Australia built a visa pathway for aged care workers and most of them were already here

Sonal Sapkota trained as an intensive care nurse in Nepal and arrived in Australia in 2018 to study a master’s degree, working through visa restrictions and bridging programmes to register as a nurse here. She moved into residential aged care in 2020. On one night shift, close to 10.40pm, a resident who had herself been a nurse demanded a vitamin K injection the facility did not stock.

When Sapkota explained that, the resident threatened to report her to the Australian Health Practitioner Regulation Agency and have her registration, and her visa, taken away. “You need to go back there,” the woman said, loudly enough for the corridor to hear. Sapkota took it to her manager, who told her, “It’s OK, she’s old.” No action followed.

She left aged care after two years. “I didn’t sleep for nights, because I was questioning my own ability as a nurse,” she told HelloCare in March 2025. “Am I not made for this? Should I quit nursing?” Sapkota is now Clinical Services Director at Community Home Australia. Her account matters because Australia’s official answer to its aged care workforce shortage rests on an assumption that people like her will keep arriving, and keep staying.

The visa deal that mostly went to people already here

The Aged Care Industry Labour Agreement has been available to providers since May 2023. As at 31 August 2025, 137 of these agreements were in effect and 2,462 primary visas had been granted under them. Of those, 2,213 went to applicants already in Australia. Just 249 were granted offshore, according to figures reported by The Weekly Source in October 2025.

That is the central fact about aged care migration in Australia, and it is not the one the policy conversation usually reaches for. The agreement was built to bring workers in. In practice it has mostly been used to keep workers who were already here, converting students and other temporary visa holders into sponsored employees with a route to permanent residence.

The Committee for Economic Development of Australia reached the same conclusion in its October 2025 report, Duty of Care. CEDA found that around 90 per cent of visas under the scheme in 2024-25 went to migrants already in the country, and that workers sponsored under labour agreements amount to less than 1 per cent of all people employed in the three occupations the agreement covers. CEDA chief executive Melinda Cilento put it bluntly: “The labour agreement approach is not working to fix the shortage and is not a substitute for an essential skills visa pathway.”

What the Aged Care Industry Labour Agreement actually offers

The terms explain some of the take-up pattern. The Home Affairs template covers three ANZSCO skill level 4 occupations, aged or disabled carer (423111), nursing support worker (423312) and personal care assistant (423313). It gives access to the Skills in Demand subclass 482 visa and the permanent Employer Nomination Scheme subclass 186. Agreements run five years. Sponsors must have signed a Memorandum of Understanding with the relevant union beforehand, cannot charge recruitment fees, and must pay workers directly.

Two concessions do the heavy lifting. English requirements sit at IELTS 5.0 overall for the temporary visa, dropping to 4.5 for providers delivering culturally and linguistically diverse care. And the income threshold is set at $51,222, well below the general Core Skills Income Threshold, which rose to $79,499 from 1 July 2026 after indexation. Workers must still be paid the annual market salary rate for their location. Permanent residence becomes available after at least two years of full-time work in the nominated occupation, and the worker also needs an AQF Certificate III or a higher or equivalent qualification.

Two years is the number that shapes behaviour. For a student already in Australia holding a Certificate III, sponsorship is a bridge to permanent residence shorter and cheaper than most alternatives. For a provider, it is a way to hold on to a trained worker. Neither party has much reason to start the process from Kerala or Kathmandu.

Who is already doing the work

The workforce those 2,462 visas sit inside is enormous. The Department of Health, Disability and Ageing puts the total at around 456,000 aged care workers. The 2023 Aged Care Provider Workforce Survey estimated 549,000 staff across the five service care types, 414,000 of them in direct care roles, including 322,000 personal care workers.

It is also, already, a migrant workforce. At the 2021 Census, just over half of residential aged care employees, 51 per cent, were born overseas, and 36 per cent of that overseas-born group were born in Southern and Central Asian countries. The Aged Care Worker Survey 2024, which drew more than 21,000 responses, found 57 per cent were born in Australia and 41 per cent spoke a language other than English.

Set that against the Australian Bureau of Statistics estimate that at 30 June 2025 there were 971,020 India-born people in Australia, the largest overseas-born group in the country for the first time on record, ahead of England. Nepal-born residents numbered 213,580 and Sri Lanka-born 184,800. The people the labour agreement was designed to recruit are, in large numbers, already here.

The pay rises, and what the work still costs

What has moved most since mid-2023 is not migration policy but wages. The Fair Work Commission’s Aged Care Work Value Case delivered a 15 per cent interim increase from the first full pay period on or after 30 June 2023, covering personal care workers under the Aged Care Award, nursing assistants and nurses under the Nurses Award, and home care workers under the SCHADS Award.

Stage 3 added increases of between 2.3 and 13.5 per cent from 1 January and 1 October 2025. The final instalment for aged care nurses took effect on 1 August 2026, completing a 12 per cent rise delivered in three tranches on top of the earlier 15 per cent. A registered nurse at Level 1, first year, moved to a minimum of $1,571.60 a week. Separately, the Annual Wage Review 2026 lifted modern award wages by 4.75 per cent from 1 July 2026.

