Aged care

activities of daily living: the section of the ACFI assessment that looks at a person’s need for support in day to day life. The ratings are based on the level of support required with eating, mobility, bathing, getting dressed, and toileting.

admission: in the context of aged care, this is an entry into aged care services. People who enter residential aged care or home care are counted as an admission on each entry to that care type. There are two types of admission to residential care: permanent admission and respite admission.

admitted patient care: care for a patient who has undergone a hospital admission process to receive treatment or care. This treatment or care is provided over a period of time and contrasts with non-admitted patient care.

Aged Care Act 1997: the Commonwealth legislation that sets out the framework for Government funding and service provision of aged care.

Aged Care Assessment Team (ACAT): a multidisciplinary team of health professionals that determines eligibility for government-subsidised residential aged care, home care packages, and transition care. ACATs assess the type and level of care that people require. An ACAT may include a doctor, nurse, social worker and/or other health professionals. In Victoria, ACAT is known as Aged Care Assessment Services (ACAS).

Aged Care Funding Instrument (ACFI): tool used to assess the care needs of people in permanent residential aged care and allocate subsidies to residential aged care services. As a resource allocation tool, it focuses on those care needs that contribute most to the cost of care.

Aged Care Planning Region (ACPR): geographic regions used by the Australian Government in the planning process to determine the distribution and types of aged care places to be made available across Australia.

aged care: various assistance, personal care and nursing services aimed at older people. See also home support, home care and permanent care.

Anatomical Therapeutic Chemical (ATC) Classification System: an international structure of classifying active substances in medicines across 5 levels:

• Level 1: anatomical main group (the organ or system in the body on which the substance’s therapeutic effect takes place)
• Level 2: pharmacological/therapeutic subgroup
• Level 3: chemical/pharmacological/therapeutic
• Level 4: chemical/pharmacological/therapeutic
• Level 5: chemical substance (this takes into account the medicine’s therapeutic use as well as the formulation and route of administration)

See also defined daily dose.

antibiotic medicines: these are antibacterial medicines, meaning that they inhibit or destroy microorganisms (bacteria). ‘Antibiotics’ here refer to those antibacterial medicines prescribed for systemic use (the medicine generally affects the whole body, for example by being absorbed through the gut).

anti-dementia medicines: these may slow the progression of dementia or relieve its symptoms and are commonly prescribed for people with mild-to-moderate Alzheimer disease.

antidepressant medicines: these are used to treat symptoms of depression. Different antidepressant medicines can have very different modes of action.

anti-Parkinson medicines: these treat the symptoms of Parkinson disease (a progressive nervous system disorder characterised by tremors, muscle rigidity and postural changes) or other similar symptoms.

antipsychotic medicines: these can be used to manage the symptoms of certain mental health conditions, such as schizophrenia (where delusions, hallucinations and paranoia are common symptoms), or to manage the behavioural symptoms of dementia. They are also known as neuroleptics or major tranquilisers.

assessment: can refer to either:

• Assessment of eligibility for subsidised aged care by an Aged Care Assessment Team.
• Assessment of care needs in permanent residential aged care using the Aged Care Funding Instrument.

Australian Medicines Handbook (AMH): a national list of medicines and related comparative information, including treatment considerations reflecting current Australian practice.

average length of stay: the average length of stay for a group of people. It is calculated by adding up all the days of care and dividing by the number of periods of care.

benzodiazepine medicines: these can be used to manage the symptoms of certain mental health conditions, such as various anxiety disorders, or to manage the behavioural symptoms of dementia. They commonly have sedating and muscle-relaxing effects.

care domain: the three areas of care needs that are assessed in the ACFI assessment, namely: Activities of Daily Living, Cognition and Behaviour, and Complex Health Care.

care level: home care is provided with varying levels of support, namely: Level 1 (for basic needs), Level 2 (low needs), Level 3 (intermediate needs), and Level 4 (high needs).

care need rating: the rating of a person’s need for support in an ACFI assessment. The ratings are: high, medium, low and nil. A rating is produced for each of the 3 care domains.

chronic obstructive pulmonary disease (COPD): serious, progressive and disabling long-term lung disease where damage to the lungs (usually because of both emphysema and chronic bronchitis) obstructs oxygen intake and causes increasing shortness of breath.

cognition and behaviour: the section of the ACFI assessment that looks at a person’s care needs in relation to cognitive skills and their behaviours. The ratings are based on assessments of cognitive impairments such as loss of memory, and on people’s behavioural patterns such as wandering away from their suitable place of care.

cohort: a group of people who share a similar characteristic (for example, age).

cardiovascular system/disease: this refers to the circulatory system, namely the heart (cardio) or blood vessels (vascular). Cardiovascular disease is any disease affecting this system, such as angina, heart attack or stroke.

