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People's care needs in aged care

Australia’s aged care system offers a variety of services to support people as their care needs change.
 

Last updated: 22 June 2021.

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For a downloadable summary of the information in this topic, view the People's care needs in aged care factsheet
 

The aged care system offers a continuum of care under three main types of service (for more information on any of these services see the Report on the Operation of the Aged Care Act):

  • Home support (Commonwealth Home Support Programme), which provides entry-level services focused on supporting individuals to undertake tasks of daily living to enable them to be more independent at home and in the community.
  • Home care (Home Care Packages Program), which is a more structured, more comprehensive package of home-based support, provided over four levels.
  • Residential aged care, which provides support and accommodation for people who have been assessed as needing higher levels of care than can be provided in the home, and the option for 24-hour nursing care. Residential care is provided on either a permanent, or a temporary (respite) basis.

There are also several types of flexible care available that extend across the spectrum from home support to residential aged care:

  • Transition care, which provides short-term care to restore independent living after a hospital stay
  • Short-term restorative care, which expands on transition care to include anyone whose capacity to live independently is at risk
  • Multi-purpose services, which offer aged care alongside health services in regional and remote areas
  • Innovative Care Programme which includes a range of programs to support flexible ways of providing care to target population groups
  • National Aboriginal and Torres Strait Islander Flexible Aged Care Program, which provides culturally-appropriate aged care at home and in the community.

For more information on aged care services in Australia see the Report on the Operation of the Aged Care Act, or visit the Department of Health website.

Care needs in the community

Some aged care services provide care to people while they live in the community. In general, individuals receiving these services have lower-level care needs than those living in permanent residential care.

Home support provides mostly entry-level care services to people requiring extra assistance at home. For more information about home support, visit the home support dashboard.

In 2019–20:

  • The most commonly used home support service was domestic assistance (22% of people), and the least used were personal care (5% of people) and specialised support services including continence, dementia, vision and hearing advisory services and client advocacy (4% of people).
A horizontal bar graph shows the proportion of people using the most common home support services. Domestic assistance was the most commonly used service (22%), followed by allied health and therapy services (16%) and social support individual (11%). The least used services were personal care (5%) and specialised support services (4%).


Home care provides varying levels of care to individuals based on their assessed care needs. Home care packages are available at 4 levels, from Level 1 (suitable for basic care needs) through to Level 4 (suitable for high-level care needs).

At 30 June 2020:

  • The majority of home care was delivered in Level 2 packages (41%), followed by Level 4 (27%), Level 3 (21%), and Level 1 (12%).
  • The distribution of home care packages was similar across Australian states and territories, although Level 4 packages were most common in Western Australia (44% of packages) and least common in New South Wales (23% of packages).

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A stacked bar graph shows the proportion of care ratings for people using home care packages across states and territories. Western Australia had the highest proportion of Level 4 packages (44%), while New South Wales had the lowest proportion (23%).

The My Aged Care platform is a website and contact centre that serves as the starting point for accessing Government-subsidised aged care services in Australia. Following an initial screening through My Aged Care, people may be directed to a home support or comprehensive assessment.

Home support assessments are conducted by Regional Assessment Services (RAS) for people seeking low-level support for independent living. Comprehensive assessments are conducted by Aged Care Assessment Team (ACAT) assessors for people seeking support for care needs greater than the Commonwealth Home Support Programme can provide for. The ACAT can assess for entry to Home Care Packages, short-term care options, and residential aged care.

For more information regarding aged care assessments, visit the My Aged Care assessments page.

Care needs in permanent residential care

Permanent residential care provides up to 24-hour care for people who need ongoing assistance with everyday tasks and health care, and who can no longer live independently in the community.

At 30 June 2020:

  • Just over 183,700 people living in permanent residential care had a current Aged Care Funding Instrument (ACFI) assessment.
  • Almost everyone living in permanent residential care was assessed as having some care needs for activities of daily living and complex health care, and 96% of people had some care needs for cognition and behaviour.
  • Most people in permanent residential care had high care need ratings in at least one care domain (63% of people for activities of daily living, 65% of people for cognition and behaviour, and 54% of people for complex health care).
  • High care need ratings when first entering permanent residential care were most common for activities of daily living (54% of people), followed by cognition and behaviour (49% of people) and complex health care (42% of people).
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The Aged Care Funding Instrument (ACFI) is a tool for assessing the care needs of people entering and living in permanent residential aged care. The tool is used to allocate government funding to residential aged care service providers based on the needs of the people in their care, regardless of the actual care planning or care provided by the service to the assessed individual.

