FTI: what’s really blocking older hospital patients from discharge

Australia’s hospital bed block crisis is not simply a failure of aged care supply, but a breakdown in how older patients move out of hospital once they are clinically ready to leave.

That is the central finding of FTI Consulting’s new ‘Unlocking Capacity’ series, which argues that delayed discharge is being driven by a complex mix of governance gaps, assessment bottlenecks, workforce shortages, housing barriers and mismatched care pathways across the health and aged care systems.

“Significant supply constraints in the aged care sector are matched by administrative and assessment barriers in hospitals, with broader demographic and workforce pressures compounding the problem,” Nathan Schlesinger, Head of FTI Consulting Health, Australia.

“It is now critical for health and aged care leaders to address the root causes of these issues to improve patient outcomes.”

The pressure is mounting. Australians aged 65 and over now account for 44% of hospitalisations and 52% of patient days and are almost three times more likely to be long-stay patients than younger cohorts. Many no longer need acute care but cannot be discharged safely.

The factors holding back patient discharge

FTI identifies several factors repeatedly holding back the flow of patients.

The first, put simply, is sheer demographics. AIHW data shows hospital bed days increase markedly in older cohorts, with Australians aged 75-84 and 85-plus accounting for the largest and fastest-growing share of hospital bed days between 2019-20 and 2023-24 (see main chart).

FTI also points to dementia as a leading driver of prolonged stays. Hospitalisations due to dementia have climbed steadily over the past decade, rising to more than 35,000 cases a year by 2023-24.

Residential aged care supply also remains tight. Capacity has grown just 3% since 2020, while the population aged 85-plus – the group most likely to need it – has grown by more than 12%.

National occupancy sits around 94%, with workforce shortages restricting the number of operational beds. Patients approved for residential aged care spend an average of 13 extra days in hospital waiting for placement.

Home care is not absorbing the pressure either. Median waits for a Home Care Package stretch to 249 to 267 days, while more than 833,000 older Australians are now supported under the Commonwealth Home Support Programme – many effectively treading water while they wait for higher-level care.

Older people funnelled towards residential aged care

Assessment and approval processes also slow discharge. The report finds duplicated assessments, rigid eligibility rules and unclear responsibilities between hospital and community services mean patients who could be supported through reablement, transition care or home modifications are often funnelled toward residential aged care instead.

Housing and social barriers drag the numbers down further, with a growing number of older Australians unable to return home due to unsuitable housing, lack of modifications or limited informal support.

Navigation programs such as Care Finders also remain underused by hospitals, leaving families to manage care pathways alone.

“Hospitals cannot solve this alone”

Nicki Doyle, FTI’s Senior Managing Director and Aged Care Sector Lead, told The Weekly SOURCE that the message is nuance, not blame.

“Hospitals cannot solve this alone; the greatest potential improvement lies in strengthening the interface between the two sectors,” she stated.

Part three of the series, due in early 2026, will examine solutions. But the warning is clear: hospitals are not inefficient – they are blocked.

You can download the first two reports here.