Acting Prime Minister Richard Marles said in August that “turnover has gone down by 30 per cent as a result of these increases.” Aged Care and Seniors Minister Sam Rae tied the rises to care quality: “Better pay for nurses means better care for older Australians. Our record boost to wages is making it easier for aged care homes to attract and retain nurses, ensuring older people can access higher quality, more consistent care.” The workers are less convinced. In the Aged Care Worker Survey 2024, just 36 per cent said they were satisfied with their total pay.

Staffing is the other variable. The 2023 provider survey counted an estimated 43,000 vacancies in directly employed nursing, personal care and clinical care manager roles, and found 27 per cent of that group had left their employment in the preceding 12 months. Providers are meanwhile held to a sector-wide average of 215 care minutes per resident per day, including 44 minutes of direct registered nurse care. Workers absorb the gap, reporting an average of 26.4 paid hours a week and a further 6.5 unpaid.

A 2025 study in Frontiers in Public Health by Monika Winarnita and colleagues interviewed ten Asian women working in aged care in Victoria, four of them from Nepal, Sri Lanka and India. A participant the study identifies as Udaya described the shift: “Within that eight hours we have to do almost everything… So, it’s like too [much] stuff to do within that period. It’s quite challenging. Sometimes yeah, we are not taking our breaks.”

Racism with a paper trail

The hardest part is documented, and has been for years. Nepali aged care worker Pratik Sigdel told ABC News in March 2023 that abuse began immediately. “From the very first day, they used to tell us: ‘You just go away, you just go back to the country where you’re from. I don’t like you, I don’t like your skin’,” he said. He had been in Australia less than a year when he started, and had worked almost three years in the sector when he spoke. “If you can’t feel safe at work, how do you work properly in the workplace?”

The New South Wales Nurses and Midwives’ Association published its Standing Together Against Racism report in September 2025, drawing on 3,289 member responses, about 14 per cent of them aged care workers. It found 64 per cent of respondents from culturally and linguistically diverse, Aboriginal or Torres Strait Islander backgrounds had experienced racism directly, 73 per cent did not report incidents, and 88 per cent of those who did report received no support.

Bianca Brijnath, professor of health communication in society at La Trobe University, has described racism in aged care as “the elephant in the room that nobody talks about.” She notes that dementia can strip inhibitions, complicating any simple account of blame, but argues the sector cannot use that as cover. “Disregarding or pretending that racism doesn’t exist or is a side issue is really missing the fundamental point that our workforce is diverse, our older people are diverse and we must take steps to create respectful relationships…”

Wollongong, and what a fix looks like

At Uniting Aged Care in Wollongong, facility manager Liam Fawell acted after a registered nurse reported racial abuse from residents and family members in 2024, and the programme began in 2025. Almost 40 per cent of the centre’s 150 staff are culturally diverse, as are almost half its residents. Fawell organised learning circles, rebuilt the reporting process and set up a Cultural Champions Committee that now runs Diwali, Holi, Philippines, Netherlands and Japan days and Christmas. In the 12 months after the programme began, reports of residents abusing staff fell by 93 per cent and staff turnover dropped from 10.4 per cent to 3.5 per cent.

Staff told ABC News in December 2025 the shift was real. Rohit Nagpal, three years at the centre, said “it’s a really big change from when I first started.” Jasvir Kaur, there two years, said “no-one is saying anything nowadays to make you feel like you are from a different world, different country.” Registered nurse Asmita Pandey said the difference was being able to escalate: “Now we can advocate to people like, ‘You’re not doing it right’, and we can get support from management.” Fawell’s message to other providers was that none of it was exotic. “This isn’t a too-hard-basket thing; you can be the change you want to see in your home.”

What the policy documents leave out

The gap between the migration settings and the working life shows up in enforcement too. In August 2026 the Australian Border Force announced that a New South Wales South Coast aged care operator had unlawfully recovered sponsorship costs from migrant workers on subclass 482 visas, affecting 13 of its 19 sponsored workers to a total of $118,197. Two workers produced evidence of paying $17,449 and $19,847 towards nomination and visa costs. The provider repaid the money and was barred from lodging new nominations for six months. ABF Acting Commander Tim Thorley said employers avoiding sponsorship obligations “should expect to be detected, investigated, and held accountable.”

There is also a silence worth naming. The Aged Care Taskforce’s final report, delivered in December 2023, discussed funding, wages and the fact that around 70 per cent of sector costs are workforce related, but contained no discussion of migration policy, overseas recruitment, labour agreements or visas. The Aged Care Workforce Industry Council, set up in 2019 to coordinate workforce strategy, wound up in August 2023.

Which returns the question to where Sonal Sapkota left it. Australian aged care already runs on migrant labour, disproportionately South Asian, much of it drawn from people who came here as students and stayed. The visa pathway built to expand that workforce has instead mostly formalised the status of workers already inside it. Whether the 400,000 additional workers CEDA expects the sector to need by 2050 arrive will depend less on the design of a labour agreement than on whether the job is survivable once they get here. “Look at the workplace that aligns with your values, not just the salary,” Sapkota tells migrants entering the sector. “Otherwise, it will really hamper your mental health.” That is advice about Australian workplaces, from someone who stayed anyway.