Timeliness of access to aged care services in Australia

Summary

This report describes the elapsed time between a person’s approval for selected aged care services (a home care package, permanent residential aged care, or both) and receipt of the service at the approved level. The cohort of interest includes everyone who had their first comprehensive aged care eligibility assessment in the 2021–22 financial year, followed up to 30 June 2024. This report also investigates the demographic and clinical factors associated with elapsed times for this cohort.

Background and Introduction

While Australian aged care services and programs have been regularly reformed to meet the care needs of the population, there are areas where needs may not be met. One source of unmet need, documented in the Royal Commission into Aged Care Quality and Safety’s Final Report (2021), is timeliness and equity in access to services, including variation in the amount of time people wait to access aged care. With increasing demand for home care services, there is ongoing community concern about the amount of time Australians are waiting to receive aged care services.

Some of the time that elapses between approval for care and receiving that care may be elective, where the person chooses not to or is unable to take up care when it is offered. However, prolonged waiting time due to system or service-level barriers to care can cause distress, lost work income for the person’s family members, and increased carer burden (McCallum et al. 2018). A study found that prolonged waiting times for home care packages were associated with a higher risk of long-term mortality as well as transition to permanent residential aged care (Visvanathan et al. 2019). Understanding waiting times, the factors that are associated with longer waiting time, and how these have changed over time and with aged care reform, can help to target policy and quality improvement initiatives.

The analytical methods used in the previous report were applied to produce this report, but using more recent data – namely the Pathways in Aged Care (PIAC) 2024 link map (see Technical notes) which is part of the National Aged Care Data Clearinghouse (NACDC). Using linked data allows for analysis of elapsed times while following individuals across multiple service types, building a clearer picture of the pathways people take through the aged care system.

This report presents analysis of data for people who had their first comprehensive assessment and were approved for a home care package or permanent residential aged care (or both) in the 2021–22 financial year. Service outcomes are reported up to 30 June 2024 along with median elapsed times between date of assessment approval and date of receipt of a service at the approved level. Results of analysis are also presented that measure the association of demographic and clinical factors with shorter or longer elapsed times within the study cohort.

Service Outcomes

During the analysis period, notable events that likely affected care availability and individual preferences to take up aged care included releases of additional home care packages by the Australian Government (Figure 1).

Figure 1 - Project timelines, key events and select government actions in aged care, 2021 to 2024

• In May 2021, just before the start of the study period, an additional 80,000 home care packages were announced, to be released over the 2021–22 and 2022–23 financial years. This increased the supply of places available for those approved for home care during the study period.
• The study period ended at 30 June 2024, just before the beginning of the change in aged care eligibility assessments, from the National Screening and Assessment Form (NSAF) to the Integrated Assessment Tool (IAT).

To align with the Report on Government Services reporting, the cohort analysed in this report includes all people aged 65+ and First Nations people aged 50-64. The analysis that follows looks at service outcomes for people, split into three groups, namely those approved for:

• home care package only,
• permanent residential aged care only, or
• home care package and permanent residential aged care.

The number of people in each approval group, and the number in each group who received their approved service before 30 June 2024 is shown in Figure 2.

• The largest group was those approved for both a home care package and permanent residential aged care (45%), while:
• Around 1 in 3 (32%) were approved for home care only.
• Around 1 in 4 (23%) were approved for permanent residential aged care only.
• Among those approved for a home care package only, 80% received their approved service.
• Among those approved for both a home care package and permanent residential aged care, 83% received their approved service.
• Of those approved for ‘both a home care package and permanent residential aged care’ who had received an approved service by 30 June 2024:
  • 4 in 5 (80%) received a home care package at the approved level,
  • 1 in 5 (20%) entered permanent residential aged care.
• Among those approved for permanent residential aged care only, 68% received their approved service.

