28. Care packages and community options

In Australia, two programs provide more intensive home-based care under brokerage-type arrangements - community options projects and community aged care packages.

Community options projects were the first government-led initiative to develop a more intensive form of home-based support. From a pilot phase in 1987, the projects were expanded and brought under the aegis of the Home and Community Care (HACC) program following a positive national evaluation in 1992. However, they retain their separate identity within the HACC program. Community options projects aim to reduce inappropriate admissions to institutional care among highly dependent people and those with complex care needs, but who could nonetheless remain at home with appropriate support. In 1994 over 6,000 people were receiving services from community options projects.

Given the success of the community options projects, a potentially more ambitious scheme was launched in pilot form in 1989 to provide an alternative home-based service for older persons who would otherwise require admission to a hostel at the 'Personal Care' level of admission. ('Personal Care' hostel residents are those who are assessed by Aged Care Assessment Teams as requiring assistance with specified personal care activities.) Originally termed 'hostel options', but renamed community aged care packages in 1992, this program has grown rapidly in recent years, from 527 packages in 1992 - 93 to 4,196 in 1995 - 96, and is expected to reach 6,077 in 1996 - 97. Community aged care packages and community options projects have demonstrated that both highly dependent people and people with complex care needs can be cared for in their homes, and therefore that effective home-based management of people requiring quite intensive levels of care is a feasible alternative to residential care.

Community options projects differ from care packages in that they are aimed at people of all ages; not surprisingly then, 23% of community options clients were aged under 60 years, but only 4% of care package clients. A substantial proportion of both client groups were over 80 years - 59% of care package clients and 37% of community options clients. Women aged over
80 years accounted for 42% of care package clients and 26% of community options clients. Overall, around twice as many women as men were being supported in their homes by these programs, with the ratio of women to men being much higher at more advanced ages.

A majority of care package clients lived alone (61%), as did a substantial proportion of community options clients (43%). This proportion increased at older ages for all female clients and to some extent for male community options clients, with a reverse trend evident for male care package clients. Twenty-five per cent of care package clients had a co-resident carer, and a further 40% had a non-co-resident carer. For community options clients the proportions were 48% and 22%, respectively. These findings both confirm the importance of informal care to maintaining highly dependent frail older people in the community, and the capacity of intensive care packages to fulfil that role in the absence of such support for a certain proportion of clients.

In general, community options clients were somewhat more likely to be highly dependent than care package clients. Both groups were somewhat less likely to be as dependent as 'Personal Care' hostel residents. Nonetheless, there was a significant proportion of the community-based clientele that was highly dependent. Among care package clients, 18% required assistance with eating, 48% with dressing, 18% with mobility inside the house and 60% with showering or bathing. For community options clients, 31% required assistance with eating, 51% with dressing, 28% with mobility inside the house, and 61% with showering or bathing.

  Care package clients Community options clients
Need for assistance with Number Per cent Number Per cent
Eating meals 699 18.4 1,898 31.1
Dressing 1,813 47.9 3,116 51.1
Caring for appearance 1,754 46.3 3,196 52.4
Mobility around house 673 17.7 1,681 27.6
Getting in and out of bed 449 11.8 1,754 28.8
Bathing/showering 2,255 59.5 3,690 60.5
Using telephone 1,257 33.2 2,590 42.6
Using transport 3,499 92.2 5,178 84.9
Shopping 3,630 95.8 5,457 89.6
Meal preparation 3,287 86.7 4,950 81.2
Housework 3,748 98.8 5,851 96.0
Minor home maintenance 3,743 99.0 5,951 97.7
Taking medication 2,206 58.3 3,724 61.2
Managing money/finances 2,763 73.0 3,944 64.8

References/further reading

Mathur S, Evans A, Gibson D 1997. Community aged care packages: how do they compare? Aged and Community Care Service Development and Evaluation Reports No. 32. Canberra: Australian Government Publishing Service (AGPS) (in press).

Data sources

Data presented here are drawn from Mathur et al. 1997.

Source: Mathur et al (1997)