Why Are Young Australians with Disability Still Living in Nursing Homes?

In 2024, Australia still faces a quiet crisis. Young people with disability some in their 20s and 30s are living in aged care facilities built for end-of-life support, not for pursuing study, work, friendship, and independence. Despite years of reform, the question remains: why is this still happening?

A Promise Broken: The Numbers Behind the Story

The government’s Younger People in Residential Aged Care (YPIRAC) Strategy 2020–2025 committed to ending placements of people under 65 in aged care by 2025, except in truly exceptional circumstances. Yet as of 30 September 2024, 1,161 people under 65 were still living in aged care. That’s a steep drop from earlier years advocates once counted many thousands but it’s far from the promised zero. Disability leaders call it a “national shame” because every remaining case represents a life on hold.
Behind these numbers are everyday stories: a hospital discharge with nowhere accessible to go; a participant approved for housing funding that hasn’t landed; a young person “temporarily” placed in a nursing home who stays there for years.

How Did We Get Here?

This problem sits at the crossroads of health, housing, and disability support. Hospitals discharge because beds are needed. Community housing can’t offer accessible options fast enough. NDIS approvals can lag behind real-world timelines. Too often, aged care becomes the “only door that’s open” not because it’s right, but because it’s available.

The NDIS: Lifeline and Labyrinth

The NDIS created new pathways Specialist Disability Accommodation (SDA) for the “bricks and mortar,” Supported Independent Living (SIL) for the support team, and Individualised Living Options (ILO) for flexible living arrangements. When these align, lives change: modern homes with assistive tech, wide corridors, emergency back-ups, and staff supports tuned to the person.
But misalignment is common. Some people are approved for SDA but not the SIL they need to actually live there an administrative catch-22. Others wait months for evidence gathering and decisions. Providers face their own hurdles: complex registration, design categories, and uncertain demand forecasts that make investment risky.

The Supply Gap

Even with funding, supply is thin. High Physical Support and Robust SDA homes are unevenly distributed, concentrated in metro areas and scarce in regional towns. Families are forced to choose between a distant suitable home or local aged care that isn’t suitable at all.

The Human Cost of Institutionalisation

A nursing home shapes identity as much as it provides a bed. Imagine being 30 and surrounded mostly by people in their 80s and 90s. Activities, routines, even the pace of care aren’t designed for rehabilitation, friendship, or career goals. Research and lived experience point to loneliness, depression, and loss of independence not because staff don’t care, but because the model isn’t built for young lives to grow.

Policy Tension: The New Aged Care Act Loophole

The new Aged Care Act is intended to limit access to government-funded aged care for people under 65. That’s good in principle close the “easy door” that keeps drawing young people into aged care. But there’s a loophole: it permits entry for Aboriginal and Torres Strait Islander people aged 50+ and for people 50+ who are homeless or at risk. These provisions reflect real needs but advocates warn they may undermine decades of bipartisan work by normalising younger placements again. If the system doesn’t simultaneously guarantee accessible housing and disability supports, a “limited access” rule risks becoming an old pathway with new signage.

Beyond Bricks: What ‘Home’ Must Mean

Ending younger people in aged care is more than building units; it’s about designing home:

• Universal Design in mainstream housing so basic accessibility is a default, not a luxury.
• Smooth transitions from hospital to home with proactive coordination between hospitals, NDIS planners, and housing providers.
• Local choice so people aren’t pushed far from community, culture, Country, or family just to get a ramp and a roll-in shower.

What’s Working and Needs Scaling

Partnerships between SDA developers, community housing providers, and quality support organisations are delivering high-support, tech-enabled homes where people regain control: cooking in accessible kitchens, hosting family, setting their own routines. These are proof-of-possibility projects. To move from pilots to normal practice, we need faster decisions, predictable rules, and targeted incentives to build in regions where the gap is widest.

The Road Ahead

Targets matter but delivery matters more. Hitting “zero” won’t happen by declaration. It takes:

• Time-bound NDIS decisions for SDA/SIL with coordinated hospital discharge plans.
• Supply targets tied to real demand data, including regional minimums.
• Guardrails in the Aged Care Act so exemptions don’t quietly re-open institutional pathways.
• Lived-experience leadership fund, listen to, and co-design with people who have been in aged care.
  Conclusion
  Young Australians with disability deserve more than a bed; they deserve a home and a life. We’ve reduced the numbers, but until no one is left in aged care because the system failed them, our work isn’t done.
  Call to Action:
  Back organisations pushing for SDA reform and regional builds. If you work in health or the NDIS, push for discharge-to-home pathways. If you’re in government or housing, fund universal design at scale. Share this post—and help close the last mile between a target and a life lived at home.