26. Assessment strategies

In 1986, the Report of the Nursing Homes and Hostels Review argued strongly that there was a need for the substantial restructuring of Australia's aged care services. The excessive emphasis on institutional care, the lack of coordination of services and the inefficiency of funding mechanisms were all central issues, as was the failure to develop adequate assessment procedures. Over ensuing years, this led to a number of policy initiatives including the creation of a national assessment program, with the objective of ensuring that older people in need of a substantial level of care and support gain access to the available residential care and community services appropriate to their needs.

In 1984, geriatric assessment teams had been trialed as a way of assessing people who wished to gain entry to Australian nursing homes. These were subsequently adopted as the preferred assessment strategy for nursing home entry, and expanded substantially over ensuing years under the new title of Aged Care Assessment Teams. By 1991 - 92, Aged Care Assessment Teams (often referred to as ACATs) were approving over half of the admissions to nursing homes and hostels.

Today, there is a network of 121 regionally based multidisciplinary Aged Care Assessment Teams which provide services across the entire continent. Some work out of large metropolitan teaching hospitals, others work in rural areas where the 'team' comprises only the community nurse and a part-time clerical assistant. Aged Care Assessment Teams are responsible for determining eligibility for admission to nursing homes (higher dependency residential care), hostels (lower dependency residential care) and for community aged care packages (an intensive form of home-based support akin to hostel level care). They may also recommend a range of Home and Community Care services, including the community options program, although they do not determine eligibility for these latter services. The clients seen by these teams thus include a number of people requiring general advice, referral or some form of assistance in managing their ongoing care in the community.

The most recently available national data from the Aged Care Assessment Teams are for the 1994 - 95 financial year. During this year, 156,156 assessments were undertaken, equivalent to 110 assessments per 1,000 persons aged 70 and over in the Australian population. Almost half of the clients assessed (45%) were recommended for long-term residential care, with 24% of these being for nursing home care and 22% for hostel care. Clients suffering from disabilities relating to mobility, continence or orientation were more likely to be recommended for nursing home care (Lincoln Gerontology Centre, undated).

The table overleaf provides an age by sex breakdown of people who were assessed by Aged Care Assessment Teams in the period from January to June 1994, and the recommendations made. People may be assessed as a result of a referral from a health or social welfare practitioner, or at their own request or that of family members.

For both men and women, the likelihood that some form of residential care would be recommended rose steadily across the three age groups. For women, the proportions range from 16 to 26% for nursing homes, and from 16 to 27% for hostels. For men, the comparable figures were 20 to 28% for nursing homes, and 16 to 21% for hostels. Overall, women were less likely than men to be assessed as requiring nursing home care, although the difference is quite small in the oldest age group. The proportion of hostel recommendations was quite similar among men and women aged 65 to 69, but for the older two groups it was higher for men than for women.

While only a very small proportion was recommended for intensive community-based care (community options or care packages), this is largely a reflection of the very small numbers of aged care packages available at that time, and the fact that Aged Care Assessment Teams do not determine eligibility for community options services. Policy development work is currently under way by the Department of Health and Family Services to determine the feasibility and appropriateness of establishing a national system of independent assessment authorities to assess eligibility for home-based care provided under the Home and Community Care program.

Aged Care Assessment Team clients aged 65 and over; recommendations and assessments by age and sex, Australia, January - June 1994 (%)

References/further reading

Department of Community Services 1986. Nursing homes and hostels review. Canberra: Australian Government Publishing Service (AGPS).

Lincoln Gerontology Centre, Aged Care Group (undated). Aged care assessment program national minimum data set report, July 1994 - June 1995. Melbourne: La Trobe University (mimeo).

Data sources

The databases used here are compiled by Aged Care Assessment Program Evaluation Units located in each State, with responsibility to collate and analyse data collected by Aged Care Assessment Teams in the relevant State or Territory.

Prepared by the Australian Institute of Health and Welfare