The ACFI contains 12 questions and two diagnostic sections used to assess how much assistance a person needs in a range of areas. The ACFI is not a comprehensive assessment; it is focused on factors that affect the cost of care. Needs are classified under the 3 funding domains

  • activities of daily living (ADL), including questions relating to nutrition, mobility, personal hygiene, toileting and continence,
  • cognition and behaviour (BEH), including questions relating to cognitive skills, wandering, verbal behaviour, physical behaviour and depression,  and
  • complex health care (CHC), including questions relating to the need for assistance with administering medications, and need for management of complex health care procedures,

with four ratings for each domain

  • nil
  • low
  • medium
  • high

The rating on each of the ACFI domains is based on the scores on the 12 underlying questions. The ratings across the ACFI domains determine the amount of funding the residential aged care provider receives per day per person in their care. People assessed as having nil or minimal care needs in a particular domain receive no funding for that domain. Reappraisals can be undertaken as a person’s needs change.

To find out more about the ACFI and subsidy amounts, see the Department of Health website.

A stacked bar graph shows the proportion of current and first assessment ratings for people in permanent residential care grouped by care domain. The greatest proportion of high care need ratings was in the cognition and behaviour domain (65%), followed by activities of daily living (63%) and complex health care (54%).

Residential care needs by age

Although the majority of people using aged care services are aged 65 and over, younger people can also access these services. In permanent residential care, people in different age groups have different patterns of care needs.

At 30 June 2020:

  • High care need ratings for activities of daily living were most common among older people (80% of people aged 100 and over) and least common among younger people (55% of people aged 65–69).
  • High care need ratings for cognition and behaviour were most common among younger people (76% of people aged 55–59) and least common among older people (59% of people aged 100 and over).
  • High care need ratings for complex health care were highest among both the youngest (61% of people 0–49) and the oldest (65% of people aged 100 and over) age groups.
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A stacked bar graph shows the proportion of care ratings for people in permanent residential care grouped by care domain and age group. High care need ratings for activities of daily living were most common among older people (aged over 100), while high care need ratings for cognition and behaviour were most common for younger age groups (aged 55–59).

Residential care needs by sex

Men and women living in permanent residential care differ in their care needs. Compared with men, women have a greater proportion of high care ratings in most domains.

At 30 June 2020:

  • Twice as many women had an ACFI assessment on record than men (122,200 compared with 61,500).
  • Compared with men, women were more likely to have high care need ratings for activities of daily living (65% compared with 59%) and complex health care (55% compared with 51%).
  • Women and men had a similar proportion of high care ratings for cognition and behaviour (65% and 64%, respectively).
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A stacked bar graph shows the proportion of care ratings for people in permanent residential care grouped by care domain and sex. Women had a greater proportion of high care need ratings for activities of daily living (65%) and complex health care (55%), while the proportion of care need ratings for cognition and behaviour were similar for males and females (64% and 65%).

Residential care needs by age and sex

The age profiles of men and women in permanent residential care differ. This is reflected in their differing care needs.

At 30 June 2020:

  • The increase in high care need ratings associated with older age in both activities of daily living and complex health care was more noticeable for women than men—71% of men aged 100 and over had high care need ratings in activities of daily living compared with 82% of similarly aged women.
  • In cognition and behaviour, the decrease in high care need ratings associated with older age was more noticeable for men than women—61% of women aged 100 and over had high care need ratings compared with 49% of similarly aged men.
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A stacked bar graph shows the proportion of nil, low, medium and high care ratings for people in permanent residential care grouped by care domain, age group and sex. The increase in high care need ratings associated with older age in both activities of daily living and complex health care was more noticeable for women, while for cognition and behaviour the decrease in high care need ratings associated with older age was more noticeable in men.

Residential care needs over time (first assessment)

The proportion of people assessed as having high care needs when they first enter permanent residential care has increased. Expand the Care need ratings in permanent residential care section for more on the limitations of ACFI. See also COVID-19 and people's care needs

Trends over the decade from 2010–11 indicate that:

  • High care ratings when first entering permanent residential care have become more common for activities of daily living (from 35% to 54% of people) and cognition and behaviour (from 33% to 49% of people). Ratings for complex health care have fluctuated.
  • Low and nil care need ratings became less common in all three domains, with the largest decrease in nil care ratings for complex health care (from 14% to less than 1% of people), and the largest decrease in low care ratings for activities of daily living (from 33% to 12%).
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A stacked bar graph shows the proportion of care ratings of first assessment for people in permanent residential care grouped by care domain over time (2010–11 to 2019–20). The proportion of high care need ratings has increased for activities of daily living and cognition and behaviour, while the proportion of care ratings for complex health care has fluctuated (likely due, in part, to policy changes relating to ratings for complex health care).

Residential care needs by dementia status

People with dementia tend to have higher care needs than people without dementia. These differences are also reflected in care need ratings as assessed by the ACFI.

To learn more about how dementia affects people in Australia, see the AIHW Dementia webpage.

At 30 June 2020:

  • The majority of people with dementia (80%) and almost half (46%) of people without dementia were assessed as having high care needs for cognition and behaviour.
  • The proportion of high care need ratings for activities of daily living was also greater among people with dementia (67% compared with 58%).
  • The smallest difference in care need ratings was for complex health care—55% of people without dementia and 52% of people with dementia received a high rating.
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A stacked bar graph shows the proportion of care ratings for people in permanent residential care grouped by dementia status and care domain. The majority of people with dementia were assessed as having high care needs for cognition and behaviour, while almost half of residents without dementia were also rated with high needs in this domain.

