Bed block: the billion-dollar problem we can’t keep ignoring

The New South Wales Government’s inquiry into stranded aged care patients in public hospitals is welcome, and overdue. But the issue it is examining is not a NSW problem. We are seeing the compounded impacts of piecemeal system architecture colliding in real time, and this is not something that can be solved one state at a time.

Across Australia in 2023–24, an estimated 460,000 hospital bed days were used by patients medically ready to leave hospital but waiting for a residential aged care place. That single cohort is costing taxpayers between $828 million and $1.61 billion a year. Between 8 and 10 per cent of public hospital bed days nationally are now occupied by patients who should be somewhere else.

In Queensland, patients awaiting discharge have more than doubled in three years, from 512 in 2022 to 1,096 in early 2025. More than 1,000 NDIS-eligible patients nationally remain in hospital despite being medically ready to leave.

These are not just numbers. They tend to be older Australians, or those living with a disability, who are spending weeks or months in acute wards because the system cannot move them on. A bed in an acute ward is not a home. Patients in this position deteriorate, lose independence, and can lose the chance to ever return home. The hospital system pays a price too: these patients require around 308 minutes of registered nursing time daily, compared to roughly 44 minutes in residential aged care. Every one of those bed days is a bed unavailable to a patient in the emergency department or on a surgery waiting list.

So why is it getting worse? Several drivers are at play – insufficient residential aged care capacity, constrained access to home care packages, and growing delays in NDIS-funded housing. Assessment processes have slowed: the median time to receive an aged care assessment rose from 22 to 27 days in 2024–25, and the median wait between approval and service commencement blew out from 118 to 245 days in the same year. Step-down options exist but are too often funded as short-term pilots rather than core system architecture.

But the most powerful driver is structural, and it is the one explaining why every well-meaning reform of the past decade has failed to shift the dial. Public hospitals are funded and operated by the states and territories. Aged care and the NDIS are Commonwealth responsibilities. The patient sits squarely in the gap. No single level of government is held to account for what happens to them, because no single level of government is responsible for the whole patient journey. The result is blurred accountability at the point of discharge, and a patient who becomes one more number in a queue that keeps growing.

Short-term measures will matter. Faster assessments and better reach from aged care providers and the NDIA into hospitals can help unblock beds in the months ahead, and we should pursue them. But this debate has lived in the short-term for the better part of a decade, and the data is unambiguous: it is not working. We cannot keep treating a structural problem with operational band-aids.

The next National Health Reform Agreement is the right place, and the right moment, to fix this. Embedding specific hospital transition measures into the next NHRA would do three things at once. It would articulate shared Commonwealth and state accountability for patients moving between hospital, aged care, disability and community settings. It would establish nationally consistent indicators, so that progress, or the lack of it, is visible. And it would shift the conversation from inputs and activity to outcomes: did the patient get to the right setting, in a reasonable time, with the right supports?

Catholic Health Australia has long argued for this kind of cross-system accountability, and we are bringing the sector together to work on it. Later this year, we will convene a Parliamentary Roundtable in Canberra to workshop these issues directly with policymakers, providers, clinicians and consumer advocates – because solutions of this scale need to be built collaboratively, not imposed.

What is new is the cost of continuing to do nothing. At more than a billion dollars a year for the aged-care cohort alone, the status quo is fiscally indefensible. It is also morally indefensible. Older Australians deserve better than a bed in an acute ward while the system argues over who pays. People with disability deserve the same. And the patients on the other side of the bed-block – in ambulances, on trolleys, on waiting lists – deserve better too.