Interfaces between the aged care and health systems
As Australians age and their needs change, they will use several different aged care programs. Although aged care services provide a key role in providing support and assistance to older people, people who use aged care also routinely use health care services, similar to the rest of the population. They may see GPs or specialists, have medications dispensed to them, visit an emergency department, or be admitted to hospital. Understanding the patterns of service use between the aged care and health systems is important for improving services and outcomes across both systems.
How do we explore the interfaces between the aged care and health systems?
To help understand these interactions, the Australian Institute of Health and Welfare (AIHW) has developed a linked data set joining data from the National Aged Care Data Clearinghouse (NACDC) with key health service data sets.
To develop this data set, the AIHW brought together routinely collected administrative data, covering 5 years from 2012 to 2017, from 6 sources:
NACDC—for aged care program data
Medicare Benefits Schedule (MBS)—for patterns of GP and specialist use
Pharmaceutical Benefits Scheme (PBS)—for patterns of prescriptions dispensed
National Non-Admitted Patient Emergency Department Care—for emergency department (ED) presentations
National Hospital Morbidity Database—for hospital separations
National Death Index—for date of death.
Which health services were included
Primary care attendances: visits or consultations with a general practitioner (GP attendances) or specialist (specialist attendances) where a rebate under the MBS was claimed.
Prescriptions dispensed: medications eligible for a subsidy under the PBS, prescribed by a doctor or other health care provider and provided by a community pharmacist. Medications that are provided in a hospital, purchased over the counter, or otherwise not eligible for a subsidy are not included.
ED presentations: visits to an emergency department where the patient is registered or triaged for care.
Hospital separations: the completion of a stay at hospital. Same day stays begin and end on the same day, and overnight stays involve at least one night in hospital.
Further information on the data set and how the analysis groups were chosen is available in the AIHW report Interfaces between the aged care and health systems in Australia.
What can the data tell us?
The linked data can be used to examine how particular groups of people using aged care differ in their characteristics and patterns of health service use in 2016–17. This information focuses on ‘stable aged care users’ (that is individuals who used the same aged care type for the year) of the 3 biggest aged care programs—permanent residential aged care, home support and home care—across the year in 2016–17, as well as a sample group of non-aged care users for comparison. The data set includes people who were aged 50 and over at 1 July 2016, and who were still alive on 30 June 2017.
The stable aged care user groups represent only a portion of all people using aged care services. There are many people using aged care who are not included who used other types of aged care, moved between types of aged care during the year, did not use these types of aged care for the full year, or were no longer alive by 30 June 2017.
People using community-based aged care were younger than those who were living in permanent residential care—of those using home support and home care, 25% and 37% were aged 85 and over, compared with 57% among people in permanent care.
The median age was 79 among those using home support and 82 among those using home care, rising to 86 among those using permanent residential care. Among the sample of older people living in the community and not using aged care in 2016–17, the median age was 80.
Overall, about 7 in 10 people in each of the 3 groups were female. The proportion of females rose with age, reflecting that women, on average, live longer than men.
Around two-thirds of people in each group lived in Major cities, ranging from 60% of those using home support to 66% of those living in permanent care.
The data do not provide a complete picture of the health care that people in these groups received—some people may receive health services as part of their aged care and those services are not included here—but they do allow us to explore usage patterns for certain types of mainstream health services.
- Generally, in 2016–17, people living in permanent residential aged care had more GP attendances per person than the other 3 groups, but fewer specialist attendances, diagnostic imaging services and operations.
- While people in permanent residential aged care were less likely to see a GP than people using home support or home care, those who saw a GP had more visits. People living in permanent residential aged care averaged almost 1 GP attendance per fortnight (25), while people using home support had on average 17 GP attendances, and people using home care 16.
- Around one-third (32%) of people living in permanent residential aged care had at least 1 specialist attendance—much lower than aged care users in the community (74% of people using home support, 65% of those using home care and 58% of those who did not use aged care.
Explore more about the interfaces between aged care and the health systems in the next section.