From Patient To Consumer To Citizen:
The Real Future Of Aged Care

The underlying message of the RACC is one of citizenship, not customer service


The Royal Aged Care Commission Report is a BIG body of work, with over 100 pages of recommendations related to the creation of a new Aged Care Act, implementation of new governing bodies, and creation of new structures and programs of support. 

However, the underlying message is, on the surface, relatively simple. Most of these recommendations are centered around core themes of dignity, autonomy, individuality, and respect.  

For example, the new proposed act (Recommendation 1) redefines aged care as “support for people to maintain their independence” as they age, and (amongst other things) enabling older people to live an “active, self-determined and meaningful life.”

We believe the recommendations in this report go beyond what we currently term “Consumer Directed Care” and to be feasibly achieved, we need to change the way we look at people in care. 

You see, we think the RACC report is an example of a much wider shift in society, and the aged care industry. Autonomy, purpose, and respect cannot be fully realized through moving the industry to consumer-first aged care, but rather must end with a model of citizen-first aged care. 

Autonomy, purpose, and respect cannot be fully realized through moving the industry to consumer-first aged care, but rather must end with a model of citizen-first aged care. 

The true future of the aged care industry


The true future of the aged care industry lies in the formation of functioning communities of elderly, carers, staff, and family members, where the person receiving care is an active citizen in their community.

Rather than viewing their participation as transactional, we believe the industry will eventually shift towards viewing their participation as an equal part of a larger group of governance, in which each retirement village or aged care facility becomes, in a way, it’s own democracy. 

/dɪˈmɒkrəsi/Learn to pronounce
control of an organization or group by the majority of its members

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What’s the difference?

This distinction is important, as it lends a new meaning to active, meaningful participation beyond what treating the elderly as ‘customers’ can provide. It involves a fundamental shift towards empowering the person in care to be an active voice in the governance and management of their community as a whole.

A great body of work on this concept, (and a large influence on this article) is the book by Jill Vitale-Aussem, titled “Disrupting the Status Quo of Senior Living: A Mindshift.” In it, she says:

Much like any consumer-focused business, we market and sell services to our customers without any expectation of reciprocity. I’ve come to believe that under this model, residents become consumers and recipients of the services we provide, rather than seeing themselves as citizens of a community.

The benefits of citizenship rather than consumership is two-fold. Enabling a more meaningful level of autonomy and self-directed purpose for people in care also shifts the weight of responsibility to become more distributed between staff, residents, and families. By enabling more active participation and autonomy between all members of the community, we can more feasibly achieve meaningful levels of social inclusion, choice, and control.

What impact would this have on organizations in aged care?

For organizations, it presents a more sustainable way of enabling better choices and quality of life. By enabling equal participation of all members of the community in the shaping and forming of methods of care, social inclusion, spiritual well being etc., organisations can move from trying to meet everyone’s needs and provide all the elements of a healthy lifestyle to their residents, to enabling the residents to design and be a part of shaping these programs themselves.

a more sustainable way of enabling better choices and quality of life

Citizenship and social inclusion rest on enablement and autonomy, rather than top-down, service-based models of participation that rest on the responsibility and resources of the organisations, and therefore are likely to be more sustainable than trying to service residents as transactional ‘consumers.’


What a consumer directed model somewhat fails to acknowledge is that autonomy and self-directed purpose go beyond the ability to choose a service, they involve defining and helping to shape the nature of those services themselves and it is this level of autonomy and responsibility that gives the highest feeling of purpose and inclusion to those in care.

By shifting the lens to enablement rather than needing to provide a customer with a service, organizations can achieve a much more sustainable model of care and support whilst also giving more meaningful choice and control to the people receiving care.

What do you think of aged care becoming a democracy rather than a service provider? Let me know your thoughts in the comments. 

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