30. Nursing homes

The Australian system of residential care has traditionally comprised two levels of care - nursing homes (for higher dependency residents) and hostels (for lower dependency residents). Under the recently announced National Aged Care Strategy, these two streams of care are to be combined into one uniform system from 1 October 1997, providing care for residents with a range of dependencies within the one aged care facility.

At 30 June 1996, there were 75,008 nursing home beds in Australia. This is equivalent to 49.5 beds per 1,000 persons aged 70 and over. Over the last decade the ratio of nursing home beds to older people has been progressively reduced. In 1985, the level of provision stood at 66.5 beds per 1,000 person aged 70 and over (in absolute terms, 71,503 beds). During this same period, the supply of hostel places and home-based services has increased, as part of a deliberate plan (the Aged Care Reform Strategy) to reduce the reliance of the Australian aged care system on the more intensive nursing home level of care.

This reduction in the level of provision by 17 nursing home beds per 1,000 persons aged 70 and over, in combination with the introduction of a national aged care assessment program to control eligibility for admission to nursing homes, led to an increase in the dependency levels of nursing home residents. Nursing home residents are classified according to the Residential Classification Instrument (RCI), with high dependency residents receiving an RCI of 1 and lower dependency residents an RCI of 5. Federal funding is tied to the RCI level, with nursing homes receiving higher levels of payment for more dependent residents. In 1987, 30% of nursing home residents fell into the 'high dependency' categories (RCI 1 and 2); in 1996 this proportion had increased to 47%. This targeting of nursing home beds on a more dependent segment of the ageing population was an expected (and desired) outcome of a series of policy reforms, which included not only reduced supply and more systematic assessment for eligibility, but also increased financial incentives for nursing home proprietors to admit more dependent residents.

An important shift in patterns of use for nursing homes occurred over this period. There was a dramatic increase in the number and proportion of admissions for respite, rather than permanent care. The proportion of respite admissions increased from 8% of all admissions in 1991 - 92, to 27% in 1995 - 96 (however, respite residents still account for less than 1% of total bed days in nursing homes). Respite admissions have a maximum length of stay of 62 days in any one financial year.

One predicted correlate of this increasing dependency among nursing home residents was a shorter length of stay, and thus an increase in turnover rates (i.e. admissions per bed per year). This shift has not transpired, however. In 1991 - 92, the turnover rate was 0.54, and in 1995 - 96 it was 0.55. When permanent residents only are considered, the length of stay has actually increased slightly among nursing home residents, with turnover dropping from 0.50 in 1991 - 92 to 0.40 in 1995 - 96. In 1995 - 96, over one-third of people admitted to a nursing home remained for less than two months, with a further 13% staying for between two and six months. The remaining half stayed for six months or more. Using a life-table technique, the median length of stay for this cohort (i.e. those admitted in 1995 - 96) was calculated to be 356 days.

The majority of nursing home residents (72%) were women, although this predominance of women was most evident at older ages. Over half the residents in nursing homes were women aged 80 and over. There were very few younger people with disabilities accommodated in nursing homes, in keeping with government policy to avoid such admissions. Only 2% of residents were aged under 55, with a further 3% being aged between 55 and 64. The majority of residents were aged 80 and over, with 46% aged 80 to 89, and 22% aged 90 and over.

References/further reading

Australian Institute of Health and Welfare 1993. Australia's welfare 1993: services and assistance. Canberra: Australian Government Publishing Service (AGPS).

Australian Institute of Health and Welfare 1995. Australia's welfare 1995: services and assistance. Canberra: AGPS.

Gibson D, Liu Z, Choi C 1995. The changing availability of residential aged care in Australia. Health Policy 32(3):211 - 224.

Data sources

Data presented here are drawn from unpublished residential care data supplied by the Department of Health and Family Services.

Prepared by the Australian Institute of Health and Welfare