Experts have raised concerns about a gradual shift in ownership and management models in Australia's aged care facilities - and the subsequent impact this has on the quality of care and resident health outcomes.
A new study published by the flagship British Medical Journal BMJOpen shows that a gradual decline in the number of government-owned and not-for-profit nursing homes in Australia, in favour of for-profit companies, could see higher rates of hospitalisation among older Australians.
The assessment is based on emergency department admissions and unplanned hospital admissions among more than 200,000 long-term care facility residents in the Registry of Senior Australians national cohort (2013-18).
Of the 205,079 residents studied, 8,961 (4.4%) lived in government-owned facilities, 105,144 (51.3%) in not-for-profit homes, and 90,974 (44.4%) in for-profit homes.
Flinders University lead author Dr Miia Rahja says the study compared different nursing home ownership models while also examining the important influence that geographic location may have on resident outcomes.
The study found government-owned aged care home residents had fewer hospital-related events, with the differences most evident in Australia's inner-regional areas.
Residents in government-owned homes had a lower emergency department presentation risk than residents in not-for-profit homes. Similar observations were made for unplanned hospitalisations and days spent in hospital, and across various regions.
The findings come at a time when ownership patterns in Australia's aged care home sector are changing. Several large providers have acquired aged care homes that were previously operated by not-for-profit organisations, reducing the number of providers from 663 in 2023, to 642 in 2024.
Senior author Professor Maria Inacio, who heads the Registry of Senior Australians Research Centre (ROSA) and the
Flinders Ageing Alliance at Flinders University, says ongoing monitoring of aged care home ownership is vital, because this has significant potential impact and consequences on residents' outcomes.
"Findings from this study agree with the Royal Commission into Aged Care Quality and Safety investigations about the influence of aged care homes ownership on the quality and outcomes of individuals in these facilities," says Professor Inacio.
Prior research also shows that for-profit providers are less likely to be compliant with sector requirements, such as mandatory care minutes.
"Our work confirms the need for financial, quality, and social accountability monitoring of aged care home integration given their significant influence on resident outcomes," Dr Rahja says.
The paper - 'The association of long-term care facility ownership and location on residents' mortality and hospitalisations: A population-based retrospective cohort study in Australia' (2026), by Miia Rahja, Ling Davies, Robert Jorissen, Maria Crotty, Craig Whitehead, Keith Evans, Megan Corlis, Carly Meyer, Gillian Caughey and Maria Inacio - will be published in BMJOpen on 21 September 2026. DOI: 10.1136/bmjopen-2026-11791.
Acknowledgements: This work was funded by the Australian Government Medical Research Future Fund (PHRDI000009 and NCRI000109) and Australian Government, National Health and Medical Research Council (GNT119378).
