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People's care needs in aged care

Australia’s aged care system offers a variety of services to support the diverse care needs of older Australians.

Last updated: 30 August 2024.

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Care needs in the community
Care needs in permanent residential care
Permanent residential care needs by age
Permanent residential care needs by sex
Permanent residential care needs by age and sex
Permanent residential care needs of Aboriginal and Torres Strait Islander people
Permanent residential care needs of people from culturally and linguistically diverse backgrounds
Permanent residential care needs in states and territories
Permanent residential care needs by remoteness
Permanent residential care needs over time (ACFI)
Permanent residential care needs by dementia status (ACFI)
Where can I find out more?

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The aged care system offers a continuum of care under three main types of service:

  • 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 4 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, and services for specific population groups, 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
  • Department of Veterans’ Affairs community nursing and Veterans’ Home Care services for eligible veterans and their families, which provides support to help people stay independent and in their own home.

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 and Aged Care 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 2022–23:

  • Of the top ten most commonly used home support services, domestic assistance was used by the most people (39% of recipients), followed by allied health and therapy services (30% of recipients). Least used were personal care (8.3% of recipients) and specialised support services including incontinence, dementia, vision and hearing advisory services and client advocacy (6.9% of recipients).
The bar graph shows the proportion of home support recipients using the ten most commonly used services. In 2022–23 domestic assistance and allied health and therapy services were the most commonly used services (39% and 30% of recipients used these services respectively).

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 2023:

  • The most common home care package was Level 2 (40%), followed by Level 3 (34%), Level 4 (21%), and Level 1 (5.2%).
  • Across Australian states Level 2 was the most common home care package in New South Wales and Victoria (44% and 43%, respectively), Level 3 was the most common package in South Australia and Tasmania (40% and 39%, respectively) and Level 3 was the most common package in Western Australia (36%).

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The stacked column graph shows the proportion of people using home care packages by care level across states and territories, at 30 June 2023. Across Australia most home care services were delivered in level 2 packages (40%), followed by Level 3 (34%), Level 4 (21%) and Level 1 (5.2%).

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 2023:

  • Almost 184,000 people living in permanent residential care had a current Australian National Aged Care Classification (AN-ACC) assessment. This represents 99.4% of all people using permanent residential care at 30 June.
  • Most people living in permanent residential care were assessed as having some mobility needs (95%).
  • The majority of people were in the assisted mobility category (58%), followed by the not mobile category (37%) and the independent mobility category (4.7%).
  • The most common AN-ACC classification was Class 5, assisted mobility, higher cognitive ability with compounding factors (20%).
  • The least common AN-ACC classification was Class 3, independent mobility, with compounding factors (1.2%).
  • Around 100 people (0.1%) living in permanent residential care at 30 June were assessed as Class 1, admitted to palliative care.

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The column graph shows the number of people using permanent residential care by Australian National Aged Care Classification (AN-ACC) mobility categories and classification, at 30 June 2023. The majority of recipients were assessed as requiring assisted mobility (58%), followed by not mobile (37%). The classifications with the highest proportion of recipients were class 5 and 7 (20% and 14%, respectively), with class one for palliative care being the lowest (0.1%).

In 2022, The Australian National Aged Care Classification (AN-ACC) replaced the Aged Care Funding Instrument (ACFI) as the tool for assessing the care needs of people entering and living in permanent residential aged care.

The AN-ACC Assessment Tool focuses on the characteristics of residents that drive care costs in residential 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.

Independent assessors use the AN-ACC Assessment Tool to assess a resident’s care needs and assign each resident with an AN-ACC classification. The AN-ACC classification assigned to the resident corresponds to the amount of government funding the approved service provider will receive, based on the residents independently assessed needs.

The assessment tool considers a residents’:

  • physical ability (including pain)
  • cognitive ability (including ability to communicate, socially interact, problem solve, memory)
  • behaviour (including ability to cooperate, physical aggression, problem wandering, passive resistance, verbally disruptive)
  • mental health (including depression and anxiety).