Figure 3 shows the service outcomes for individuals in the study cohort at 30 June 2024. The outcomes at the end of the study period were as follows:

• Over 3 in 4 (79%) received the approved service.
• Over 1 in 6 (18%) received another service, either at a lower level or different from first approved.
• A small percentage (2.2%) died prior to or on 30 June 2024 without receiving a home care package, permanent residential aged care or home support
• A small percentage (1.3%) did not receive an aged care service in the analysis period.

Figure 3: Aged care service use outcomes following first comprehensive assessment approvals in 2021–22, up to 30 June 2024

• Of those approved for ‘both a home care package and permanent residential aged care’
  • Over 4 in 5 (83%) had received their approved care service
  • Almost all (97%) had received an aged care service, including home support.
• Of those approved for a home care package only
  • 4 in 5 (80%) had received their approved home care package
  • almost all (98%) had received any aged care service, including home support.
• Of those approved for ‘permanent residential aged care only’
  • Almost 7 in 10 (68%) had received permanent residential aged care
  • Over 9 in 10 (93%) had received any aged care service, including home support.

Elapsed time from assessment to receipt of approved service

Several circumstances may contribute to the length of elapsed time between approval for an aged care service and receipt of that service, including:

• time spent waiting for a service to become available,
• time spent organising financial, guardianship and other arrangements necessary to accept care, and
• choosing not to accept an offered service.

The elapsed times calculated using the available linked data cannot differentiate between these elements.

The median elapsed time is the length of time that falls in the middle of all elapsed times for each approval group who received their approved care service, so that half of the group had a shorter elapsed time and half had a longer elapsed time. The median times reported here are based only on those who received their approved service before 30 June 2024. If the cohort was able to be followed for longer, and more people received their approved service after 30 June 2024, the calculated median values would be higher.

Figure 4: Median elapsed time from approval in 2021–22 to receipt of service at the approved level by 30 June 2024

• The median elapsed time from approval for home care only, and for home care and permanent residential care to receipt of approved service was 176 days, or around 6 months.
• The median elapsed time from approval for permanent residential aged care to receipt of approved service was shorter at 53 days, or around 7.5 weeks.
• The interquartile range is marked for each group with a black bar, which includes 50% of all elapsed times among those who received their approved service. 25% of elapsed times were shorter than those included in this range, and 25% of elapsed times were longer.

The priority level assigned at assessment resulted in differences in elapsed time to receipt of service, as shown in Table 1. According to previous guidance from the Department of Health, Disability and Ageing, the default priority is medium priority with only a small percentage of people who are at immediate risk being approved as high priority. For the group approved for both home care and permanent residential aged care, the priority level for residential care was used, because it is a higher level of care than home care.

Table 1: Elapsed time to receipt of approved service by care priority level, for approvals in 2021-22 and services received by 30 June 2024

Median elapsed time (days) by priority level	'HCP and PRAC' approval group*	'HCP only' approval group	'PRAC only' approval group
1-Low	181	160.5	63
2-Medium	161	181	50
3-High	76	15	52
Total	176	176	53

Note: HCP: home care package; PRAC: permanent residential aged care
* For those approved for ‘both a home care package and permanent residential aged care’, the priority level presented in this table relates to the priority level assigned for entry into permanent residential aged care (the higher care needs service), which is different from the priority level assigned for home care package in the same assessment.
Source: https://www.gen-agedcaredata.gov.au/

• Among those approved for both a home care package and permanent residential aged care in 2021–22:
  • Around 3 in 4 (76%) had a low priority assigned for permanent residential aged care.
  • Those with a high priority had a shorter median elapsed time (76 days) for their approved service, compared to those with medium priority (161 days).
• Among those approved for a home care package only in 2021–22, the difference was more pronounced:
  • Those with high priority had a median elapsed time of only 15 days.
  • The median elapsed time was 181 days (about 6 months) for those with medium priority.
• Among those approved for permanent residential aged care only in 2021–22, only a small difference was seen:
  • Those with high priority had a median elapsed time of 52 days (or less than 2 months).
  • The median elapsed time was 50 days (also less than 2 months) for those with medium priority.

