Our Position – A more connected, efficient approach to address workforce shortages in the care economy

Hospital exit block, where people who no longer require acute care are unable to leave hospital due to a lack of suitable downstream supports, has become a system-wide threat to hospital capacity, quality and safety. It is a symptom of a care economy under strain: hospitals, aged care, disability supports and housing function as interdependent systems, yet are funded, governed and held accountable in isolation. Each day, thousands of acute beds are occupied by people who are medically ready for discharge but waiting on residential aged care placements or home care packages, NDIS-funded housing and supports, transitional or step-down accommodation, or community and social supports adequate for safe discharge. The consequences ripple across the system: reducing inpatient capacity, driving emergency department overcrowding and ambulance ramping, and delaying elective and emergency surgery, while exposing people to avoidable functional decline, hospital-acquired complications and poorer quality of life, and displacing them from the care setting best suited to their needs and preferences.

This paper argues that reform must be system-wide rather than hospital-bound, and sets out a national reform package to address exit block at its source. CHA urges the Australian Government to embed dedicated, cross-system discharge and transition coordination roles across hospitals, aged care, the NDIS and housing; invest in time-limited, clinically appropriate transition accommodation and step-down care; align incentives and accountability by embedding hospital transition measures into the next National Health Reform Agreement under shared Commonwealth–state responsibility; improve data, transparency and system interoperability to make exit block visible; and scale upstream and downstream solutions, including integrated Support at Home, Hospital-in-the-Home and Residential In-Reach models. By connecting reform across the care economy, Australia can create the downstream capacity needed for safe, timely discharge, uphold person-centred care, and prevent avoidable hospital admissions in the first place.