Under the AN-ACC model, independent assessors are trained and qualified aged care clinicians with a minimum of 5 years’ experience as registered nurses, physiotherapists or occupational therapists delivering clinical services in aged care settings.

The AN-ACC model separates care planning done by providers from funding assessments done by independent assessors. The separation of assessors and providers ensures the integrity of the system and that residents’ care needs come before funding decisions. Further, the AN-ACC model is designed to contribute to better planning and quality care of aged care residents.

There are 13 classes of care funding under the AN-ACC model with each class based on the cost of care.

Each class represents residents with similar needs and the cost of staff time to deliver consistent care, whose daily care costs are similar and residents with similar clinical risks and safety indicators.

  • Class 1 is reserved for people near end-of-life. This class allows frail residents with a life-expectancy of less than 3 months, with an approved palliative care plan, to enter a facility without an AN-ACC assessment.
  • Residents identified as Class 2 and 3 are considered ‘Independently mobile’.
  • Residents identified as Class 4–8 are considered as having ‘Assisted mobility’.
  • Residents identified as class 9–13 are considered as being ‘Not mobile’.

For more information about AN-ACC, see the AN-ACC Reference Manual and AN-ACC Assessment Tool and the AN-ACC Funding Guide on the Department of Health and Aged Care website.

Permanent residential care needs by age

Although the majority of people using aged care services are aged 65 and over, people aged under 65 can also access these services. In permanent residential care, people in different age groups have different patterns of care needs. Mobility steadily decreases with each age group over 65 years.  

Government-subsidised aged care in Australia is provided based on need, not age. As such, sometimes younger people (aged under 65 years) enter permanent residential aged care to have their care needs met. For more information about this age cohort, see Younger people in residential aged care.

At 30 June 2023:

  • The proportion of people in the independent mobility category decreased with age from age 65, from 9.1% of people aged 65–69 to 1.1% of people aged 100 and over.
  • The age group with the highest proportion in the assisted mobility category was people aged 90-94 (62%), compared with people aged 0–49 who had the lowest proportion (23%).
  • The proportion of people in the not mobile category was highest among people aged 0–49 (67%), followed by those aged 50–54 (50%), 55–59 (49%) and 100 and over (45%).

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The stacked column graph shows the proportion of assigned mobility categories for people using permanent residential care by age group, at 30 June 2023. Those aged 50–54 had the highest proportion of people in the independent mobility category (11%), from this age the proportion of people in this category decreased with increasing age.

Permanent residential care needs by sex

Men and women have different life experiences that lead to them having different care needs when living in permanent residential care. Both sexes reported similar proportions of mobility across the three mobility categories of independent mobility, assisted mobility and not mobile.

At 30 June 2023:

  • A slightly higher proportion of men were in the independent mobility category compared with women (6.1% and 4.0%, respectively).
  • There were similar proportions of women and men in the assisted mobility category (58.7% of women compared with 58.3% of men).
  • A slightly higher proportion of women were in the not mobile category compared with men (37.3% and 35.6%, respectively).

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The stacked column graph shows the proportion of assigned mobility categories for people using permanent residential care by sex, at 30 June 2023. Men and women had similar proportions across the mobility categories.

Permanent residential care needs by age and sex

From age 65, mobility generally decreases with each age group and care needs generally increase. Women were more likely than men to have some mobility needs at every age group.

At 30 June 2023:

  • The groups with the greatest proportion of people in the independent mobility category were men aged 0–49 (15%) and women aged 50–54 (10%).
  • The groups with the greatest proportion of men and women in the not mobile category were aged 0–49 (65% and 70%, respectively). This may include younger people with disability living in residential aged are.
  • The lowest proportion of people in the not mobile category were women aged 85–89 (35%) and men aged 90–94 (32%).

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The stacked column graph shows the proportion of assigned mobility categories for people using permanent residential care by age group and sex, at 30 June 2023. Overall, men had higher proportions of people assessed in the assisted mobility category, and women had higher proportions of people who were assessed in the not mobile category across all age groups.