Residential care needs of Aboriginal and Torres Strait Islander people

The target population for aged care (that is, all people aged 65 years and over and Aboriginal and Torres Strait Islander people aged 50–64) acknowledges the younger age structure and differing care needs of the Aboriginal and Torres Strait Islander population in Australia.  Indigenous and non-Indigenous Australians using aged care services differ in their age and sex profiles.

You can learn more about these differences on the People using aged care GEN topic page. You can also learn more about Indigenous Australians in aged care by viewing the Indigenous Australians Dashboard, or learn about the health and welfare of Indigenous Australians on the AIHW website.

At 30 June 2020:

  • Compared with non-Indigenous people, Indigenous people had lower assessed care needs for activities of daily living (57% compared with 63% high care ratings) and complex health care (45% compared with 54%).
  • The proportion of high care need ratings in cognition and behaviour was similar for both Indigenous and non-Indigenous people (66% and 65%).
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A stacked bar graph shows the proportion of care ratings for people in permanent residential care grouped by Indigenous status and care domain. Indigenous people had a lower proportion of high care needs for activities of daily living and complex health care compared to non-Indigenous people. The proportion of high care ratings for cognition and behaviour was similar across Indigenous and non-Indigenous people.

Residential care needs of people from culturally and linguistically diverse backgrounds

Many older Australians, including those living in permanent residential care, were born overseas, speak a variety of languages, may not speak English fluently or have different religious or cultural practices. These can influence how people access and engage with aged care services, as well as how their care needs are assessed while using aged care. Expand the Care need ratings in permanent residential care section for more on the limitations of ACFI assessments. Due to data availability, this section focuses on country of birth and preferred language as measures of cultural and linguistic diversity.

At 30 June 2020:

  • Compared with people born in Australia or other English-speaking countries, people born in non-English-speaking countries were assessed as having higher care needs in each domain. For example, in cognition and behaviour, high care needs were recorded for 72% of people born in non-English speaking countries, compared with 62% of people born in Australia and 66% of people born in other English-speaking countries.
  • Similarly, care need ratings were highest among people who preferred to speak languages other than English—74%, 68% and 57% of people were assessed as having high care needs in cognition and behaviour, activities of daily living, and complex health care, respectively.
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Two stacked bar graphs show the proportion of care ratings for people in permanent residential care grouped by care domain, country of birth and preferred language. People born in non-English-speaking countries were assessed as having higher care needs in each domain compared to people born in Australia or other English-speaking countries. Care ratings were highest among people who preferred to speak other languages compared to those who preferred to speak English.

Residential care needs in states and territories

The care need ratings of people living in permanent residential care vary across Australia, although variability in how ACFI assessments are used may also contribute to these differences.

At 30 June 2020:

  • Western Australia had the highest proportion of high care need ratings for activities of daily living (70% of people) and cognition and behaviour (75% of people), while Victoria and South Australia had the highest proportions of high care need ratings for complex health care (both 59% of people).
  • Medium and low care need ratings were most common for activities of daily living in the Australian Capital Territory (46% of people), for cognition and behaviour in South Australia and Tasmania (both 42% of people), and for complex health care in New South Wales (51% of people).
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A stacked bar graph shows the proportion of care ratings for people in permanent residential care grouped by care domain and state and territory. Western Australia had the highest proportion of high care need ratings for activities of daily living and cognition and behaviour. The proportion of high care need ratings for complex health care was highest in Victoria and South Australia.

Explore people’s care needs

Use the interactive table below to explore the care needs of people using permanent residential care by age group, sex, Indigenous status, preferred language, country of birth and geography (state and territory).

If you are interested in accessing a confidentialised data set that includes selected information about care needs in permanent residential aged care in Australia by state and territory please see the relevant Confidentialised Unit Record File available on GEN.


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A table shows the care needs of people in permanent residential aged care by care domain, care rating, age group, sex, Indigenous status, preferred language, country of birth and geography (state and territory).

COVID-19 and people’s care needs

Australia has faced significant challenges during the COVID-19 pandemic. COVID-19 illness can be more serious for people who have pre-existing health conditions, including older Australians.

COVID-19 affected health care services in many ways. Residential aged care services locked down and restricted visitors throughout much of 2020. This reduced activity and social interaction is likely to have negatively affected the wellbeing and functional abilities of people using aged care services, especially those living in residential care where lockdowns were strictest. COVID-19 also particularly affected people with dementia, and the confinement measures brought about accelerated cognitive and psychological declines among some in this group.

The data presented here are to 30 June 2020, spanning the early months of the COVID-19 pandemic and associated restrictions in Australia. The extent of pandemic-related impacts will be clearer in future data releases.

For further information related to aged care and COVID-19, including access to advice and support resources, see the Australian Government’s My Aged Care website. To access additional information about types of care and the care needs they cater for, see My Aged Care’s types of care page. For more information on COVID-19-related changes to aged care assessments, see the My Aged Care assessment page.


 

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