What does quality aged care look like?: Now it’s personal
What nursing, training, compliance and being a daughter have taught me about caring for others.
Aged care isn’t just an issue for providers, educators or regulators. It’s something that will touch most of us at some point, whether we’re caring for someone we love or eventually needing care ourselves.
We spend a lot of time talking about standards, systems and training. And rightly so. However, at the end of the day, care comes down to people looking after other people and that’s not always as straightforward.
Some personal reflections
I’ve seen care from a few different perspectives.
I started my career as a nurse in the Philippines. Later, in Australia, I moved into training and education, eventually running an RTO that trained aged care, home care and palliative care workers. These days, much of my work is in compliance, looking at whether what organisations say they do actually happens in practice.
More recently, I experienced palliative care from a very different perspective. This time, I wasn’t the nurse, trainer or compliance person. I was the daughter.
My father received care in Japan, which also gave me an opportunity to see how another country approaches care.
What this experience has given me is a deeper appreciation of something I already knew. Keeping someone clean, fed, medicated and safe is essential, but that’s not what makes a good quality of life. Those are the basics. They should be a given, not the end goal.
In nursing and aged care training, we talk a lot about dignity, autonomy and person-centred care. They’re important concepts, but they can easily become just words we learn, teach and repeat without really thinking about what they mean in everyday life.
Because what does dignity or person-centred care actually look like?
It’s not just making sure someone is fed. It’s making mealtimes something they enjoy, with food they actually like, perhaps sharing a meal and a conversation with friends rather than eating simply because it’s time to eat.
It’s not just making sure they have clean clothes. It’s letting them choose what to wear, something they feel comfortable and good in, something that still feels like them.
It’s not just keeping them safe. It’s helping them find things they enjoy doing, even if that means accepting some reasonable risks rather than leaving them safe but bored.
It’s about having choices, maintaining relationships, feeling useful, having something to look forward to and not losing your sense of who you are just because you now depend on someone else.
There’s something almost ironic about the end of life. Sometimes, when people know they’re dying, that’s when they most want to do some living. Even when life is coming to an end, there is still living to be done.
When standards meet real life
The strengthened Aged Care Quality Standards introduced in 2025 place greater emphasis on dignity, choice and person-centred care. That’s a positive step, but there’s often a gap between what a standard says and what happens in practice.
A policy can say we respect people’s choices, but what happens when someone refuses a shower and the worker is already running behind?
An auditor can check whether a care plan exists, but that doesn’t necessarily tell us how the person actually experiences their care.
In the first article in this series, I shared an experience of observing a care worker trying to assist an older person who didn’t want a shower. The worker knew how to provide care safely. The challenge was knowing how to respond when the person didn’t want it.
How do you respect someone’s right to say no while still managing their care needs? How do you recognise whether they’re frightened, embarrassed, in pain or simply don’t feel like having a shower?
These are the situations where dignity, autonomy and person-centred care stop being words in a training manual and become real skills.
And I think this is where our training needs to do better.
My dad was dying, and he wanted a say
In nursing and aged care training, we spend a lot of time teaching people how to care for someone’s physical needs. Less attention is paid to preparing them for the more difficult conversations they will encounter.
What do you say when someone asks if they’re dying? When a family member is frightened or angry? When someone wants to talk about death, but the people around them aren’t ready to hear it?
I thought about this a lot during my father’s final months.
Towards the end of his life, Dad became quite practical about dying. He wanted to choose what he would wear at his funeral. He wanted to see the clothes and make sure they fitted. He wanted to talk about arrangements and things that needed to be put in order.
Looking back, I think getting the practical things in order helped Dad become emotionally ready too. And perhaps seeing us prepared helped him find some peace. In some ways, I think that was one of the greatest gifts he gave us. He helped us prepare for life without him. He didn’t seem frightened or full of regrets. He seemed ready, and remarkably brave. And seeing him that way made us feel a little more ready, and a little braver too.
Something I noticed during that time was that he tended to have these conversations with me more than with my siblings or other family members. It wasn’t because he loved me more, or because I was more compassionate. I think it was simply because I wasn’t uncomfortable talking about death. I’d seen it before.
As a nurse, I’d cared for dying patients, witnessed grief and had conversations about death that most people thankfully don’t have to face very often. So when Dad wanted to talk about dying, I didn’t immediately tell him not to think like that, or that he needed to stay positive. I didn’t change the subject because it made me uncomfortable. We could talk about it quite openly, sometimes almost curiously.
Was there anything he was worried about? Anything he still wanted to organise? Something he wanted us to know? And I think that mattered to him. He had things on his mind, and he needed somewhere to put those thoughts.
My siblings and other family members have openly admitted that these conversations were difficult and uncomfortable for them. I completely understand that. Most people haven’t spent years around illness and death. Why would they automatically know what to say?
