19. Changing patterns of care (1988 - 1993)

One of the more important policy developments in Australia over the last decade has been the shift in the balance of care away from the more intensive types of residential care and towards home-based care. Data from the Disability, Ageing and Carers Surveys provide a useful basis on which to examine this changing balance of care by looking at the current location of frail and disabled older people in Australia.

In 1993 the majority of older people with a profound or severe handicap were living in the community (70%). The proportion in health establishments (including those in residential care) increased quite markedly with age; 17% of 65 - 79 year olds were in health establishments compared to 42% for people aged 80 and over. There was also a distinct sex effect, with older women more likely to be in health establishments than older men (46% compared to 34%), a finding consistent with the notion that men are able to remain in the community due to the greater availability of wives as carers for older men. Among the younger age groups, men were more likely than women to be in health establishments. This finding is consistent with the higher prevalence rates of profound and severe handicap among men than women in the pre-retirement years.

The proportion of frail and disabled older people living in the community has increased over the last decade. Between 1988 and 1993, the proportion of people aged 80 and over living in the community increased from 50% to 59%, while the comparable increase in the 65 - 79 age group was from 79% to 84%. These findings are also supported by analyses of administrative by-product data on residency in both hostels and nursing homes, which show an overall reduction in age-specific utilisation rates for nursing homes and hostels (AIHW 1997). These trends are consistent with government policy over the last decade, which has emphasised the need to reduce reliance on residential care in favour of an expanded community care sector. A finer analysis of the health establishment data revealed that this reduction has occurred in both acute care (hospitals) and chronic care facilities, with the trend being most marked in acute care facilities (AIHW 1995).

These increases in the proportion of the older population with a profound or severe handicap and living in the community have impacted differently according to sex and age group, with the shifts being most marked among women and the very old. The proportion of women aged 80 and over increased by 10 percentage points, while for men the increase was only 5 percentage points. Again, these findings are further supported by an analysis of administrative by-product data which examined changes in the age and sex structure of nursing home residents over this period (Gibson et al. 1993).

These changes in the balance of aged care services have important implications for home-based care services, residential care services, the informal support network and society at large. The increased proportion of highly dependent older people living in the community means greater demands on both informal and formal support. Access to respite care has become an increasingly important policy issue, and there has been greater provision and use of home-based respite care, day centre care and residential respite services. In addition, the implications for the roles, rights and expectations of older people need to be considered. Government moves to develop a system of quality appraisal for Home and Community Care services, and to promote community awareness and develop support systems pertaining to elder abuse, are both examples of the recognition of these issues in Australia.

Location of persons aged 65 and over with a profound or severe handicap; sex by age, Australia 1993 (%)

References/further reading

Australian Institute of Health and Welfare (AIHW) 1995. Australia's welfare: services and assistance. Canberra: Australian Government Publishing Service.

Australian Institute of Health and Welfare (AIHW) 1997. Australia's welfare: services and assistance, 1997. Canberra: AGPS (forthcoming).

Gibson D, Liu Z, Choi C 1993. Changing patterns of residential care 1985 to 1992: supply and utilisation. Welfare Division Working Paper No. 3. Canberra: Australian Institute of Health and Welfare.

Working Party on the Protection of Frail Older People in the Community 1994. Report. Aged and Community Care Service Development and Evaluation Reports No. 14. Department of Human Services and Health. Canberra: AGPS.

Data sources

Data presented here are drawn from Australian Institute of Health and Welfare (1995) and unpublished data from the Australian Bureau of Statistics 1993 Survey of Disability, Ageing and Carers.

Prepared by the Australian Institute of Health and Welfare