The maths is not mathing. So what do aged care providers do next?

I am an unabashed admirer of Natalie Siegel-Brown.

Natalie has a rare ability to speak about aged care with intellectual clarity, moral courage and refreshing directness. Natalie says the things many people in the sector are thinking, but do not always feel able to say out loud.

Natalie’s recent National Press Club address was powerful, honest and, at times, uncomfortable—which is precisely why it mattered.

I would have loved to have been there in person. Unfortunately, the address coincided with school holidays. As every working parent knows, the diary can become something of an aspirational document during school holidays.

I did, however, make time to listen carefully afterwards.

For those who were also unable to attend—or who have not yet had the opportunity to watch the address—I wanted to share some of the messages that resonated most strongly with me.

More importantly, I wanted to consider what happens next.

Because Natalie’s address deserves more than enthusiastic applause, a few LinkedIn quotes and a collective agreement that “someone really should do something”.

Natalie has given the sector an honest diagnosis. The next responsibility is ours: governments, providers, boards, executives and advisers must decide what we are going to do with it.

A question that goes to the heart of aged care

Natalie’s central question was confronting: is Australia funding independence, or are we funding decline?

Natalie was not simply calling for more money.

Natalie was asking whether the more than $40 billion already committed to aged care is being directed towards the right interventions, at the right time and for the outcomes older Australians have been promised.

In Natalie’s memorable formulation, the maths is not mathing.

That is not because investment in older people is inherently unaffordable. It is because the system too often waits until people have lost independence, experienced deterioration or reached crisis point before providing meaningful support.

We then spend substantially more trying to manage the consequences.

That is not only poor economics. It is a poor human outcome.

Natalie’s argument was that dignity, independence and financial responsibility are not opposing objectives. Earlier, better-targeted interventions can improve people’s lives while reducing avoidable hospitalisation, delaying entry into residential care and easing pressure across the broader health and aged care systems.

That should not be controversial.

Yet, somehow, in aged care, the sensible can become surprisingly radical.

Rights on paper must become outcomes in practice

The new Aged Care Act places dignity, independence, choice, connection and cultural safety at the centre of the system.

That is an important and long-overdue shift.

But rights expressed in legislation do not automatically become lived experiences.

Rights must be translated through funding rules, assessment processes, service models, workforce decisions, technology, governance and thousands of daily interactions between providers and older people.

When these elements are not aligned, an apparently well-designed system can still produce outcomes that are delayed, expensive and deeply frustrating.

Natalie illustrated this through the story of an older woman who urgently needed a relatively inexpensive pair of crutches.

Before the system would fund the crutches, an additional professional assessment was required. A need that might have been resolved promptly reportedly became a three-month wait and approximately $1,800 of process for an item costing around $50.

The issue was not that allied health assessment is unimportant.

The issue was proportionality.

The process cost significantly more than the solution, took substantially longer than the person could safely afford to wait and exposed the older woman to additional risk in the meantime.

Only aged care could occasionally make a $50 solution feel like a major infrastructure project.

The example captured a fundamental problem: a process may be technically correct, properly documented and entirely compliant—and still fail to deliver value.

Waiting is not free

One of Natalie’s most important observations was that waiting is not free.

When an older person waits for assessment, equipment, allied health, home modifications, transport, meals or social support, the cost does not disappear.

The cost changes form.

It may emerge as a fall, a hospital admission, medication deterioration, carer burnout, malnutrition, isolation, cognitive decline or the premature need for residential care.

The ledger may record the original delay as a saving.

The older person experiences it as a loss.

The health and aged care systems may eventually pay many times the original amount.

This is why prevention, rehabilitation and reablement cannot continue to be treated as pleasant additions to “real” care.

They are real care.

Meals, transport, assistive technology, home modifications, allied health, social connection and early clinical intervention are part of the infrastructure that helps people maintain function and remain safely at home.

Natalie’s message was not that every service should be approved without scrutiny or that providers should spend without discipline.

Natalie’s message was that scrutiny must be intelligent, timely and proportionate.

Otherwise, we risk being extraordinarily efficient at administering the wrong outcome.

Financial sustainability is not the enemy of care

Natalie’s address strongly resonated with a message Anchor Excellence has consistently advanced: financial sustainability must not be treated as an embarrassing or inappropriate topic in aged care.

Since March 2025, Anchor has consistently supported talking about margins, productivity, cash flow and cost does not mean placing profit before people.

It means recognising that a financially fragile organisation cannot provide safe, consistent and high-quality care indefinitely.

A provider without sufficient financial resilience will struggle to:

• retain and develop its workforce;
• maintain buildings and equipment;
• invest in technology and clinical systems;
• respond to changing consumer needs;
• manage regulatory and operational risk;
• fund service innovation; or
• continue operating through unexpected disruption.

Financial weakness does not remain confined to the finance department.

It eventually becomes a workforce problem, a quality problem, a governance problem and a risk to older people.

At the same time, financial sustainability cannot be achieved through indiscriminate cost-cutting.

Removing expenditure without understanding the effect on consumers, workforce capacity, clinical risk and future demand may reduce today’s cost while creating tomorrow’s crisis.

Aged care does not need a race to the bottom.

It needs a much more disciplined conversation about the difference between cost and value.

A low-cost service that achieves very little may be poor value.

A timely intervention that protects mobility, confidence, nutrition, cognition or social connection may represent excellent value, even when its immediate cost is higher.

The real questions are therefore not simply:

Providers cannot control everything—but they are not powerless

The government has a clear responsibility to design adequate, equitable and workable funding arrangements.