That experience made me think about the role of care workers differently.
Sometimes the care worker is the most experienced person in the room
We often describe care workers as entry-level workers. This undervalues the complexity of some of the situations they find themselves in.
A daughter who has never watched a parent die. A husband struggling to understand changes in his wife’s behaviour. A son feeling guilty because he can’t visit more often. Family members arguing because everyone is frightened and nobody knows what to do.
For the family, this might be the first time they’ve experienced anything like it. The care worker may have supported many people through illness, dementia, grief and end-of-life care. They may recognise what’s happening and have a better understanding of what the family is going through.
I think care workers have an important role in helping families navigate these situations. Sometimes that means explaining what they can, recognising when someone needs additional support, or helping families find the right person to talk to. Sometimes it’s helping a family understand and respect what their loved one wants, even when those wishes are difficult to hear.
Sometimes it’s simply about making an uncomfortable conversation feel a little less frightening.
We underestimate how much difference a care worker can make, not just to the person receiving care, but to the people around them. I’m not convinced we prepare them well enough for that responsibility.
So what should we be teaching?
We can teach students about empathy, dignity and person-centred care. We can give them a PowerPoint presentation, ask them to read a learner guide and answer questions about what these concepts mean.
They might get every answer right but does that mean they’ll know what to do when someone refuses care and they’re already twenty minutes behind schedule? Or when a family member becomes upset and accuses them of not caring?
I don’t think we can teach these skills through theory alone.
We need to give students opportunities to practise dealing with real situations. Let them get it wrong in a safe environment. Let them feel the awkwardness. Let them hear how their tone sounds and see how a different approach can change someone’s reaction.
If we want workers to communicate well under pressure, we need to see how they respond under pressure. If we want them to respect people’s choices, we need to see what happens when those choices make their job more difficult.
Perhaps we could also involve residents and families more directly in the process.
We’ve all heard the familiar message when calling a business: “This call may be recorded for quality and training purposes.”
It makes me wonder whether we could apply a similar idea to aged care. Not necessarily by recording care interactions, but by inviting residents and families to share their experiences, participate in discussions or help develop realistic training scenarios.
Imagine hearing directly from an older person about how it feels when decisions are constantly made for them, or from a daughter about what a care worker did that made a difficult time just a little easier.
I suspect many people would willingly participate if they understood that their experiences could help improve the care others receive. Perhaps even the care they themselves might need one day. Of course, this would need to be voluntary and respectful of people’s privacy and circumstances.
Having worked in training and compliance, I know we can have beautifully written training materials that cover every requirement on paper, but that doesn’t necessarily mean we’ve prepared someone to do the job well. Ultimately, it’s not enough for students to just know the right answers.
It still takes a village
We often say it takes a village to raise a child. I think something similar is true at the other end of life. As aged care has become more professionalised, I wonder whether we’ve started expecting care providers and care workers to replace the whole village.
There are good reasons we need professional aged care. People’s needs become more complex, families have jobs and responsibilities, some live far away, and not everyone has family or a supportive network around them.
But while we can pay someone to help with showering, meals, medication and mobility, we can’t completely outsource love, connection, companionship or someone’s sense of belonging. And we can’t expect care workers to provide all of that on their own either.
I’ve worked as a nurse. I know how emotionally and physically exhausting caring for others can be, even when you genuinely care about the people you’re looking after.
We can teach workers to be patient, compassionate and respectful, but if they’re constantly rushing from one task to another, with little time or support, how realistically can we expect them to put those skills into practice?
Care providers have a responsibility to create workplaces where good care is actually possible. But families and communities have a role to play too.
Rather than expecting care workers to become someone’s entire support system, perhaps we should be better at preparing them to help maintain and strengthen the connections that already exist, or build new ones where they’re missing.
Sometimes that means helping families understand what’s happening. Sometimes it’s encouraging them to stay involved in ways that are meaningful to the older person. And sometimes it’s simply helping people have conversations they might otherwise avoid.
Good care shouldn’t mean replacing someone’s world with a care system. It should mean helping them continue to have a world beyond it.
What I wanted for my dad
When I think about my dad and his final months, of course I wanted him to be safe, comfortable and well cared for.
Beyond that, I wanted him to still feel like himself. To have choices, to be heard, to enjoy the things he still could and to feel that his life continued to matter, even as it was coming to an end. I wanted him to feel loved, not just looked after. When I think about it, that’s probably what most of us would want for the people we love and eventually, for ourselves.
One day, if I need someone to care for me, I hope they see more than just a person who needs looking after. I hope they still see me.
This personal reflection builds on previous articles in this series looking at the importance of person centred aged care delivery and the challenges achieving this.
Author
Abigail Rotem is a guest contributing author with many years experience working in vocational education delivery and compliance. She has worked as a nurse, VET compliance auditor and CEO of an accredited aged care training organisation.
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