Royal Commission into Aged Care: What It Found, What It Changed, and What It Means Today
Quick answer: The Royal Commission into Aged Care Quality and Safety was a national inquiry that ran from October 2018 to February 2021. Its final report delivered 148 recommendations covering everything from a new rights-based Aged Care Act to mandatory staffing minimums, pay reform, and stronger regulation. Since then, the Aged Care Act 2024 has commenced, mandatory care minutes are law, the Aged Care Work Value Case has delivered the sector’s largest pay increases in decades, and the ACQSC has significantly strengthened its enforcement powers. This guide explains what the Commission found, what it recommended, and what has genuinely changed as a result.
What Was the Royal Commission into Aged Care?
The Royal Commission into Aged Care Quality and Safety was a formal national inquiry established by the Australian Government on 8 October 2018, following a series of high-profile reports of neglect, abuse, and poor care in residential aged care facilities across Australia. It was led by Commissioners Tony Pagone QC and Lynelle Briggs AO, who heard testimony from thousands of older Australians, families, carers, clinicians, aged care workers, and providers over more than two years.
The Commission examined both residential aged care and home care, and was given broad powers to investigate quality, safety, governance, funding, workforce, regulation, and the lived experience of older Australians. It received more than 10,000 submissions and heard from more than 640 witnesses across 108 days of hearings. The final report, titled Care, Dignity and Respect, was delivered to the Governor-General on 26 February 2021.
established
the final report
received
delivered
Why the Royal Commission Was Called: What Was Already Known
The Commission was not called into a vacuum. By 2018, a series of high-profile media investigations and reports had already documented patterns of neglect that the government’s existing oversight mechanisms had failed to prevent. The ABC’s Four Corners programme aired footage from inside a South Australian aged care facility showing residents being physically mistreated. The ACQSC’s own predecessor, the Aged Care Quality Agency, had been criticised as insufficiently independent and too slow to act on complaints.
The government had also been aware of significant structural problems: waiting lists for home care packages that ran into hundreds of thousands of people, funding models that did not adequately link payment to care quality, and a workforce that was underpaid, undertrained, and stretched across facilities that were chronically understaffed. The Commission’s purpose was to investigate these issues comprehensively and independently, with the power to compel evidence and make binding recommendations to government.
What the Royal Commission Found
The Commission’s findings were, in the words of the final report, “a shocking tale of neglect.” Some of the most significant findings included the following.
The 148 Recommendations: What Was Called For
The Commission’s 148 recommendations were the most comprehensive overhaul of Australia’s aged care system ever proposed. They spanned every dimension of the system: legislation, funding, workforce, regulation, governance, clinical care, consumer rights, dementia care, home care, and transparency. The following were among the most significant.
Key recommendations from the final report
- A new rights-based Aged Care Act to replace the 1997 Act
- Mandatory minimum staffing: 200 direct care minutes per resident per day, including 40 minutes from a registered nurse
- A registered nurse to be on-site 24 hours a day, seven days a week
- Significantly increased wages for the aged care workforce
- A new independent Aged Care Safety and Quality Authority
- A new star rating system for aged care facilities
- Increased government funding to reduce the home care package waitlist
- Restrictions and clearer rules around the use of restrictive practices
- Better access to allied health, dementia care, and palliative care in residential settings
- Independent assessment rather than provider-led assessment for care needs
What Has Actually Changed Since the Royal Commission
This is the question families most need answered, and it deserves a specific rather than a generic answer. The following changes are confirmed and in effect.
The Aged Care Act 2024
The most significant legislative change recommended by the Commission became law on 1 November 2025, when the Aged Care Act 2024 commenced. This replaced the Aged Care Act 1997 and introduced a rights-based framework for the first time. The new Act places older people’s rights, dignity, and wellbeing at the centre of the system rather than treating them as recipients of services to be managed.
The Statement of Rights
The Aged Care Act 2024 introduced a legally enforceable Statement of Rights for every person receiving aged care. Unlike the previous Charter of Aged Care Rights, this is not simply a statement of aspiration. Providers must take all reasonable and proportionate steps to act in line with it, and residents can raise complaints when they believe it has been breached.
Mandatory Care Minutes
From 1 October 2023, mandatory minimum care time requirements became law. From 1 October 2024, every residential aged care facility must provide a minimum of 215 direct care minutes per resident per day, including at least 44 minutes from a Registered Nurse. A Registered Nurse must now be on-site 24 hours a day, seven days a week. These figures exceeded the Commission’s original recommendation and represent a genuine, measurable improvement in the minimum standard of care residents receive.
The Aged Care Work Value Case
The Commission’s finding that aged care workers were significantly undervalued directly prompted the ANMF and HSU to bring a Work Value Case before the Fair Work Commission. The resulting decision delivered a total 23% pay increase for personal care workers, phased in between 2022 and October 2025, and further staged increases for aged care nurses, with the final nurse increase due 1 August 2026. These are the largest pay increases the aged care sector has received in its history, and they are funded by the government.
Strengthened Quality Standards
The seven strengthened Aged Care Quality Standards, which replaced the previous eight standards, commenced on 1 November 2025 alongside the new Act. They introduced new dedicated standards for Food and Nutrition (responding directly to Commission findings about malnutrition) and strengthened expectations around clinical care, individual rights, and organisational governance. The ACQSC now assesses providers against a graded performance scale rather than a simple pass or fail.
