National System Lens – Hospital-to-Home, Aged Care Discharge Failures, and System Gridlock

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By 2026, Australia’s hospitals and aged care systems will be operating at a critical inflection point. Rising numbers of older Australians and younger people with complex disabilities are placing unprecedented pressure on hospital capacity. Delayed discharges and “long-stay” patients who no longer require acute care are contributing to bed block, emergency department congestion, elective surgery delays, ambulance ramping, workforce burnout, and increased costs — while undermining patient dignity and wellbeing.

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In this session, delegates will:

• Understand the national scale of hospital-to-aged care challenges, including workforce, funding, regulatory, and infrastructure pressures

• Explore how long-stay patients affect hospital operations, patient flow, and emergency department performance

• Learn practical strategies from health services across Australia, including step-down and transitional care models, sub-acute rehabilitation, enhanced discharge planning, and community-based supports

• Examine governance, funding, and accountability reforms that can incentivise timely discharge and align health, aged care, and disability sectors

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This session will combine policy overview, real-world data, and case examples, enabling delegates to see both the systemic issues and actionable solutions that can be applied locally. Participants will leave with a comprehensive understanding of national challenges, tools to support operational decision-making, and insights into cross-sector collaboration to restore patient flow and maintain safe, high-quality care.

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Format: Keynote + Panel
Audience: Senior leaders, policymakers, health, aged care, disability, housing, and community stakeholders

Queensland at the Front Line – Managing Long-Stay Patients and Regional Hospital Capacity

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Queensland hospitals are experiencing sustained pressures from long-stay patients who no longer require acute care but remain in hospital due to limited aged care, disability accommodation, and community supports - particularly in regional and remote areas.

This session will provide delegates with a clear understanding of Queensland’s unique challenges and operational realities.

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Delegates will:

• Examine population growth, ageing demographics, and workforce constraints specific to Queensland

• Learn how long-stay patients impact patient flow, emergency department access, elective surgery, and ambulance off-stretcher times

• Explore practical solutions being implemented in Queensland, including sub-acute care, step-down facilities, transitional accommodation, regional rehabilitation, and hospital-to-home pathways

• Gain insight into cross-sector coordination, including partnerships between Queensland Health, aged care providers, disability services, housing, and community supports

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This session will be highly practical, providing examples of what is working in Queensland, measurable outcomes, and transferable lessons for other regions facing similar pressures.

Delegates will leave with actionable strategies to address capacity constraints and improve patient experience in a regional context.

Audience: Queensland Health leaders, hospital executives, aged care and disability providers, regional services, planners, and policymakers

Time to Think: A Western Australian Model for Compassionate Hospital-to-Aged Care Transition 

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This session will explore Western Australia’s Time to Think program, a nation-leading initiative designed to support older Western Australians who are medically ready for discharge but need additional time to make informed decisions about their long-term care and living arrangements.

The program provides dedicated short-term aged care beds across multiple providers, enabling patients to transition out of hospital with dignity while freeing up much-needed hospital capacity. Since its launch, Time to Think has already supported its first 100 patients and freed more than 1,100 hospital bed days, demonstrating measurable impact on both patient outcomes and hospital flow.

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Attendees will gain a clear understanding of how the program delivers a person-centred, compassionate approach to aged care transitions, the operational model and governance partnerships that underpin its success, and how it integrates with broader WA initiatives, including hospital-to-home pathways, community-integrated care hubs, and residential respite pilots.

The session will highlight practical lessons learned, enablers for scaling the model, and the role of targeted investment and cross-sector collaboration in reducing hospital congestion while supporting older Australians to make informed care choices.

By the end, delegates will appreciate how WA’s approach balances patient-centred care with system efficiency and provides a blueprint for sustainable, high-quality hospital-to-aged care transitions.

Victorian Case Studies – Digital and Surgical Innovations :  Optimising Hospital-Aged Care Transitions: Digital Summaries, Surgical Discharge, and Safer Medicines

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This session explores practical innovations and evidence-based strategies that improve hospital-to-aged care transitions, enhancing patient flow, safety, and outcomes.