Commonwealth Home Support Program (CHSP): an Australian Government-funded aged care program which provides entry-level support services such as domestic assistance for older people (everyone aged 65 and over, and Indigenous people aged 50 and over) so that they can continue to live independently at home. This program integrated various services previously providing basic home support (including the Commonwealth Home and Community Care program (HACC), National Respite for Carers, Day Therapy Centres and Assistance with Care and Housing for the Aged). States and territories transitioned from HACC to CHSP at different times between 2015 and 2018.

complex health care: the section of the ACFI assessment that looks at medical needs. The ratings are based on a person’s usual requirements (not those after a period of specific illness), such as the provision of drugs and other medical procedures.

core activity need for assistance: self-reported information from the Census (conducted by the Australian Bureau of Statistics) recording whether a person needs help with daily activities, such as eating, moving about, and communicating.

defined daily dose: a World Health Organization (WHO) measure for estimating the consumption of a medicine that can be used to compare volume of medicine use. For most distinct medicines, the WHO determines the assumed average maintenance dose per day for its main indication in adults. Using this in combination with the prescribed quantity and amount of medicine allows for an estimate of how many days the prescription will last.

dementia: a general term for disorders characterised by worsening mental processes (include impaired memory, understanding, reasoning and physical functioning). Common types of dementia are Alzheimer disease and vascular dementia. Dementia can be identified from multiple sources; in aged care this information is commonly captured in assessments such as the Aged Care Funding Instrument.

depression: a mental health condition characterised by low mood and other symptoms. When recorded in the ACFI assessment, this broad term includes affective (mood) disorders, bipolar disorder and related conditions.

diagnostic imaging: The production of diagnostic images; for example, computed tomography, magnetic resonance imaging, X-rays, ultrasound and nuclear medicine scans.

dialysis: this is a medical procedure that artificially cleans the blood to remove waste products that build up (a function that kidneys would normally perform). It is most often required due to kidney failure. 

digestive diseases: this refers to conditions that affect the digestive system, including the gastrointestinal tract, liver or pancreas. These conditions can be acute (such as diarrhoea and gastroenteritis) or chronic (such as hepatitis and inflammatory bowel conditions). 

discharge reason: in the context of aged care, this is the reason for an exit from aged care services. The reasons recorded for leaving aged care are: death, going to hospital, transferring to another care facility or another program (depending on which program a person is leaving), returning home, and other reasons.

distinct medicines: these are identified by the lowest level of the ATC classification (level 5). See also Anatomical Therapeutic Chemical (ATC) Classification System and medicine types.

emergency department presentation: the presentation of a patient at an emergency department occurs following the arrival of the patient at the emergency department. It is the earliest occasion of being registered clerically, or triaged. The full stay is the period between when a patient presents at an emergency department, and when that person is recorded as having physically departed the emergency department. See also non-admitted patient care.

exit: in the context of aged care, this is leaving an aged care service. Also known as ‘discharge’. The discharge reason is recorded. When a person leaves aged care services, the time that they had spent receiving that type of care is added up to calculate the length of stay.

external cause: this is based on information coded within the hospital system and can be used define the mechanism of an injury (for example, that it related to a fall).

eye diseases: these are conditions that affect the eye or related parts of the body such as eyelids. Common eye diseases are cataracts and macular degeneration. 

fall-related injury: these are based on information coded within the hospital system, where the principal diagnosis for the hospitalisation was an injury, the external cause was a fall and the person had not been admitted as a transfer from another hospital.

flexible care: an aged care stream that addresses people's needs, in either a residential or home care setting, in ways other than the care provided through the mainstream residential and home care programs. Flexible care programs include Multi-Purpose Services, the National Aboriginal and Torres Strait Islander Flexible Aged Care Program, and Innovative Pool. Some publications also include transition care and short-term restorative care under the term ‘flexible care.’

general practitioner (GP): a medical practitioner who provides comprehensive and continuing care to patients and their families within the community. See also GP attendance.

