Healthcare leaders who treat aged-care delays as someone else’s problem will watch their hospitals continue to buckle under preventable strain.
Australian public hospitals are in the thick of a challenge that is both highly visible and deeply structural: older patients who no longer need acute care are stuck in hospital beds because aged-care supports and placements are not available.
This problem is commonly categorised under the broad umbrella of “bed-block.” Yet this phrase masks the actual complexity of what’s really happening. What we’re talking about is not just about blocked beds.
This is about the friction at the fault line between two systems that were originally designed to operate separately, but whose failures are now intersecting at the hospital bedside.
For healthcare leaders, this is not just an operational frustration, but a more strategic issue with implications for safety, system resilience, and financial sustainability of an industry.
Why this matters right now
The raw figures being painted across the country are striking — hundreds of patients a day in some states alone, and almost 2500 Australians nationwide who are currently waiting for aged-care services.
But the significance of these numbers is in what they reveal about how the various systems within our healthcare sector interact, and what that means for leaders who are responsible for keeping hospitals functioning.
Hospitals are absorbing the costs of aged-care delays:When acute hospital beds are filled with patients waiting for aged-care placement, the financial burden and workforce strain fall squarely on hospitals.
These beds are among the most expensive pieces of real estate in the health system. From a leadership perspective, this means hospitals are carrying costs for inefficiencies they do not directly control.
Recognising this dynamic shifts the conversation. So instead of treating delayed discharge as a “downstream” issue, leaders must frame it as a cross-sector accountability challenge.
Patients experience silent harm:Every additional day in hospital exposes older people to more and more risks — deconditioning, delirium, infection, and loss of independence.
From a governance point of view, this is a quality and safety issue, not just a flow issue. Healthcare leaders should be prepared to explain to their boards and communities that keeping patients in acute beds when they no longer need acute care is, in itself, unsafe care.
Policy reforms may be too slow to relieve the current pressure:While the Aged Care Act 2024 and the Support at Home reforms promise structural change, their impact will take years to materialise.
Hospitals cannot continue to wait for perfect policy solutions. And this in itself is what creates the leadership tension we see playing out across many health serices.
How do we effectively manage the present crisis with agility while preparing for a different aged-care environment ahead?
The leadership lens
Understanding this issue through a leadership lens requires a reframing of roles and responsibilities.
From discharge planning to system partnership: In the past, and in most cases to this very day, hospitals tend to treat discharge as the end of their responsibility.
But perhaps now, health leaders must change their vantage point, move upstream and see themselves as co-designers of a multi-pronged solution – approach the solutions from a network perspective inclusive of aged-care providers, primary health networks, and community organisations.
Leadership is no longer about handing over the patient, but about ensuring that the transition point is safe and appropriate as well as timely and dignified.
From throughput management to stewardship: Traditionally, hospital leadership responsibilities are designed to focus on bed flow and efficiency within the four walls of the institution.
The challenge we face now though is broader than that, it is now more a case of stewardship of scarce health resources across system and sector boundaries.
This means taking ownership of problems that do not belong neatly within the boundary of the hospital, because the consequences will land squarely back on the hospital regardless.
Stewardship requires using influence, data, political capital, and most importantly the will to align incentives across sectors.
From crisis response to system shaping reform: It is easy to treat delayed discharges as operational crises to be solved with the declaring of institutional code yellows and single patients at a time.
But healthcare leaders should now take the opportunity to elevate this tired old conversation, at a time when the visibility of this problem seems to be at a maximum, and to advocate for systemic fixes like faster assessments, expanded home-care packages, and integrated funding models.
System shaping reform requires healthcare leaders and health executives to hold a longer term view, even while putting out the daily fires.
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What healthcare leaders can do differently
Make the problem visible and unavoidable: Delayed discharges are often hidden in operational statistics.
By making this data public, for example using the standalone metric of “patients medically ready for discharge but awaiting aged care” create focus and urgency. Transparency reframes the issue from an internal efficiency challenge to a public accountability issue.
Health leaders who are transparent about these numbers weekly, can start to shift the conversation from anecdote to evidence.
Invest in interim solutions, even if they’re imperfect: Hospitals and patients cannot afford to wait for grandstand national reforms to flow through.
Step-down beds, transitional care units, and short-term community supports are not ideal, but they buy back capacity and protect patients from prolonged stays.
Leaders need to overcome the “it’s not our remit” mindset and be willing to fund or broker interim solutions. The return on investment, in both patient outcomes and bed capacity, will surely be significant.
Reframe the advocacy narrative: When hospitals lobby governments, they often talk about emergency department queues and elective surgery backlogs.
But the stronger narrative is perhaps to link aged-care delays to two outcomes politicians care deeply about: patient safety and productivity.
This issue is about frail older Australians deteriorating in hospital corridors and millions of dollars of taxpayer funding being wasted on the wrong kind of care. Leaders who connect these dots stand better positioned to build a stronger case for reform.
Champion practical integration: Grand integration reforms, while commendable, can take years to come to fruition.
But at the local level, nothing stops hospital leaders from brokering small but powerful agreements in the meantime – aged-care assessments that get triggered automatically when a patient is declared “medically ready for discharge”, guaranteed response times for ACAT assessments, or priority access agreements with local aged care providers.
These micro-integrations may not make headlines, but they would demonstrate that effective leadership is about solving the problem at the patient level, not just the policy level.
The bigger picture
The bottleneck between aged care and hospitals is more than a symptom of underfunding or poor planning. It is a stress test of how well our systems work together. And right now, the test is revealing nothing but fragility.
Healthcare leaders cannot simply wish this away, nor can they wait passively for policy reforms to catch up. The responsibility of leadership is to step into these spaces where systems collide and patients suffer.
That means expanding the boundaries of what hospital leadership traditionally covers, and embracing stewardship of the whole patient journey.
If we take this somewhat different approach to what is just another difficult year in health, it could well lead to a significant turning point.
Healthcare leaders who treat aged-care delays as someone else’s problem will watch their hospitals continue to buckle under preventable strain. Leaders who step up, by reframing, partnering, investing, and advocating, will not only ease today’s crisis, but also shape a more integrated and humane healthcare system for tomorrow.
And at the core of that type of leadership, is governance: the ability to make sound, accountable decisions across complex systems.
For health leaders and board directors who want to strengthen this capability, the AICD – AIHE Foundations of Directorship Health Variant program provides a practical grounding in governance — a skillset that is critical for navigating challenges like the aged-care backlog and ensuring your organisation leads, rather than lags, in the face of system stress. Register for the inaugural intake in October.
Dr Sidney Chandrasiri is the CEO of the Australian Institute of Health Executives.
This article was first published by the AIHE. Read the original here.