Promoting Choice in Residential Aged Care

It is a common misconception that older people lack the ability to make their own decisions and participate in their own care planning. Unfortunately, for individuals living in aged care facilities, this misconception can often mean feeling isolated, vulnerable and stripped of control and freedom (Seniors Rights Vic 2024).

Factors such as set meal times, food choices, waking times and fixed daily routines can take away a resident's sense of independence. People who once managed their own schedules and diet become reliant on providers who assume control of those decisions (Wheeler, Abbey & Capra 2025).

Following the establishment of the Royal Commission into Aged Care Quality and Safety in 2018, the Australian Government was provided with 148 recommendations to reform the sector, focused on ensuring older Australians have:

• Greater choice and independence
• Access to services that respect and meet their needs
• Support to stay independent as they age.

(DoHDA 2025a)

Over a period of nearly two and a half years, the Royal Commission conducted 23 public hearings that heard testimony from 641 witnesses, and gathered more than 10,500 submissions from the public (Storen 2021).

Loss of Autonomy in Aged Care: Findings from the Royal Commission

During the 2018 Royal Commission, over 10,000 public submissions were received from a range of contributors, including aged care residents, their families, carers, health professionals and service providers. These spanned a broad range of concerns centred on residents' loss of autonomy over everyday aspects of life, including what they ate, when they slept and how and when personal care was provided (Smyth et al. 2025).

A recurring concern across submissions and hearings was that daily care activities were scheduled around staff resources and rosters rather than resident preferences.

Excerpts taken from the Royal Commission:

"These staff were expected to wake residents at 0500 to commence the personal hygiene tasks. If they didn't do this, the morning PCAs would be openly angry because they didn't have time and weren't able to help all the residents with their personal hygiene according to their needs. Both morning and afternoon staff were rushed and, therefore, the residents were rushed.” (Australian Nursing and Midwifery report, hearing transcript)

"All residents were put into bed in the evening by 7pm, without any choice or decision in relation to what they wanted." (Aged care worker, submission)

(Smyth et al. 2025)

These findings highlight that for many residents, institutional routines have replaced personal choice.

The Legislative Push for Change

After reviewing these submissions, the Commission concluded that the existing Act (Aged Care Act 1997) - and surrounding legislation were designed for the needs of providers, and lacked consideration and focus for the people accessing the services (DoHDA 2025c).

In response, the Australian Government reformed aged care legislation to adopt a rights-based approach. Central to this reform was the introduction of the Aged Care Act 2024, which came into effect on 1 November 2025.

For more information, see Ausmed’s Article on ”Understanding the New Aged Care Act"

A key feature of the new Act is the Statement of Rights, which upholds older people's entitlement to:

• Independence, autonomy, empowerment and freedom of choice
• Equitable access
• Quality and safe funded aged care services
• Respect for privacy and information
• Person-centred communication and the ability to raise issues without reprisal
• Advocates, significant persons and social connections.

(DoHDA 2025c)

A key focus of the new Act is the recognition that older people have the right to make their own decisions. Where extra support is needed, individuals can appoint a ‘registered supporter’ to help guide their decision-making, enabling them to stay in control of their own lives and care (DoHDA 2025b).

The Australian Government also acted on the Commission's recommendation to review the Aged Care Quality Standards. The result was the Strengthened Aged Care Quality Standards", released in August 2025.

The standards include:

• Standard 1: The individual
• Standard 2: The organisation
• Standard 3: The care and services
• Standard 4: The environment
• Standard 5: Clinical care
• Standard 6: Food and nutrition
• Standard 7: The residential community

(DoHDA 2025d)

For more information, see Ausmed’s Training Module on Strengthen Aged Care Quality Standards

From Policy to Practice

With these legislative reforms in mind, it is important to consider how these rights can be upheld in everyday practice and empower older people to voice their own preferences.

Practical examples that can be used include:

• Offering a range of activities and respecting each person's chosen level of involvement
• Participation should never be assumed or expected
• Supporting the individual to choose their own clothing each day, wherever possible
• Exploring personal preferences around daily routines, including preferred times for bathing or showering
• Encouraging individuals to personalise their own room/space in a way that feels meaningful to them
• Getting to know the person, including their history, interests, and what they enjoy or find difficult
• Sharing a person’s preferences during handover to ensure consistent care across the team.

(Moilanen, Suhohen & Kangasniemi 2021b; Moilanen el a. 2021a; Baxter et al. 2024)

Conclusion

It is important to acknowledge that care workers are frequently challenged to balance an individual’s wishes with their duty of care to protect them from harm. There is a need to balance autonomy and risk, while ensuring the dignity of the person is always maintained (Moilanen, Suhonen & Kangasniemi 2021b).

By taking the time to understand each resident’s routines, preferences, history and goals, aged care workers can help ensure that care is not only safe, but genuinely person-centred. In doing so, providers can support the intent of recent aged care reforms: to create environments where older people are respected as individuals and empowered to maintain control, independence and meaningful choice in their everyday lives.

For more information, see Ausmed’s Training Module on Dignity of Risk & Decision-Making in Aged Care