This paper critically examines intersecting domains of cultural, legal and structural barriers that are predicted to contribute to the exclusion of residents with dementia from direct participation in aged care consultation processes. This unaddressed exclusion is argued to be a form of epistemic injustice for residents with dementia that may contribute to unresponsive aged care delivery and high rates of proxy participation. Future directions propose data transparency of resident participation in aged care consultation, and a radical shift towards innovative approaches to ensure all resident voices are heard.

In failing to address normative gendered patterns, the ACRC Final Report entrenches rather than unseats marginalisation of women in dementia research and policy and is a missed opportunity to address gendered labour, discrimination and harms in long-term care. Ultimately, the paper highlights the need to recognise long-term care as a key site for critical dementia and feminist scholarly and activist interventions and intersectional approaches in reforms.

Where people with dementia face practical and legal barriers to participate in civic and legal processes, the RCAC failed to adjust its methodologies to ensure their voices were “heard”. The RCAC’s re-inscription of marginalisation of people with dementia raises concerns for the legitimacy and success of its recommendations for dementia aged care reform.

Successful ageing continues to be a key theme in contemporary ageing discourses, where good physical and cognitive health in older age is an individualised responsibility. This paper explores how Australian aged care stakeholder discourse contributes to constructions of self-responsibility for brain health and dementia prevention in older persons.

Although dementia care and restrictive practices received substantial attention in the RCAC, this paper reveals a missed opportunity for deeper review of institutionalised use of restraints that has relevance for ongoing reform of Australian aged care following conclusion of the RCAC.