Before the royal commission into aged care, and over the years in which it has been running, the stories have been disturbing.

Elderly Australians have been drugged or physically restrained in their beds so they are easier for poorly-trained staff to handle, forced to ration or re-use incontinence pads.

So called "unplanned weight loss" is rife, the royal commission has found, because there is not enough money to buy and prepare nutritious food, and staff do not have the time to help ensuring those with trouble eating get fed.

But, as Commissioner Tony Pagone notes in his introduction to the eight-volume final report of the royal commission, the legislation that governs how aged care is offered in this country is all about cutting costs.

"It is worth dwelling upon it once more in this outline - not to lay blame but to shed light upon how systems working well can cause harm," he writes.

It comes back to the Aged Care Act passed in 1997, the Cabinet Memorandum for which "is not primarily concerned with the quality of care or with ensuring that older people can access the care that they need, but identifies the 'billions' in savings that had been achieved to that time by 'capping service provision' and the 'risks' to the Government's budgetary position".

While the outcomes are shocking, the system is in many ways working as intended. And that is an indictment on the government, and our society.

It was about money, not about care, dignity or respect - the themes of Commissioner Lynelle Briggs' overview.

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That cost-cutting motivation has not only left one in three Australians in aged care receiving sub-standard care, it has also meant the regulatory systems meant to weed out poor practices and bad behaviour have been "weak and ineffective," Commissioner Pagone writes.

"In essence, having not provided enough funding for good quality care, the regulatory arrangements could only pay lip service to the requirement that the care that was provided be of high quality," he wrote.

For a system to begin with such a motivation, it is destined to fail the vulnerable people at its core.

More money is needed, but the commissioners didn't put a dollar figure on just how much.

Prime Minister Scott Morrison also didn't commit to how much his government would spend to right the wrongs outlined in the report, saying "the answer is not known yet".

Much has been made of the diverging recommendations from Commissioners Pagone and Lynelle Briggs - each favouring different models for regulation and oversight of the sector.

As Commissioner Briggs writes "in a system as complex and as interwoven as aged care, reasonable people can come to different conclusions around the best course of action".

But, however the government chooses to respond to the 146 recommendations made by the royal commission, whatever governance and regulatory models are decided upon, we can not once again decide to minimise costs in a way that leaves elderly Australians under-fed, restrained, and without basic dignity.

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