In October 2020, the Royal Commission into Aged Care Quality and Safety published its report, setting out some of the devastating effects the COVID-19 pandemic has had on the sector. The aged care sector has long been in need of reform, it continues to struggle to meet the needs of its population, and the pandemic has made the issue more visible than ever before. The featured papers in this Special Focus comment on the changing trends in residential aged care use, the longstanding (and global) issue of an increasing older and more clinically complex population, the work of case managers in community aged care, and the value of advance care planning among residential aged care facility residents.