Nic Stuart | Who will pay for the aged-care sector into the future?

The background's simple. After excoriating evidence heard by the royal commission, Labor in opposition came up with a simple solution that sounded right. It insisted every home must have a qualified nurse on duty 24 hours a day and insisted this would happen a year before originally recommended. Perhaps it was the image of caring nurses attending to every aged-care resident that made that picture so powerful. Maybe the imaginary swish of starched white dresses appealed to older voters, while younger ones perhaps allowed the icon of baggy-blue professionals caring for their elderly relatives to stick in their mind.

The point was the then-opposition seemed to have found an answer to the catalogue of dysfunction accompanying the continuing stream of revelations from the inquiry. It told us all we needed to know. Put nurses in homes and you'll solve all the problems.

It's now become apparent the solution isn't that simple. Why don't nurses want to work in aged-care homes? The answer's simple. They're paid less to do work that's often more demanding and emotionally enervating. Unfortunately Labor didn't carve out the funding to match its trumpeted ambition.

Universal mandates sound great. They cater to our instinctive belief that fixing the aged-care system really shouldn't be that hard. This ignores the massive complexity of this multibillion-dollar industry that's being shoved in different directions by very different drivers. Any enforceable mandate was inevitably going to cause at least some short-term problems as it was bedded down. Navigating these was an issue that was going to require flexibility and re-writing the bold (and stupid, simply because it was always unenforceable) clarity of that simple election promise.

And that's where Aged Care Minister Anika Wells now finds herself. She's already conceded at least five percent of providers won't meet the government's target by the end-June deadline. Now additional spot fires are flaring up as other, not-for-profit organisations are making the sensible, focused decision - from their point of view - to pull out of the sector. Last month it was St Vincent's de Paul abandoning 100 residents in Tasmania; last week the Wesley Mission announced it was closing three centres in Sydney and slash another 200 aged-care beds from a consistently shrinking total. Then, on Friday, Perth-based provider Brightwater joined in to say it will close three centres, throwing out another 75 beds.

The important point is that all three of these organisations are non-profit charities. If these can't survive under the new rules, how will for-profit services ever be induced to pick up the slack? Is aged care in crisis? As the previous government found, issues in a sector like this are always complex and simplistic, sound-bite solutions rarely provide an answer. Equally, it's incorrect to search for a scapegoat. What we are witnessing is the slow work-through of a market-based system where not-for-profits are refusing to pick up the slack if they can't provide high-quality service.

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From one perspective, the current situation is a disaster. From another, it's exactly how the market-based system is meant to work. How you perceive the problem depends very much on how urgently you, or your parents, need aged care.

Wells herself is very aware the system was already under extreme inflationary pressures. Factor in the usual shortage of nurses and couple this with an already tight labour market and the pressure was already building. Add a dash of regulatory tightening and a splash of sharper business focus from charities, and its difficult not to have a moment of sympathy for the minister. That's not the same as excusing her.

Wells has made some unfortunate slips as she's responded to the media blowtorch. Expecting one person to manage two portfolios as diverse as Aged Care and Sport rapidly became a problem for the previous government - it shouldn't be done. The sight of previous minister Richard Colbeck sitting at the cricket while COVID was raging through nursing homes rapidly destroyed any chance Scott Morrison had of distancing himself from that particular crisis. It's bizarre that Anthony Albanese, a supposed political professional, would repeat this mistake. Memes that destroy political careers quickly surround anyone responsible for aged-care precisely because voters will not tolerate any failure to look after older people.

The political answer is simple. Initially, Wells needs to ask to be relieved from Sport so she can commit herself full-time to working through these issues. Secondly, government needs to engage in a long-term plan to inject certainty into the sector by providing a funding model that will outlast whatever particular model has suddenly become the new fetish of management gurus. And finally, as society, we need to ask is how much we really want to pay for people who need care, whether they happen to be old or disabled - because this is the real issue.

Great. Think of all the times you've read strident editorials where columnists have outlined simple three-point plans outlining a clear way forward. Now contrast that with how often anything's happened. Never, and the reason's simple. The difficulty is every solution either costs money or tramples over vested interests, with the result that answers keep getting postponed until some new minister (or government) gets stuck with attempting to patch together a solution.

At some point decisions have to be made and, when they are, someone will be hurt. At some point - and very probably in this budget - Albanese will admit the stage-three tax cuts won't go ahead. The sooner he does so the better. The second need is to accept the need for real reform of aged care and other financial suck-holes like the NDIS. This requires supporting Bill Shorten, a minister who is genuinely engaged in re-structuring the sector. The final, and most critical requirement is, however, to change the way we think about society. Money shouldn't be the driving force for allocating time, care and resources.

But, just like every idealistic three point plan, that will never happen ...