Respite use on the way to permanent residential aged care

Older people are increasingly using residential respite care on the way to entering permanent residential aged care (PRAC), according to our analysis of linked data from the Pathways in Aged Care (PIAC) link map.

Many of these people are entering permanent residential care on the same day that they are leaving respite residential care, and this is increasing over time.

Of everyone who entered PRAC for the first time in 2019–20 (60,674 people), 52% entered PRAC on the same day as they exited respite. This compares with 26% of people who entered PRAC for the first time in 2010–11.

Last updated: 28 June 2023.

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Contents

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Residential respite use on the way to PRAC in Australia

While the number of people who ever use residential respite before entering PRAC has been steadily increasing over time (blue bars), the proportion of people entering PRAC on the same day they leave residential respite (purple bars) has been increasing at a faster pace.

In 2019–20, most people who used residential respite on the way to PRAC left residential respite and entered PRAC on the same day.

This is consistent with a 2018 report published by the Aged Care Financing Authority for which many submissions noted an increasing trend of people using residential respite care to "try-before-you-buy" permanent residential care. The report notes that this trend may reflect market demand and that providers may give preference to admissions where it is indicated that the person is considering entering permanent care.

The Aged Care Act 1997 defines respite care as:

residential or flexible care (as the case requires) provided as an alternative care arrangement with the primary purpose of giving a carer or a care recipient a short-term break from their usual care arrangement.

According to this definition, residential respite care is offered as a temporary break for carers or the people for whom they provide care. Prior research has shown that accessing residential respite care can delay a person’s entry to PRAC (Harrison et al., 2020). An increase in the practice of using residential respite care to try out permanent residential care might mean there are less places available for people to use residential respite as a short-term carer break.

Not all people who enter PRAC the same day they exit respite will be 'trying before buying' – there are many reasons a residential respite stay might end in PRAC entry. This includes a sudden change in care needs for the person, and/or a sudden change in availability of other formal or informal care. A person may need to enter residential care urgently but may also need time to organise financial or other matters before being admitted as a permanent resident. A provider supplying respite may also use this time to assess the suitability of their service for the resident.

Changes to funding arrangements for different programs can also affect whether people are admitted as respite or permanent residents. Upcoming policy and funding changes may continue to affect these trends, including the availability of short-term funds to help residents settle in at entry to a facility.

Who is most likely to leave residential respite and enter PRAC on the same day?

There were 31,693 people who left residential respite and entered PRAC for the first time on the same day in 2019–20.

Compared to everyone else who entered PRAC for the first time in 2019–20, people who entered directly from residential respite care were:

• more likely to own their own home
• more likely to have dementia
• more likely to come from a culturally and linguistically diverse (CALD) background
• more likely to be aged over 85 years
• more likely to be be female rather than male
• more likely to have an informal carer

Residential respite length of stay

For people who entered PRAC for the first time in 2019–20 and had previously had one residential respite episode, those who entered PRAC on the same day that they left residential respite had a longer length of respite stay than those who entered PRAC at a later date.

The median length of stay for one-off residential respite users who left residential respite and entered PRAC for the first time on the same day was 35 days (ranging from 1 day to 882 days).

In comparison, the median length of stay for one-off residential respite users who entered PRAC for the first time at a later date was 18 days (ranging from 1 to 306 days).

How many times do people use residential respite before entering PRAC?

In 2019–20, 38,590 people who entered PRAC for the first time had previously used residential respite. Most of these people (70%) had only one respite stay before entering PRAC. A small proportion (4%) of people who entered PRAC in 2019–20 had stayed in residential respite four times or more.

Among people who had used residential respite prior to PRAC first admission, people who exited respite on the same day as they entered PRAC were more likely to have 1 respite episode (72%) compared with people who exited respite and entered PRAC at a later date (63%). 

Do people choose a PRAC facility that they have previously used for residential respite?

Among people entering PRAC for the first time in 2019–20, 38,590 people had previously used a residential respite service in 2,523 unique facilities. The way people used residential respite could be categorised into four groups:

• People used one facility for all of their residential respite episodes and their PRAC (72%)
• People chose multiple facilities for their residential respite episodes and one of these facilities for their PRAC (15%)
• People chose one facility for all of their residential respite episodes and a different facility for their PRAC (11%)
• People chose multiple facilities for their residential respite episodes and none of these for their PRAC (2%)

These data show that the majority of residential respite users (27,638 people, 72%) used the same residential aged care service for their respite episode(s) and PRAC. Some people used residential respite in multiple facilities and chose one of those for their PRAC (15%). Even where the person did not enter PRAC on the same day as they left residential respite, they usually came back to the same facility.

Only a small minority of people chose a different facility for PRAC than they had used before for residential respite.

6,714 people used more than one facility for their respite service before entering PRAC. This might reflect a ‘shopping around’ approach to finding a suitable facility for PRAC. Among this group:

• 51% had dementia
• 61% were female
• 82% had an informal carer
• 8% were from a culturally and linguistically diverse (CALD) background

Key messages

• It is becoming more common to use residential respite care on the way to permanent residential aged care over time. This is a different pattern of use than originally envisaged in the Aged Care Act 1997, in which informal care would resume after a temporary break.
• People who move straight from residential respite to permanent residential aged care stay for longer in respite than those who return home.
• This pattern of use may reflect older adults using residential respite care to test out a facility before entering permanent residential aged care. However, only a small minority of people tried more than one facility before entering PRAC. Most people choose to stay in the first facility that they try for residential respite.
• There are many other reasons why a person may use residential respite on the way to permanent residential aged care, including as a means to shorten hospital length-of-stay and to allow time to make financial arrangements.
• The increasing use of residential respite on the way to permanent residential aged care may reduce resources available for those using residential respite for its originally intended purpose.
• Ongoing policy and regulation changes may affect these patterns. The AIHW will continue to update these figures as new data become available. 

References

Carers Australia. (2017). Improving access to aged residential respite care. https://www.carersaustralia.com.au/wp-content/uploads/2020/07/final-residential-respite-care-report-2-1.pdf

Harrison, S., Lang, C., Whitehead, C., Crotty, M., Corlis, M., Wesselingh, S., & Inacio, M. (2020). Residential respite care use is associated with fewer overall days in residential aged care. Journal of the American Medical Directors Association, 21(5). doi:10.1016/j.jamda.2019.08.023