27. Home and Community Care (HACC) program

Prior to 1985, home-based care services in Australia were scanty and poorly coordinated. The problem had been raised in a succession of government reviews and inquiries, but gained particular prominence in a report of the House of Representatives Standing Committee on Expenditure in 1982. One consequence was the Home and Community Care (HACC) program, announced in the 1984 budget, and aimed at substantially improving the quantity and range of services available to frail and disabled older people living at home.

In the years that followed, both the quantity and variety of services increased substantially. Between 1985 - 86 and 1991 - 92, expenditure on this program doubled in real terms. In addition to the more commonly available areas of home nursing, home help and delivered meals, there was an expansion of centre-based and in-home respite services, transport services, gardening, and home handyman assistance. This rapid growth has not continued in recent years, although expansion of the program has, in broad terms, been sufficient to keep pace with the growth in the size of the dependent aged population for most service types (AIHW 1997).

In 1995 - 96, there were 399 hours of home help provided per 1,000 persons aged 70 and over, 169 hours of home nursing, and 114 hours of personal care. In terms of absolute hours of service provided, nationally there were 588,300 hours of home help, 249,300 hours of home nursing and 167,200 hours of personal care. Further details of hours of service per 1,000 persons aged 70 and over, and the absolute number of hours provided are given for other service types in the table below.

Most HACC clients (69%) were women, with 29% being women aged 80 and over. Overall, 40% of clients were aged 80 and over, with 19% being aged under 65. The HACC program includes as part of its target group younger people with disabilities as well as older people and their carers. Perhaps one of the most pronounced differences in the age profiles of HACC and residential care clients is to do with the proportion aged 90 and over. While only 6% of HACC clients fell into this category, 19% of hostel and 22% of nursing home residents were aged 90 and over. For the more intensive forms of community care (community options and care packages), the comparable figures were 6% and 13% (Jenkins 1996). This pattern suggests that home-based care may less frequently be an option for clients in the 90 years and over age category.

Just over one-half of HACC clients lived alone, although this proportion increased with age. Women were more likely to live alone than were men. Among female clients aged 80 and over, 66% lived alone. On average, 38% of HACC clients had a resident carer; this proportion was higher for men than for women, and higher among younger rather than older clients. So, while 59% of clients under 55 had a co-resident carer, only 38% of those over 80 did so. Moreover, among those aged 80 and over, the proportions with a co-resident carer were 50% for men, but only 32% for women (Jenkins 1996).

HACC service provision levels by service type, Australia 1995 - 96

References/further reading

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

Fine M 1992. Community support services and their users: the first eighteen months. SPRC Reports and Proceedings No. 100. Sydney: University of New South Wales.

Graham S, Ross R, Payne T, with Matheson G 1992. The evaluation of community options in New South Wales. SPRC Reports and Proceedings No. 103. Sydney: University of New South Wales.

House of Representatives Standing Committee on Expenditure 1982. In a home or at home: accommodation and home care for the aged. Canberra: AGPS.

Jenkins A 1996. Client profiles for aged care services in Australia. Welfare Division Working Paper No. 11. Canberra: AIHW.

Data sources

Data presented here are drawn from unpublished
data from the 1993 - 94 HACC Service Users Characteristics Survey and the 1995 - 96 HACC Service Provision Data Collection, supplied by the Department of Health and Family Services.

Prepared by the Australian Institute of Health and Welfare