Initiatives and frameworks for inclusion in care systems and services aim to promote equitable access for people in marginalised, disadvantaged and underserved communities. However, these frameworks do not always work as intended to ensure inclusion. Some of the reasons for this include structural and systemic challenges that limit the scope of inclusive practice. 

This paper explores several challenges to achieving greater inclusion in Australian aged care, including systemic barriers stemming from a market-based model that limits equitable access and the difficulty for individuals to navigate the complex system.

A fundamental shift is needed to appropriately and adequately address the diverse needs and experiences of older Australians. This requires tackling systemic issues of rationing and access, integrating fragmented services, actively combating ageism and ableism, and embracing the complexity of individual identities through personalised and flexible care. 

Key barriers

1. Rationing and (in)equity of access. The continuation of a rationed, market-based system, rather than a service to meet the rights and needs of individuals, perpetuates inequity of access.
2. Policy silo-ing and segmentation of the life course (and the community). Different government departments and services, such as health, housing, social services and aged care, are not well integrated.
3. Ageism and ableism. Both ageism and ableism in aged care represent significant barriers to inclusive practice.
4. Lack of personalisation and embracing complexity.