Dr Nicole Sutton

University of Technology Sydney

The Corporatisation of Australian Residential Aged Care

Thursday 13 October 2022

7:30am – 9:00am

Speaker Bio

Dr Nicole Sutton is a Senior Lecturer in management accounting in the Business School at the University of Technology Sydney and member of the UTS Ageing Research Collaborative. Her research examines the design and use of management accounting and control systems to support decision making within and across organisations. She completed her PhD in 2015, studying the management control of inter-organisational R&D projects in the Australian cotton industry. She has since supervised several doctoral projects, including an investigation of the cognitive effects of performance measurement systems on aged care managers, and the effective outsourcing of human services by government. In 2019, she joined the Management Committee of Palliative Care NSW as Treasurer. She is currently part of a project team that is examining data generated by the Royal Commission into Aged Care Quality and Safety to understand the implications for the future development and sustainability of the aged care sector.


The Royal Commission into Aged Care Quality and Safety highlighted two concerning trends in the ownership structures of Australian residential aged care homes. The first is a shift in market share from non-profit and government providers to the private sector. The second is an increasing level of provider concentration, with the ten largest providers responsible for 39% of all residential care places in the industry. Further consolidation of the sector is expected as incoming sector reforms and the impact of COVID-19 place increasing financial pressure on providers and potentially lead to further acquisitions of smaller, independent homes by large for-profit providers.

These trends raise concerns about the impact of corporatisation on quality of care. Prior studies have found that for-profit ownership of homes is associated with poorer quality outcomes. However, evidence regarding other features of corporate structure, such as the number and location of homes owned by a for-profit provider, is more limited. On the one hand, a home operated by a larger entity may benefit from greater oversight, managerial experience and governance, which allow for improved accountability and standardisation of care services. Yet on the other, larger homes tend to operate with greater distance between managers and operations, and can impose additional administrative requirements and cost consciousness that may constrain the delivery of quality care.

We address this research gap by investigating whether homes operated by providers of varying ownership structures and scale deliver different levels of quality care. To answer this question, we analyse an archival dataset of operational and quality of care outcomes for a large sample of Australian aged care homes. Given the trend towards further concentration and private sector involvement in health and aged care markets, both in Australia and internationally, evidence from this study will contribute to explanations of how corporate structures can be expected to influence quality of care.

A study of the effects of corporate ownership structure and scale on quality of care in residential aged care homes.