Permanent residential care needs of Aboriginal and Torres Strait Islander people

Aboriginal and Torres Strait Islander (First Nations) people face multiple health and social disadvantages. As a consequence, they are more likely to develop serious medical conditions earlier in life and have a lower life expectancy than their non-Indigenous counterparts. In recognition of poorer health among First Nations communities, aged care services are offered to First Nations people from age 50.

In practice, First Nations people may face barriers to accessing and using aged care services for complex, inter-related reasons, including remoteness, language barriers, and the effects of racism and continued socioeconomic disadvantage. Delivering culturally appropriate aged care can improve access to, and the quality of, aged care for First Nations people. The National Aboriginal and Torres Strait Islander Flexible Aged Care (NATSIFAC) Program provides culturally appropriate care for First Nations people in certain locations, mostly in rural and remote areas, which are close to their communities.

You can learn more about Indigenous Australians in aged care by viewing the Aboriginal and Torres Strait Islander people dashboard, or view the First Nations topic on the AIHW website.

At 30 June 2023:

  • There was a greater proportion of First Nations people in the independent mobility category compared with non-Indigenous people (6.1% and 4.6%, respectively).
  • There were fewer First Nations people in the assisted mobility category than non-Indigenous people (56% and 59%, respectively).

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The stacked column graph shows the proportion of assigned mobility categories for people using permanent residential care by Indigenous status, at 30 June 2023. Compared with non-Indigenous people, First Nations people had slightly lower proportions of people in the assisted mobility category, but slightly higher proportions of people assessed in the independent mobility or not mobile categories.

Permanent residential care needs of people from culturally and linguistically diverse backgrounds

Many older Australians were born overseas, speak a variety of languages, may not speak English fluently or have diverse cultural and religious and cultural practises. These groups of people are referred to as being culturally and linguistically diverse (CALD). Older CALD Australians may face additional barries when engaging with aged care services and the supports they may require.

Cultural and linguistic factors may influence how people access and engage with aged care services as well as how their needs are assessed while using aged care. Due to data availability, this section focuses on country of birth and preferred language as measures of cultural and linguistic diversity.

At 30 June 2023:

  • A greater proportion of people born in non-English-speaking countries were in the not mobile category compared with people born in Australia and people born in other mainly English-speaking counties (41%, 36% and 34%, respectively).
  • People who preferred to speak other languages had a greater proportion of people in the not mobile category compared with people who preferred to speak English (42% and 36%, respectively).

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The two stacked bar graphs show the proportion of assigned mobility categories for people using permanent residential care by country of birth and preferred language, at 30 June 2023. People born in non-English-speaking countries had the highest proportion of people assessed as not mobile and lowest proportion of people in the independent mobility category (41% and 4.1% respectively). Similarly, recipients who preferred to speak languages other than English had higher proportions people assessed in the not mobile category and lower proportions of people assessed in the independent mobile category, compared with people who preferred to speak English.

Permanent residential care needs in states and territories

The AN-ACC classifications of people living in permanent residential care vary across Australia.

At 30 June 2023:

  • Western Australia and Victoria had the highest proportion of people in the independent mobility category (5.9% and 5.2% respectively) while Tasmania had the lowest (2.3%).
  • The Australian Capital Territory had the highest proportion of people in the assisted mobility category (64%) while the Northern Territory had the lowest (51%).
  • The Northern Territory had the highest proportion of people in the not mobile category (46%), while the Australian Capital Territory had the lowest (32%).

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The stacked column graph shows the proportion of assigned mobility categories for people using permanent residential care by state and territory, at 30 June 2023. The Northern Territory followed by Tasmania had the highest proportion of people who were assessed as not being not mobile (46% and 40%, respectively). The Australian Capital Territory followed by Western Australia had the highest proportion of recipients who were assessed in the assisted mobility category (64% and 61%, respectively). Finally, Western Australia followed by Victoria had the highest proportion of people in the independent mobile category (5.9% and 5.2%, respectively).

