When Jeff Gilling looked through the contract for the aged care home his mother Dorothy was about to enter, one charge stood out.

It was $52 a day.

The fee covered extras including Foxtel, outings, newspapers and a choice of wines.

For some residents, those services might have represented genuine lifestyle choices. But Dorothy was living with advanced dementia.

According to her son, she could not even turn on a television by herself, let alone select a channel or meaningfully enjoy what she was watching.

Yet when Gilling was told the additional service fee was not optional, he signed the contract.

His priority was the same one confronting thousands of Australian families every year: getting a vulnerable parent out of hospital or an unsafe situation and into residential care.

It was not the moment for a prolonged commercial dispute over every line of a complicated aged care agreement.

That decision would eventually cost Dorothy tens of thousands of dollars in charges for services her son says she simply could not use.

Her case is now part of a much bigger question confronting Australia’s aged care system: how many vulnerable residents are paying for extras they cannot access, do not want or do not understand?

The Aged Care Quality and Safety Commission received 199 complaints involving fees, funds or service charges at residential facilities in the first six months of 2026 alone.

Of those complaints, 121 related to for-profit providers, 75 to not-for-profit providers and three to government providers.

The national regulator has confirmed it is investigating several providers over concerns about the alleged misuse of fees.

Aged Care Quality and Safety Commissioner Liz Hefren-Webb has said the investigations remain ongoing and the commission will not identify the providers involved at this stage.

However, she said a number of operators had already voluntarily reviewed and changed their practices.

The investigation comes as families, advocates and lawyers raise concerns about residents being charged for services they are physically or cognitively unable to use — and about optional fees allegedly being presented as unavoidable.

For families dealing with dementia, the issue goes directly to the question of consent.

If a resident cannot understand a package of premium services, cannot choose between the services and cannot benefit from them, why are they paying for the package?

In Dorothy’s case, her son eventually began researching the rules himself.

What he discovered transformed a family concern into a lengthy battle over fees.

Gilling contacted managers at Estia Health’s Epping aged care facility in Sydney’s north-west in 2019, arguing that charging a resident with advanced dementia for services she lacked the cognitive ability to choose or enjoy was unconscionable and, in his view, unlawful.

After a review, he received a refund of $26,741 in February 2021 covering 537 days of charges while Dorothy was in a dementia support unit.

He continued challenging the fees.

In October 2021, a further $10,088 refund was approved after he successfully argued the charges should never have been applied from the day his mother entered the facility.

The total reimbursement came to almost $37,000.

For Gilling, the outcome exposed another problem.

He had the time, confidence and persistence to research aged care rules, write to management and continue arguing his mother’s case over an extended period.

Many families do not.

People often enter the aged care system at a moment of crisis. A parent may be leaving hospital. Dementia may have progressed beyond what relatives can safely manage at home. A fall, illness or sudden deterioration can force decisions to be made quickly.

Families are simultaneously confronting medical information, financial paperwork, accommodation decisions and the emotional reality that a parent may no longer be able to live independently.

In that environment, a contract presented as standard can carry enormous practical authority.

If a family is told a fee is not optional, many will assume the provider understands the law better than they do.

That imbalance is one reason the current regulatory investigation matters.

The rules do not allow providers to turn mandatory care into a premium product.

Under Australia’s aged care framework, registered providers must supply standard funded residential care services in accordance with the Aged Care Quality Standards and the Statement of Rights.

They cannot charge an additional Higher Everyday Living Fee, known as a HELF, for services they are already required to provide.

Providers can offer genuine extras or a higher standard of service and charge residents for those premium options.

But the distinction between a legitimate extra and a basic service is now under intense scrutiny.

The HELF system was introduced under the new aged care arrangements that took effect on 1 November 2025, replacing previous additional and extra service fee structures.

The idea is straightforward.

A resident should receive the required standard of care and everyday living services. If they want something beyond that standard — a premium option or an additional lifestyle service — a provider may offer it for an extra fee.

The problem begins if the standard service is stripped back to encourage residents to pay more.

The Aged Care Quality and Safety Commission has explicitly warned providers they must not use HELF arrangements to reduce standard care.

Meals provide a clear example.

Residents who do not pay for premium meal options must still receive varied and nutritious food that meets their health and wellbeing needs.

A provider cannot degrade the quality, quantity, choice or nutritional adequacy of its standard meal service and then effectively pressure residents into purchasing a better package.

Hefren-Webb has expressed concern that some unnamed providers may have reduced standards, including the choice and availability of meals, in ways that encourage residents to purchase premium options.

Earlier this year, Aged Care Minister Sam Rae also asked the regulator to examine allegations that facilities were stripping back existing services under the new reforms.

Reports included televisions being removed from bedrooms and wi-fi being turned off unless residents paid for an upgraded package.

Rae described reported attempts to sidestep the rules as unacceptable and said older Australians were entitled to be treated with dignity.

The stories emerging from families show how absurd some charges can appear when matched against an individual resident’s circumstances.

One Sydney woman told ABC Radio her mother, who has dementia, was being charged $140 a month for services including free-to-air television and pet therapy.

Her mother did not like dogs.