Receipt of interim care while waiting for approved service

• Among all three approval groups most people (86% or 101,700 out of 118,100) received either a lower-level home care package or home support while waiting for their approved service.
• Of the almost 91,500 people approved for either a home care package only or both a home care package and permanent residential aged care in 2021–22:
  • about 6,300 (6.9%) received a lower-level home care package before going on to receive their approved service.
  • The median elapsed time was 131 days (or over 4 months) to receive a lower-level home care package before going on to receive the approved service (interquartile range: 1–215 days).
  • Over 1 in 3 (36% or 33,200) had a median elapsed time of over 6 months for either a lower-level home care package only or for their approved care service. 

Characteristics associated with elapsed time to receipt of approved care service

Understanding who experiences longer elapsed times to receiving an approved care service can help identify barriers and opportunities to improve care delivery to those most in need. Figure 5 shows the median elapsed time from service approval to service receipt, broken down by age group and sex for people first approved for aged care services in 2021–22.

Figure 5: Elapsed time from service approval in 2021–22 to receipt of the service at the approved level by 30 June 2024, by age group and sex 

• Median elapsed times were similar for men and women aged 65 and over who were approved for both a home care package and permanent residential aged care in 2021–22.
• Elapsed times were more varied below the age of 65, most likely due to smaller numbers in these age groups.
• Among both men and women approved for permanent residential aged care only in 2021–22, median elapsed times decreased with increasing age.

To examine which demographic and clinical features most strongly impacted elapsed time to receiving an approved aged care service, multivariate competing risk modelling was undertaken (Fine and Gray 1999). This analysis quantifies the effect of each factor on the incidence of receiving the approved level of care at any point in time after approval and before a competing risk event, while controlling for other factors. A higher incidence is associated with a shorter elapsed time, and a lower incidence with a longer elapsed time. More information about the data and methods used here are available in the Technical notes.

Figure 6: Factors associated with elapsed times for those who had their first approved comprehensive assessment approved in 2021-22, by approval groups

• Younger age groups were associated with:
  • shorter median elapsed time to receipt of approved service among those approved for a home care package only
  • longer elapsed time for those approved for permanent residential aged care only (compared to those aged 90+).
• Being First Nations was associated with longer elapsed time among those approved for permanent residential aged care (compared to non-indigenous).
• High priority level was associated with shorter elapsed time for all approval groups (compared to low priority level).
• Having dementia was associated with shorter elapsed time for those approved for either permanent residential aged care only, or both a home care package and permanent residential aged care (compared to those with no dementia).
• Being assessed in hospital was associated with longer elapsed time among those approved for a home care package only (compared to those not assessed in hospital).
• Living alone was associated with shorter elapsed time for those approved for permanent residential aged care only (compared to those not living alone).
• Living outside of metropolitan areas and regional centres (MM 3 – 7) was associated with longer elapsed time for those approved for permanent residential aged care only (compared to living in a metropolitan area or regional centre).

Comparison to previous cohorts and other reported numbers

This section compares the number of people in each approval group, the proportion of people who received a care service at the approved level, and median elapsed times to receipt of approved service across the following three reporting periods:

• The initial report, Timeliness of access to aged care services in Australia 2023, which examined elapsed times for individuals approved for an aged care service in 2017–18 and followed up to 30 June 2020, and
• Timeliness of access to aged care services in Australia 2024, which examined elapsed times for individuals approved for an aged care service in 2019–20 and followed up to 30 June 2022, and
• The findings presented in the current report, which examines elapsed times for individuals approved for an aged care service in 2021–22 and followed up to 30 June 2024.

Key results from other recent reports examining elapsed times experienced by individuals before receiving aged care services are also presented for comparison. These reports contain more recent data, though they use different methods for measuring wait times, and are not based on linked datasets.