Providers should continue to advocate strongly where funding is insufficient, delayed or poorly structured.

However, providers cannot wait for every national policy problem to be solved before strengthening their own organisations.

Anchor has consistently encouraged providers to focus on what they can influence.

That includes understanding:

• the actual cost of delivering each service;
• the difference between the cost of care and the cost of operating the organisation;
• which services are sustainable under current funding and pricing;
• whether workforce deployment reflects consumer demand;
• where duplication and administrative burden are consuming scarce capacity;
• whether current technology and procurement arrangements are producing value;
• whether pricing decisions properly reflect cost and risk;
• and whether cash, capital and reserves are sufficient to manage future obligations.

Providers should be able to trace funding from receipt through to service delivery and explain what that expenditure achieved.

• Did it protect independence?

• Did it respond to an assessed need?

• Did it reduce risk?

• Did it improve the person’s experience?

• Did it strengthen the workforce?

• Did it support the provider’s capacity to continue delivering care?

This is not financial analysis conducted separately from care.

It is financial analysis in the service of care.

The problem with measuring what is easy

Natalie also challenged a system that is very capable of measuring activity but less capable of demonstrating outcomes.

Aged care records tasks, minutes, units, assessments, reports and completed processes.

These measures matter.

But they do not automatically tell us whether an older person has retained mobility, remained socially connected, avoided hospital, recovered function or continued living safely at home.

Completing the activity is not the same as achieving the outcome.

Anchor’s own workforce and care-minute reviews have repeatedly reinforced this distinction.

A provider may achieve an aggregate care-minute requirement while still experiencing duplication, inefficient task allocation, poor roster alignment or a mismatch between staffing patterns and the actual needs of residents.

Conversely, better workforce design, clearer competencies and more thoughtful deployment can improve care while releasing skilled capacity for the people who need it most.

The question must therefore evolve from:

“Did we deliver the required activity?”

to:

“What changed for the older person because we delivered it?”

That is a harder question. It is also the one that matters.

What should providers do next?

Natalie’s address should prompt every provider board and executive team to undertake an honest examination of its own organisation.

Not a ceremonial review.

Not another beautifully formatted strategy document that quietly retires to the shared drive.

A genuine examination of whether resources, services, workforce and governance are aligned with the outcomes the organisation claims to value.

Providers should consider four immediate areas.

Understand the economics of care

Providers need reliable service-line information, unit costing, cash-flow visibility and scenario modelling.

Leaders should understand which services generate or consume resources, what drives financial performance and where funding, pricing or delivery models are misaligned.

Without this information, organisations risk making decisions based on instinct, averages or incomplete financial statements.

Connect expenditure to outcomes

Investment decisions should be considered through both a financial and consumer-outcome lens.

The cheapest option is not always the wisest.

Equally, longstanding expenditure should not be protected simply because “we have always done it this way”—five words responsible for a remarkable amount of organisational clutter.

Examine workforce deployment

Workforce expenditure is typically the largest cost for aged care providers.

The question is not simply whether enough people are rostered.

Providers must consider whether the right skills are available at the right times, whether work is allocated appropriately and whether unnecessary processes are drawing qualified staff away from direct care.

Strengthen governance and accountability

Boards need clear, decision-useful information that connects financial performance, operational delivery, clinical risk and consumer outcomes.

Financial sustainability should not appear as a separate agenda item discussed after quality and care.

These matters should be considered together because, in practice, they are inseparable.

Where Anchor Excellence can help

Anchor Excellence’s role is to help organisations translate these challenges into practical action.

Our work is deliberately integrated because aged care challenges rarely fit neatly into a single service line.

Our Complex Business and Finance Advisory team supports providers with financial sustainability reviews, service costing, pricing, margin analysis, cash-runway assessment, scenario modelling, prudential reviews and finance-function improvement.

Our Strategy, Governance and CEO Excellence work assists boards and executives to translate purpose, consumer rights and statutory responsibilities into clear priorities, accountable decisions and executable plans.

Our Risk Advisory team provides independent assurance across clinical, operational, workforce, financial and regulatory risks—testing whether reported information reflects what is actually occurring within the organisation.

Our workforce and operational reviews help providers examine care models, rostering, productivity, role clarity and the relationship between staffing inputs and consumer outcomes.

Through Anchor Policy and Anchor Academy, we support organisations to embed decisions into practical policies, systems, education and everyday work.

This matters because there is little value in developing a compelling strategy if it is not reflected in budgets, workflows, rosters, policies, reporting and staff capability.

A good idea that is never operationalised remains, unfortunately, just a very well-dressed idea.

Spending wisely is an expression of respect

Natalie’s address was ultimately about respect.

Respect for older people requires more than good intentions.

It requires a system that responds before preventable deterioration becomes crisis.

Respect for the workforce requires service models that allow people to use their skills meaningfully rather than being trapped in unnecessary administration.

Respect for taxpayers requires evidence that expenditure is proportionate, disciplined and connected to outcomes.

Respect for providers requires realistic funding, but also strong governance and the information needed to make difficult decisions confidently.

The sector must continue advocating for adequate and better-designed funding.

But that advocacy will be stronger when it is accompanied by evidence that existing resources are being managed thoughtfully, transparently and effectively.

Financial sustainability should not be a taboo in aged care.

It is not separate from dignity, quality or rights.

It is one of the conditions necessary to deliver them.

Natalie has provided a powerful and honest call to action.

The next question is ours to answer:

How wisely are we using the resources already available to us—and what difference are they making in the lives of the older people we serve?