Another family reported a father paying $380 a month for services that included access to a conference centre and a hairdresser.

The man was bald.

His family said the activities he actually wanted, such as a weekly bus trip, could attract another charge on top of the package fee.

These cases illustrate why the ability to opt out is so important.

An aged care home is not a hotel selling a holiday package to a customer comparing optional upgrades.

Residents may be frail. They may have dementia or other forms of cognitive impairment. Their representatives may be making decisions under severe time pressure.

For some residents, the facility is likely to be their final home.

The commercial relationship therefore exists alongside an extraordinary level of vulnerability and dependence.

Providers control accommodation, daily routines and the delivery of essential care. Families may worry about creating conflict with the organisation responsible for looking after someone they love.

That can make challenging a fee psychologically difficult even when the amount appears unreasonable.

The regulator’s own rules recognise the need for protection.

HELF arrangements are intended for additional services or a higher standard of services. Providers cannot charge a HELF for services included on the Residential Care Service List.

Government guidance also makes clear that premium arrangements cannot be used to diminish the standard offering available to residents who choose not to pay more.

The commission says it is monitoring how providers offer HELF services and can take regulatory action when obligations are not met.

Possible measures include fines, compliance notices and, in serious circumstances, revocation of a provider’s registration.

The current controversy is not limited to individual complaints.

For-profit aged care provider Arcare is facing a Federal Court class action alleging residents were unlawfully charged additional fees for services including high teas, hot meals and exercise classes.

The allegations include claims that some residents were charged even when health conditions or cognitive impairment meant they could not use the services.

The action also alleges fees were applied for some services providers were already legally required to supply.

Arcare has not yet responded to the allegations in court. A spokesperson has said it would be inappropriate to comment on the claims while legal proceedings are under way.

The law firm acting for the class action applicants has said it is actively investigating other operators.

That creates the possibility that the current scrutiny of aged care fees could expand well beyond the providers already facing complaints.

Advocates are also warning about the broader structure created by premium aged care fees.

Dr Sarah Russell, director of Aged Care Matters, has raised concerns that providers have considerable discretion over the price and inclusions of HELF packages.

She has pointed to an example of an aged care home in New South Wales listing entertainment as an extra service even though the entertainment was provided by a volunteer.

Russell argues the system risks creating a two-tier model of residential aged care: one experience for people who can afford additional services and another for those who cannot.

There is nothing inherently improper about allowing an older Australian to pay for a genuine luxury or premium service they actively want.

A resident who understands the choice and wants a particular extra should be able to make that decision.

The more troubling question is what happens when the line between standard care and premium care begins to move.

If yesterday’s ordinary television access becomes tomorrow’s paid extra, has the resident received a new premium service or simply been asked to pay for something that disappeared?

If meal choice is reduced and a premium package restores variety, is the provider offering a luxury or creating a financial incentive out of a diminished standard?

If a person with advanced dementia is charged for wine selection, newspapers and entertainment they cannot understand, who has actually chosen the service?

Those are precisely the types of questions now confronting the regulator.

Estia Health has said concerns about fees raised by residents or families are reviewed and that incorrect charges are corrected and refunded.

The provider has also said residents and their authorised representatives can request a review of additional services or opt out at any time.

It said caring for older Australians, including people living with dementia, was a privilege and that it took its obligations seriously.

But Dorothy Gilling’s case demonstrates why relying entirely on families to identify questionable charges can leave vulnerable residents exposed.

Her son had to discover the rules, challenge the provider and continue the dispute before almost $37,000 was returned.

Had he accepted the contract and the explanation that accompanied it, the money may never have been questioned.

That is the uncomfortable issue at the centre of the investigation.

Australia’s aged care system is dealing with people who may be among the least able to scrutinise a recurring charge on a bill.

A resident with advanced dementia may not ask why Foxtel appears on an invoice.

They may not remember agreeing to a package.

They may not understand that a choice exists.

They may not be able to tell their children that they never watch television, read a newspaper or attend an exercise class.

The protection must therefore exist before the charge is applied, not only after a determined relative discovers it years later.

For families with someone in residential aged care, the emerging cases also carry a practical warning: additional service fees deserve close scrutiny.

Relatives and authorised representatives can ask exactly what is included in a premium package, whether each service can genuinely be accessed by the resident, whether the resident benefits from it and whether the service is already part of the provider’s standard obligations.

They can also ask for a review of charges and raise concerns with the Aged Care Quality and Safety Commission.

For the regulator, the task is larger than resolving individual billing disputes.

The HELF system is still relatively new. How aggressively the commission enforces the boundary between standard services and paid extras may determine whether the model delivers meaningful choice or becomes another layer of complexity for families already struggling to navigate aged care.

The commission has made its formal position clear: standard funded services must be provided, residents who decline premium services must not receive diminished care, and providers can face regulatory action if they fail to meet their responsibilities.

Now the investigations will test how those principles have worked in practice.

For Jeff Gilling, the issue is already painfully concrete.

His mother was charged $52 every day for a package that included television, newspapers, outings and wine choices while living with advanced dementia.

Nearly $37,000 was eventually returned.

The question hanging over Australia’s aged care sector is how many other families have never thought to ask for the money back.