Australia’s care sector is entering a defining period. Margins are tightening, regulatory expectations are increasing, audit scrutiny is intensifying, and workforce pressure continues to rise. Against this backdrop, senior leaders are being asked to do more than simply comply — they are being asked to build care‑first organisations that are financially resilient, operationally disciplined, and workforce‑sustainable.

At our recent Building Sustainable Care Businesses in 2026 boardroom roundtable, ShiftCare and RSM Australia brought together senior care leaders for a candid, peer‑level discussion on what sustainable care leadership truly looks like today. 

Moderated by Laurel Millar (National Manager, Digital Advisory, RSM Australia) and featuring insights from Matthew Cagney (CEO, ShiftCare), Patrick Flanagan (Partner, Business Advisory, RSM Australia) and Ash Howden (CEO, Your Home Care), the conversation focused on translating industry complexity into practical, executive‑level clarity.

What emerged were seven clear insights shaping how leading providers are thinking about care, cost and compliance in 2026.

Seven insights shaping sustainable care leadership

1. Documentation quality is a revenue lever

Across large providers, an estimated 3–8% of potential NDIS revenue is lost through conservative claiming, rework, or rejected claims driven by weak or inconsistent documentation. High‑performing organisations are reframing documentation as core infrastructure — not administration — recognising that if services are delivered but not defensibly recorded, revenue becomes optional.

2. Margin leakage is small, daily — and expensive

With labour accounting for 70–80% of total costs, margin erosion rarely comes from strategic missteps. Instead, it compounds quietly through roster variances, overtime, clock‑out inconsistencies and SCHADS interpretation gaps. These small, distributed inefficiencies accumulate into material financial impact over time.

3. Compliance risk is operational, not episodic

Audit failures are rarely the result of a single incident. They emerge from cumulative misalignment between rosters, care notes, incidents, service agreements and claims. Providers unable to produce participant‑level evidence on demand carry heightened regulatory and reputational risk.

4. Workforce systems are now retention systems

Payroll confidence, clear rules and reduced administrative friction are among the strongest predictors of workforce retention. With replacement costs for skilled support workers estimated at $8,000–$12,000 per role, operational friction increasingly manifests as attrition rather than complaints.

5. Technology complexity has a direct cost

Providers operating fragmented systems across rostering, care, payroll and billing typically carry 10–15% higher indirect cost per participant. Integration is no longer an IT preference — it is a cost‑to‑serve decision with direct financial consequences.

6. Growth without cost visibility destroys value

More providers are exiting services that appear profitable at headline rates but fail once travel, supervision, compliance and workforce strain are fully costed. As a result, discipline is increasingly replacing scale as the defining executive capability.

7. The best providers are reframing leadership itself

High‑performing organisations are moving away from retrospective reporting toward near‑real‑time visibility across care delivery, cost and compliance. Data is no longer treated as an after‑the‑fact explanation, but as decision‑making infrastructure.

Turning complexity into clarity

The roundtable reinforced a shared belief among participants: sustainable care delivery requires stronger operational foundations, clearer visibility, and leadership models that protect both participants and the workforce. Technology, financial discipline and compliance are no longer separate conversations - they are inseparable components of care quality.

ShiftCare and RSM Australia are committed to continuing these conversations and supporting care leaders as they navigate the realities of 2026 with confidence.

To discover more about the services RSM Australia offers in the care space, visit our NDIS homepage.