Delegates will gain insight into how co-designed digital health summaries are transforming communication between hospitals, general practice, residential aged care, and ambulance services, enabling timely and accurate information sharing that reduces avoidable hospitalisations and supports better clinical decision-making.

The session will also examine the design, implementation, and evaluation of these digital tools, highlighting lessons learned from real-world pilots.

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In addition, the Discharge Optimisation for Planned Surgery (DOPS) program will be showcased, demonstrating how structured discharge planning, multidisciplinary collaboration, and process standardisation can optimise surgical patient flow.

Delegates will understand the measurable efficiency gains, bed day savings, and improved patient outcomes achieved through this program, and explore practical approaches for adapting the model across different hospitals and surgical specialties.

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Finally, the session will address safer medicines in transitions, focusing on the 2025 National Framework and practical strategies to reduce medication errors during transfers between hospitals, aged care, and home.

Delegates will explore inter-professional collaboration, governance frameworks, and the use of digital tools to enhance safety and continuity of care, while learning how national guidance can be applied effectively in local hospital and aged care settings.

By the end of the session, participants will have a clear understanding of integrated approaches to improve patient flow, optimise discharge processes, and strengthen safety across hospital-to-aged care pathways.
 

Prevention and Community Support – Reducing Hospital Admissions

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Preventing hospital admissions is as critical as improving discharge processes. This session focuses on upstream, preventative approaches that reduce pressure on acute care while improving outcomes for older Australians.

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Delegates will:

• Explore early intervention, chronic disease management, and dementia care programs

• Learn how multidisciplinary community-based models and integrated care planning improve health outcomes and reduce avoidable admissions

• Examine collaboration between health, aged care, social services, and community providers

• Gain practical strategies to invest in prevention, maintain independence, and enhance quality of life for older people

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This session provides delegates with practical examples and evidence-based interventions to apply in their own communities, helping shift the focus from hospital-based care to sustainable, preventative solutions.

Support at Home 2026: Building an Integrated Hospital-to-Home Ecosystem for Older Australians

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As hospitals continue to face delayed discharges and long-stay patients, the 2026 Support at Home reforms represent a transformative opportunity to improve hospital-to-home pathways for older Australians.

This session will explore how government-set price caps, eight tailored funding classifications, and strengthened consumer protections will directly influence discharge planning, care coordination, and safe transitions from hospital to home.

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Delegates will gain insight into practical strategies for aligning hospital discharge processes with the new Support at Home framework, optimising home-based support, and reducing hospital bed block.

The session will also highlight how NDIS providers, disability services, allied health, and community support organisations can actively participate in this ecosystem, offering coordinated services that complement aged care supports and enable older Australians—and younger people with disability—to live safely and independently at home.

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Through case studies and real-world examples, participants will learn how cross-sector collaboration, data sharing, and integrated care models can create a seamless hospital-to-home ecosystem, enhancing patient outcomes, maintaining dignity, and improving system efficiency.

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By attending, delegates will leave with actionable insights to streamline hospital-to-home transitions, engage multi-sector partners, and implement the 2026 Support at Home reforms effectively, ensuring a sustainable and person-centred pathway from hospital care to home or community support.

Integrated Approaches to Hospital Flow and Aged Care Transitions: From prevention to discharge

This plenary session synthesises insights from national, Queensland, WA, and Victorian streams to provide a comprehensive, integrated view of hospital-to-aged care transitions.

Delegates will:
•    Examine short- and long-term strategies to improve hospital flow and patient outcomes
•    Explore step-down and transitional care beds, home-based support, and residential care expansion
•    Discuss digital systems, funding alignment, governance, and policy reforms to support integrated pathways
•    Understand how preventative and community-based approaches complement discharge and capacity solutions
 

The panel will provide delegates with practical, multi-sector strategies and policy frameworks to restore hospital efficiency, protect patient dignity, and deliver sustainable, integrated health and aged care for Australia’s ageing population.