doing nothing, and that is measured in lives lost waiting for care, billions spent on preventable hospitalisations and a system that lurches from one crisis to the next. Investing now in proactive assessments is not just compassionate policy; it is sound fiscal strategy.

^{1. Office of the Inspector-General of Aged Care. Preventive approach to aged care. Last updated 4 May, 2026. Accessed 25 September, 2026. https://www.igac.gov.au/preventive}

^{2. Victorian Department of Health. Updated national falls prevention guidelines — April. No Falls Month. Last updated 22 April, 2026. Accessed 25 September, 2026. https://www.health.vic.gov.au/news/updated-national-falls-prevention-guidelines-april-no-falls-month}

^{3. Australian Government. Australian Institute of Health and Welfare. Injury in Australia: Falls. Last updated 17 June, 2026. Accessed 25 September, 2026. https://www.aihw.gov.au/reports/injury/falls}

^{4. Australian Government. Australian Institute of Health and Welfare. GEN Aged Care Data. Support at Home program data report 1 January–31 March 2026. Released 31 May, 2026. Accessed 25 September, 2026.
https://www.gen-agedcaredata.gov.au/resources/publications/2026/may/support-at-home-program-data-report-1-january-31-march-2026}

^{5. Australian Government. Department of Health, Disability and Ageing. Aged Care Act 2024 Wait Times Report: Residential care and Support at Home, Second Report, Quarter 4: 1 April 2026 to 30 June 2026. Published 11 August, 2026. Accessed 25 September, 2026.
https://www.health.gov.au/sites/default/files/2026-08/aged-care-act-2024-wait-times-report-residential-care-and-support-at-home-second-report-quarter-4_0.pdf}

^{6. Parliament of Australia. Community Affairs Legislation Committee — Senate Estimates. Hearing 11 February, 2026. Accessed 25 September, 2026.
https://www.aph.gov.au/Parliamentary_Business/Hansard/Hansard_Display?bid=committees/estimate/29370/&sid=0000}

^{7. Australian Government. Australian Institute of Health and Welfare. Cost of potentially preventable hospitalisations in Australia, 2014–15 to 2023–24. Web report. Last updated 26 November, 2025. Accessed 25 September, 2026.
https://www.aihw.gov.au/reports/health-welfare-expenditure/cost-pph-in-australia-2014-15-to-2023-24/contents/summary}

^{8. Australian Government. Department of Health, Disability and Ageing. Financial Report on the Australian Aged Care Sector 2024–25. Published June 2026. Accessed 25 September, 2026.
https://www.health.gov.au/sites/default/files/2026-06/financial-report-on-the-australian-aged-care-sector-2024-25.pdf}

^{9. The Grattan Institute. Smarter spending: Getting better care for every hospital dollar. Report published 18 November, 2025. Accessed 25 September, 2026.
https://grattan.edu.au/report/smarter-spending-getting-better-care-for-every-hospital-dollar}

^{10. Australian Government. Australian Institute of Health and Welfare. Health system spending on disease and injury in Australia 2023–24. Last updated 29 October, 2025. Accessed 25 September, 2026.
https://www.aihw.gov.au/reports/health-welfare-expenditure/health-system-spending-disease-injury-aus-2023-24/contents/spending-on-disease-by-area-of-spending}

*Paymon Daneshpay is CEO of Lumia Care.

Top image credit: iStock.com/Ridofranz