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The Australian aged care system provides a range of services that support older people—and a small number of younger people with disability—in both a residential and community setting.

There are two types of aged care provided in residential aged care facilities, both of which are available on a low-care or high-care basis depending on the individual’s needs (see Box 1). In addition, flexible aged care services provide care in mixed delivery settings, and are designed to meet the needs of recipients in ways other than that provided through mainstream community and residential aged care—examples include the Transition Care Program and the National Aboriginal and Torres Strait Islander Flexible Aged Care program.

Box 1: Residential aged care: permanent and respite

Two types of aged care provided in residential aged care facilities: permanent and respite care (see below). Client eligibility for both of these is determined through a mandatory assessment carried out by an Aged Care Assessment Team/Service (see Accessing aged care services).

Funding for residential aged care facilities is calculated using the Aged Care Funding Instrument (ACFI). Using the ACFI, a residential aged care facility will assess the care needs of residents requiring permanent care—it is not used for residents requiring respite care. Once the care needs have been assessed, the outcomes are then used in determining the funding to be paid to the aged care provider.

Permanent residential aged care is offered to people who can no longer be supported living in the community. Using the ACFI, a residential aged care facility will assess the care needs of residents requiring permanent care. Depending on a person’s assessed needs, permanent care is currently offered at two levels: low care and high care. Assessments focus on a person’s physical, medical, psychological, cultural and social needs. Permanent residents receiving low-care require accommodation and personal care, and residents receiving high-care require 24-hour nursing care in addition to their low-care needs.

Residential respite care is short-term care in aged care facilities. It is available on a planned or emergency basis to older people who intend returning to their own home yet need residential aged care on a temporary basis. It supports older people in transition stages of health, as well as being used by carers to provide them with a break from their caring duties. Residential respite care is provided on either a low-care or high-care basis.

The Community Aged Care Package (CACP), Extended Aged Care at Home (EACH) and EACH Dementia (EACHD) programs—collectively referred to as ‘community packaged care' for the purpose of these factsheets—provide individually tailored packages of care to people with complex care needs, but who are able to live at home with assistance (see Box 2). CACPs offer low-level care, while EACH and EACHD offer high-level care.

Other community care programs—which are not detailed in this series of factsheets—that provide support to older people include:

The largest of these, HACC, provides a wide range of basic maintenance and support services to frail older people and older people with disability.

An annual report on HACC activities, derived from the HACC National Minimum Data Set (320KB PDF) is published by the Department of Health. 

Box 2: Community packaged care: CACP, EACH and EACHD programs

The CACP, EACH and EACHD programs are alternatives to residential aged care, designed to provide choices of care and individually tailored packages.

The services the packages provide are co-ordinated (and may also be delivered) by care providers who are approved under the provisions of the Aged Care Act 1997 (Approved Providers). The CACP, EACH and EACHD programs are funded by the Australian Government in the form of subsidies paid to the approved providers. Client eligibility for the packages is determined through a mandatory assessment carried out by an Aged Care Assessment Team (ACAT)1 (see Accessing aged care services).

Type of care available

Broadly speaking, CACP is equivalent to low-care in a residential aged care facility and EACH and EACHD are equivalent to high-care in a residential aged care facility.

The type of care available through CACP packages may include: domestic assistance, meals at home and other food services, transport services, home or garden maintenance, social support, personal care, counselling, equipment and home modifications, respite care and linen services.

Assistance available through EACH packages is similar to CACP, but to a higher degree, and may also include nursing and allied health/therapy. EACHD packages provide similar care to EACH packages, but also involve care and links to services directed specifically at managing challenging behaviour associated with dementia.

1. In Victoria, this is known as an Aged Care Assessment Service.

A new direction in aged care

The Living Longer Living Better aged care reform package was passed into law on 28 June 2013. The reform package gives priority to providing more support and care in the home, better access to residential aged care, more support for those with dementia and strengthening the aged care workforce.

From 1 August 2013, the existing CACP, EACH and EACHD packages were replaced with four levels of Home Care Packages. Existing CACP will be equivalent to level 2 and EACH and EACHD will be equivalent to level 4 home care. A dementia supplement is available at each level if the client meets certain criteria, to assist the care provider to deliver services appropriate to the client’s care needs.

The new Australian Government has committed to establish a five-year Healthy Life, Better Ageing Agreement, with further reforms anticipated for the care of older Australians.

Aged care spending

In 2011–12, direct government expenditure on aged care programs and services was approximately $12.9 billion (note that this does not include all Australian Government or state and territory government expenditure on caring for older people, as some components are allocated to other areas of expenditure). Of this, nearly $9 billion was spent on residential aged care and just over $3 billion on community care (Table 1). This provided 252,890 residential and community care places.