Figure 7: Number of people who had their first comprehensive assessment and number who received their approved care service, by approval group and comparing analysis periods

• The number of people in all three approval groups increased from 103,400 in the 2017–18 cohort to 118,100 in the 2021–22 cohort, an increase of 14%.
• The number of people approved for permanent residential care only increased from 22,600 in the 2017–18 cohort to 26,600 in the 2021–22 cohort, an increase of 18%.
• The number of people approved for a home care package only increased from 20,300 in the 2017–18 cohort to 38,200 in the 2021–22 cohort, an increase of 88%.
• The number of people approved for both a home care package and permanent residential aged care decreased from 60,500 in the 2017–18 cohort to 53,300 in the 2021–22 cohort, a decrease of 12%.
• Among those approved for only permanent residential aged care, the proportion who received their approved service within the study period was stable over the three cohorts at around 68%.
• Among those approved for only a home care package, the proportion who received their approved service within the study period increased from 60.5% for the 2017–18 cohort to 79.6% for the 2021–22 cohort.

Figure 8: Median elapsed times from approval to receipt of service, by approval group and comparing analysis periods

• The median time to receipt of approved service decreased over time for those approved for home care only, from 472 days (about 15.5 months) for the 2017–18 cohort to 176 days (around 6 months) for the 2021–22 cohort.
• The median time to receipt of approved service decreased over time for those approved for home care and permanent residential care, from 342 days (about 11 months) for the 2017–18 cohort to 176 days (around 6 months) for the 2021–22 cohort.
• The median time to receipt of approved service increased over time for those approved for permanent residential care only, from 34 days in the 2017–18 cohort to 53 days in the 2021–22 cohort.

Figure 9: Median elapsed times to receipt of approved service and number of home care packages released by quarter, from 1 July 2017 to 30 June 2024

• Between Q4 in 2018–19 and Q4 in 2022–23 the number of home care packages released was mostly between 40,000 and 50,000 per quarter, an increase from earlier periods.
• The observed decrease in median elapsed time to receipt of approved home care packages occurred over the period where this higher than usual number of home care packages were released.
• From Q1 in 2023–24 to Q1 in 2025–26 the number of home care packages released was mostly between 30,000 and 35,000 per quarter.

The decrease in median elapsed time observed over the three iterations of this report is reflected in data reported in Table 14A.33 from the 2026 Report on Government Services (ROGS) (SCRGSP 2026). The ROGS table reports the median times from approval to commencement of a home care package (including a lower-level package) for people commencing a home care package in each financial year, so the results are not directly comparable to this report.

The ROGS table shows the median time from approval to commencement of a home care package decreasing between 2018–19 (447 days or about 14.5 months) to 2023–24 (118 days or about 4 months) before increasing again in 2024–25 to 245 days (~8 months).

The new Aged Care Act 2024 – Wait Times Report (DHDA 2026) reports elapsed time from application for an assessment through to receipt of service.

Because linked data were used in the current report, it was possible to observe how people moved between service types over time. This pathway context is important because approvals can involve multiple services: in the 2021–22 cohort, 45% of people were approved for both home care and permanent residential aged care in their first comprehensive assessment. For this combined-approval group, the first approved service received was most often home care (around 80%), indicating that many people’s journeys involve receiving home-based support, ahead of permanent residential aged care.

Where can I find more information

A detailed description of this report can be found in the Technical notes document.

For the previous version of this report, using the PIAC 2022 link map, see Timeliness of access to aged care services in Australia (released December 2024). For more PIAC link map analysis, see Pathways in aged care.

The PIAC 2024 link map is part of the National Aged Care Data Clearinghouse. A detailed account of how the linked dataset was created and prepared for reporting is available in the Pathways in Aged Care 2020: technical guide.

For more information on aged care in Australia, including elapsed time between aged care assessment approval and entry to aged care services, see:

• Aged Care Act 2024 – Wait Times Report
• Report on Government Services
• Report on the Operation of the Aged Care Act 1997
• Home care packages report
• Support at Home program data report