Star Ratings
A publicly available Star Rating system for residential aged care facilities was introduced in December 2022 on the My Aged Care website. Ratings cover overall quality, staffing levels, residents’ experience, and compliance. Any family choosing a facility can now compare providers by overall rating and individual dimension scores before making a decision, which was not possible before the Commission.
Home Care Package Waitlist
The government committed significant additional funding to address the home care package waitlist. Since the Commission, waitlist numbers have reduced substantially, and the Support at Home programme has replaced the previous Home Care Package and Commonwealth Home Support Programme framework with a more integrated model, providing greater flexibility for how funding is used to support people to remain at home.
Serious Incident Response Scheme
The Serious Incident Response Scheme (SIRS), which commenced in 2021, requires providers to report serious incidents including abuse, neglect, and unexplained absence to the ACQSC within strict timeframes. This addressed the Commission’s finding that incidents were being managed internally without proper external oversight.
What the Commission’s Findings Still Mean for Families Today
Understanding the Royal Commission helps families ask better questions when choosing an aged care provider or evaluating the care a loved one is already receiving. The Commission’s findings effectively published a checklist of what had gone wrong across the sector, and each item on that list translates into a practical question worth asking any provider today.
Questions families can ask any provider, informed by the Commission’s findings
- “How many care minutes per resident per day do you currently deliver, and how does this compare to the 215-minute minimum?”
- “Do you have a Registered Nurse on-site 24 hours a day, 7 days a week?”
- “What is your current Star Rating on My Aged Care, and what does each dimension score reflect?”
- “How do you approach the use of medication for behaviour management?”
- “What is your internal complaints process, and how are concerns followed up?”
- “How do you involve residents and families in care planning and decision-making?”
What Has Not Yet Changed: Honest Acknowledgment
Progress has been genuine but uneven. The Commission was explicit that reform of this scale takes time, and not every recommendation has yet been fully implemented. Workforce shortages remain significant across the sector, with rural and regional areas particularly affected. Consistent quality of care across all providers is still not a given, and the ACQSC’s expanded enforcement powers are being tested and calibrated in practice. The home care transition to Support at Home, while well-intentioned, created real complexity and disruption for some families during implementation.
Disability advocates have also raised ongoing concerns about younger people in residential aged care, a specific issue the Commission highlighted that has not yet been fully resolved despite continued government investment in the YPIRAC program. And the intersection between the aged care and NDIS systems for people aging with disability remains genuinely complex to navigate without dedicated guidance.
Frequently Asked Questions: Royal Commission into Aged Care
When was the Royal Commission into Aged Care held?
The Royal Commission into Aged Care Quality and Safety was established on 8 October 2018 and delivered its final report, Care, Dignity and Respect, on 26 February 2021. It ran for approximately two years and three months.
How many recommendations did the Royal Commission make?
The Commission made 148 recommendations covering every dimension of the aged care system, from a new Aged Care Act to mandatory staffing requirements, pay reform, stronger regulation, and improved home care access.
What did the Royal Commission find?
The Commission found that substandard care was widespread and systemic, not isolated. It found the workforce was underpaid and understaffed, regulation was too weak and reactive, chemical restraint was overused, and home care was badly underfunded with waiting lists of more than 100,000 people.
What changed after the Royal Commission into Aged Care?
Significant changes include the Aged Care Act 2024 (commenced 1 November 2025), mandatory care minutes of 215 per resident per day including 44 RN minutes, a 24/7 registered nurse requirement, the Aged Care Work Value Case delivering 23% pay increases for care workers, seven strengthened Quality Standards, a public Star Rating system, and the Serious Incident Response Scheme.
Who were the Royal Commission Commissioners?
The Commission was led by the Honourable Tony Pagone QC and Ms Lynelle Briggs AO. Both brought extensive legal and public sector governance experience to the role. They delivered a joint final report and also each submitted separate statements where their recommendations differed.
What This Means If You Are Choosing Aged Care Now
The Royal Commission changed the landscape that every family enters when choosing an aged care provider. In 2018, there was no public Star Rating system, no mandatory minimum care minutes, no 24/7 nurse requirement, and no legally enforceable Statement of Rights. None of those protections existed. All of them exist now.
That does not mean every provider has uniformly improved. It means the minimum floor has been raised, enforcement is more rigorous, and families now have more information and more rights than at any previous point in the system’s history. The Commission’s legacy is most visible not in what happened during the inquiry itself, but in the concrete, measurable changes to how aged care is delivered and regulated today.
At Superior Care Group, we welcomed the Royal Commission’s findings and the reforms they produced because they aligned with what we had always believed: that older Australians deserve care built around dignity, safety, and genuine respect for the individual. Our two Queensland residences, Wellington Park in Wellington Point, South East Brisbane, and Merrimac Park on the Gold Coast, have operated with that philosophy since 1979. The reforms that followed the Commission have not changed our direction. They have confirmed it.
Questions About Aged Care Quality and Standards?
We’re happy to explain how the reforms apply to our two residences.
Wellington Park | Wellington Point, Brisbane South East | (07) 3822 1876
Merrimac Park | Merrimac, Gold Coast | (07) 5618 1111