Table 1: Government recurrent expenditure on aged care services, by type of service, 2011–2012 ($Million)
Expense type NSW Vic Qld WA SA Tas ACT NT Australia (a)
Assessment and information (b) 34.8 25.6 18.1 10.9 10.3 2.9 1.3 1.7 108.7
Residential care services (c) 3,000.8 2,341.9 1,651.8 727.3 873.2 232.2 91.0 29.0 8,939.9
Community Aged Care Packages (CACPs) 186.9 146.2 88.8 49.9 47.0 14.7 7.9 8.0 549.5
Extended Aged Care at Home (EACH) 91.8 74.5 69.1 55.3 17.8 7.2 10.4 4.2 330.3
EACH Dementia (EACH-D) 42.6 36.9 36.0 23.9 9.7 4.3 3.0 1.3 157.6
Other Community care services (d) 620.0 486.4 457.2 203.5 164 61.8 27.1 16.2 2049.5
Services provided in mixed delivery (e) 199.1 140.3 115.8 76.0 92.0 22.1 5.7 11.8 725.9
Total expenditure 4,176.0 3,251.8 2,436.8 1,146.8 1,214.0 345.3 146.4 72.2 12,861.3
  1. Includes Australian Government expenditure that cannot be attributed to individual states or territories.
  2. Includes Australian Government expenditure on the Aged Care Assessment Program (ACAP), additional COAG funding for ACATs, Commonwealth Respite and Carelink Centres and Carers Information and Support.
  3. Includes DoHA, DVA and State and Territory governments’ funding and expenditure.
  4. Includes the Home and Community Care (HACC) program, National Respite for Carers Program (NRCP), Veterans Home Care (VHC), DVA Community Nursing and Assistance with Care and Housing for the Aged. The expenditure for HACC in Victoria and WA includes only that under the HACC review agreement.
  5. Includes Multi-Purpose Service (MPS) program, Transition Care Program (TCP), National Aboriginal and Torres Strait Islander Flexible Aged Care Program, Day Therapy Centres, Continence Aids Assistance Scheme, Continence Aids Payment Scheme, National Continence Program, Innovative Care Pool, Dementia Education and Support, Longer Stay Older Patients (LSOP) Initiative, Financial Assistance for LSOP, Community Visitors Scheme and Culturally and Linguistically Diverse expenditure.

Source: SCRGSP (Steering Committee for the Review of Government Service Provision) 2013: Table 13.1.

The Australian Government has historically based the allocation of places on the size and location of the population aged 70 and over. In 2011–12, places in aged care programs and services were allocated across Australia with the objective of equitable distribution across 73 Aged Care Planning Regions.

Expenditure on aged care services by jurisdiction broadly reflects the distribution of the population aged 70 and over (Figure 1).

Figure 1: Distribution of the Australian population aged 70 and over and recurrent government expenditure on aged care, by state and territory, 2011–12 (per cent)

FS1 Expenditure on aged care by state PNG

Note: The expenditure estimates do not include all Australian or state and territory government expenditure on caring for older people—see notes under Table 1 for inclusions.

Source: SCRGSP 2013: Table 13.1.

Who uses aged care?

People aged 70 and over (or 50 and over if Indigenous) are used as a ‘planning population’ for the allocation of aged care places; however, note that services for older people are provided on the basis of frailty or functional disability, rather than on specific age criteria. Some younger people are currently using aged care services, where no other appropriate care is available.

In 2011–12, 79,395 people used community packaged care (that is, CACP, EACH or EACHD) and 247,290 people used residential aged care. Other large scale programs include Home and Community Care (HACC—over 900,000 clients per year), Veterans’ Home Care (VHC—over 71,800 clients per year) and National Respite for Carers Program (NRCP—109,210 people in 2011–2012).

The median age of clients in permanent residential aged care at 30 June 2012 was 86. The corresponding ages for packaged care programs were CACP (83), EACH (82) and EACHD (83). Most older Australians prefer to remain in the community as long as possible. At 30 June 2012, about 54,000 people received a CACP (79%), EACH (14%) or EACHD package (6%) to help them stay living in the community. The majority (68%) of these clients were women.

In recent years, around 8–9% of the population aged 70 and over received residential aged care on a permanent basis. Over two-thirds (70% in 2011–12) of people living in residential aged care facilities were women and 77% were aged 80 and over. In 2011-12, 64% of new admissions required high care.

References

SCRGSP (Steering Committee for the Review of Government Service Provision) 2013. Report on Government services 2013. Canberra: Productivity Commission.

Glossary of aged care terms