Permanent residential care needs by remoteness 

People’s care needs and access to aged care services are also impacted by how regional or remote the location is in which they live and the types of aged care services available. Remoteness reported in this section is based on the location of the residential care facility (service) from which care is delivered.

At 30 June 2023:

  • A greater proportion of people were in the independent mobility category in rural and remote areas (MM 3 – MM 7) compared with metropolitan areas (MM 1) and regional centres (MM 2).
  • Very remote communities (MM 7) had the highest proportion of people in the independent mobility and assisted mobility categories (7.8% and 64%, respectively).
  • Metropolitan areas (MM 1) had the highest proportion of people in the not mobile category (38%).
  • There was a gradual decrease in the proportion of people in the not mobile category from 38% in metropolitan areas (MM 1) to 33% in small rural towns (MM 5).

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The stacked column graph shows the proportion of assigned mobility categories for people using permanent residential care by remoteness, at June 30 2023. People in less densely populated areas (MM 5‒7) had higher proportions of people assessed in the independent mobile category.

The Modified Monash Model (MMM) is one of several classifications for defining whether a location is a city, rural, remote, or very remote. The model measures remoteness and population size on a scale of Modified Monash (MM) category MM 1 to MM 7. MM 1 is a metropolitan area, including Australia’s major cities, and MM 7 is a very remote community, such as Longreach. You can learn more about MMM on the Department of Health and Aged Care website.

On 1 October 2022, the Australian National Aged Care Classification (AN-ACC) residential care funding model replaced the Aged Care Funding Instrument (ACFI).

The ACFI was a tool for assessing the care needs of people entering and living in permanent residential aged care between 2008 and 2022. The tool was 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 and 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. If a person is assessed as having nil or minimum care needs in a particular domain, the provider receives no funding for that domain for that person. Reappraisals can be undertaken as a person’s needs change.

To find out more about the ACFI and subsidy amounts, see the Aged Care Funding Instrument (ACFI) User Guide on the Department of Health and Aged Care website.

Permanent residential care needs over time (ACFI)

This section is based on the ACFI up to 30 June 2022 because there is insufficient data to report on trends based on the AN-ACC. For more information on the ACFI, see the Care need ratings in permanent residential care (ACFI) section.

The proportion of people assessed as having high care needs when they first enter permanent residential care has increased over time.

Trends over time for the 10 years from 2012–13 to 2021–22 indicate that:

  • High care ratings when first entering permanent residential care have become more common for activities of daily living (from 36% to 58% of people) and cognition and behaviour (from 35% to 55% of people). Ratings for complex health care have fluctuated, reflecting changes to the rating method for complex health care that were introduced in January 2017.
  • 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 11% to less than 1% of people), and the largest decrease in low care ratings for activities of daily living (from 32% to 8.9%).

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The line graph shows the proportion of care need ratings at first assessment for people in permanent residential care by care domain over time (2012–13 to 2021–22). The proportion of high care need ratings has increased for activities of daily living and cognition and behaviour over the years. However, 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.

Permanent residential care needs by dementia status (ACFI)

This section is based on the ACFI up to 30 June 2022 because the AN-ACC does not collect information about health conditions (including dementia). For more information on the ACFI, see the Care need ratings in permanent residential care (ACFI) section.

People with dementia tend to have higher care needs than people without dementia. These differences are also reflected in care need ratings of people in permanent residential care, as assessed by the ACFI. To learn more about how dementia affects people in Australia, see the dementia topic on the AIHW website.

At 30 June 2022:

  • The majority of people with dementia (83%) and over half (51%) 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 (71% compared with 65%).
  • High care need ratings for complex health care were more common for people without dementia (60%) than with dementia (56%).

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The stacked column graph shows the proportion of care need ratings for people in permanent residential care by dementia status and care domain, at 30 June 2022. The majority of people with dementia were assessed as having high care needs for cognition and behaviour (83%), compared with just over half (51%) of people without dementia.

Where can I find out more?

Related information can be found on other GEN topic pages:

For a confidentialised unit record file (CURF) on this topic, view the GEN data: People’s care needs in aged care.

 

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