A more mature national dialogue requires grounding in the existing research rather than in political rhetoric or sectoral blame.
I started this piece of work intending to include it as a post on LinkedIn. However, the more I read and the more I wrote, I realised it needed its own presence.
This brief analysis arises from a growing sense of frustration, professionally and personally, with the way delayed discharge is being discussed in Australia.
Despite the intensity of public and political debate, it remains remarkably difficult to obtain a clear picture of how many older people are affected, why delays occur, and where the real bottlenecks lie.
The states blame the Commonwealth, the Commonwealth blames the states, and what we are left with is a tragedy where the people at the centre of the issue – older Australians who are (by definition that is not the same everywhere) medically ready to leave hospital – remain, quite literally, stranded.
Prime Minister Albanese recently told state and territory leaders they must “rein in public hospital spending” and “reduce growth in hospital activity and costs to more sustainable levels” if they want the Commonwealth’s full funding commitment honoured.
But with hospitals already overwhelmed and demand driven by structural system failures, I must wonder how the PM expects the states to achieve this.
And still the older Australians wait for care that doesn’t come and a release from being kept in an environment that is neither fit for purpose or conducive to quality of life.
It is important to clarify from the outset that the aged care sector is not being blamed. This is despite recent comments by Ageing Australia’s CEO Tom Symondson to the contrary. I have not seen any evidence of fingers being pointed at providers.
The structural pressures this sector faces, including workforce shortages, funding constraints, and regulatory demands have been thoroughly documented. The challenges we see now reflect decades of fragmentation between hospital, aged care, primary care and community systems, not failure of providers or clinicians.
One of the most frustrating aspects is the absence of a coherent national dataset on delayed discharge. There is still no publicly accessible national dataset on older people experiencing delayed discharge; instead, we are reliant on a patchwork of state and territory reporting that does not use standardised definitions or methods (here, and here).
International reviews likewise highlight wide variation in how “delayed discharge” is defined and measured, making it nearly impossible to quantify the problem with confidence.
Earlier work reinforces that, without integrated data, system-level reform is fundamentally constrained.
This data gap is not a minor technical issue; it directly shapes public understanding and policy responses. How can a system respond appropriately when the very measures it needs to make sound policy decisions are different depending on the postcode from which you are looking at the data?
The evidence we do have consistently shows that acute hospitals are not appropriate places for older adults who do not require acute care.
I have seen this firsthand working in the health, aged and social care sectors for over 30 years. Prolonged hospitalisation is associated with functional decline, deconditioning, delirium, hospital-acquired complications and increased long-term needs.
Recent analysis supports this: the UK’s Health Foundation documents rising harms associated with delayed discharge, while Ahmed et al demonstrates the consequences of delayed access to community social care for older people.
We must not overlook the social and psychological toll: prolonged hospitalisation often isolates older people from their social networks – and increasing social isolation is linked to accelerated cognitive decline, higher risk of dementia, functional loss and even mortality.
Another misconception, and a source of ongoing frustration, is the assumption that discharge delays are primarily driven by a lack of residential aged care beds.
Contemporary evidence does not support this. Recent Australian research shows that limited access to home care services, especially high-level packages, is the predominant barrier to discharge (here, and here). This further highlights that hospital congestion is strongly linked to inadequate community capacity, not bed shortages (and don’t get me started on the broken primary care system in this country).
This aligns with what many practitioners know from experience: a substantial proportion of older people assessed as medically ready to go home cannot be discharged because the necessary home care supports simply do not exist.
They do not need a residential aged care bed. They need services at home. And because these services are unavailable or insufficient, they remain in acute settings where the risks to their wellbeing are well known.
Related
Finally, research indicates what “good” looks like: early geriatric assessment, coordinated discharge planning, rapid response home care models and integrated community-based support. These solutions are not abstract; they are evidence-based and achievable.
What is missing is a national, data-informed commitment to implement them.
This rapid, imperfect review reflects the current state of the conversation: fragmented evidence, strong narratives, and older people stranded between systems. A more mature national dialogue requires grounding in the existing research rather than in political rhetoric or sectoral blame.
If you have got to the end of this document, thank you for reading. It certainly doesn’t solve any of the problems; and nor does it provide any of the solutions.
What I do know is that every time I visit a hospital, I am confronted by the numbers of older people who have recovered from their acute illness and need to get out of there for their own good.
I am not in any position of influence these days but read and watch with interest how the sector, the funders and the policymakers are not responding to what is a national shame.
Tracey Silvester is executive officer of the Australasian College of Health Service Management and a lecturer in health services management at Griffith University. She has worked in the aged care, home care and government sectors.
This article was originally published on Ms Silvester’s LinkedIn feed. Read the original here.