The hundreds of deaths in aged care homes during the COVID-19 pandemic have again highlighted the need for major improvements in the largely-privately operated sector. More trained staff – such as registered nurses – and higher staff-to-patient ratios will likely be necessary if we are to protect older Australians from infectious disease and guarantee them a dignified life with proper care.

The Royal Commission into Aged Care, which has played a crucial role in exposing the failings in the system, has now turned its attention to the difficult choices that lie ahead if we are to fund these costly services in the most efficient way.

It is already clear that, without reform, increasing government subsidies is a recipe for wasting money. Unscrupulous operators of private aged care homes, which account for about 90 per cent of residents, could use the cash to boost their profits – worth $1.1 billion in 2018 alone – rather than improve care. A report by consultants BDO for the commission found that the sector’s income had risen by 6.7 per cent a year on average since 2009, while their expenses rose by just 6.4 per cent.

BDO says there is a “weak relationship” between government subsidies and the quality of care. For example, aged care homes receive higher subsidies for looking after residents with more serious health conditions but the federal government has no way of checking if they use this money to offer better care for the most vulnerable.

Federal health secretary Brendan Murphy told the inquiry last week that aged care operators were legally “over-claiming” using loopholes opened up by rule changes in 2016.