GP attendance: a GP attendance is an unreferred patient-doctor encounter (with Medicare funding benefits), such as a visit, consultation and attendance (including a video conference) with a medical practitioner who has been recognised as a general practitioner for the purposes of Medicare benefits.

home care: see Home Care Packages Program.

Home Care Packages Program: an Australian Government-funded aged care program which provides support and care services to older people in their homes. Services are offered in packages of care, which can consist of personal care and domestic support, as well as clinical and allied health services. There are four levels of care to support those with basic (Level 1), low (Level 2), intermediate (Level 3), and high (Level 4) care needs. The program launched in 2013, combining previous community-based aged care packages under one: Community Aged Care Package (CACP), Extended Aged Care at Home (EACH), and Extended Aged Care at Home Dementia (EACHD).

home support: see Commonwealth Home Support Program.

hospital: A health-care facility established under Commonwealth, state or territory legislation as a hospital or a free-standing day procedure unit and authorised to provide treatment and/or care to patients. Hospital services are provided to a patient who is receiving admitted patient care or non-admitted patient care in a hospital (excluding community health services, health research done within the hospital, non-admitted dental services, patient transport services and public health activities). They can include hospital services provided off-site, such as in the patient’s home.

hospital separation: episodes of care for admitted patients start with the formal admission process and end with the formal separation process. Only completed episodes of care for the reference period are reported here. These can be total hospital stays (from admission to discharge, transfer or death), or portions of hospital stays (beginning or ending in a change of care type within the hospital system, rather than entering or leaving the hospital system). See also overnight and same-day separations.

International Statistical Classification of Diseases and Related Health Problems (ICD): The World Health Organization’s internationally accepted classification of death and disease. The Tenth Revision (ICD-10) is currently in use. The ICD-10-AM is the Australian Modification of the ICD-10; it is used for diagnoses and procedures recorded for patients admitted to hospitals.

interquartile range: a measure of variability based on dividing values in to quartiles (four equal parts). The interquartile range shows the first and third quartile in a list of observations (the second quartile, or the midpoint, being the median).

mainstream aged care: an aged care stream that includes both types of residential aged care (permanent and respite), as well as home care. Mainstream care does not include places in flexible care. Some publications refer to places in mainstream aged care as 'non-flexible places.'

median: the midpoint of a list of observations that have been ranked from the smallest to the largest. The median age, for example, is the age point at which half the population is older than that age and half is younger than that age. See also interquartile range.

Medicare: a national, government-funded scheme that subsidises the cost of personal medical services for all Australians and aims to help them afford medical care. The Medicare Benefits Schedule (MBS) is the listing of the Medicare services subsidised by the Australian Government. The schedule is part of the wider Medicare Benefits Scheme (Medicare).

medication management review: an MBS item for GP-initiated reviews of a person’s medications by a pharmacist (separate MBS items apply for people living in the community and people living in residential aged care).

medicine: these are active chemical substances (such as drugs or other preparations) that treat, manage or prevent a disease. They can be taken, for example, orally, as skin patches, injected or inhaled. Some medicines are only available on the prescription of a registered practitioner and can only be bought from a pharmacy. In these cases, they can be subsidised through the Pharmaceutical Benefits Scheme (PBS) (or bought privately from a pharmacy without attracting a PBS subsidy). Many medicines can also be bought over-the-counter from a pharmacy or retail outlet without a prescription.

medicine types: particular chemical substances (medicines) can be grouped up to a level within the Anatomical Therapeutic Chemical (ATC) Classification System. In some publications, ‘medicine type’ refers to particular ATC level groups.

Multi-Purpose Service: services in regional, rural and remote areas, providing access to a mix of aged care, health, and community services.

musculoskeletal diseases: group of conditions that relate to muscles, joints and bones. Specific conditions include different types of arthritis, back pain and osteoporosis (low bone density).

National Aged Care Data Clearinghouse (NACDC): a database bringing together aged care data from various sources, particularly the administrative data that are collected through Australian Government-funded aged care programs. 

National Death Index (NDI): a database developed and maintained by the AIHW, listing all deaths that have occurred in Australia since 1980.

National Hospital Morbidity Database (NHMD): a compilation of episode-level records from admitted patient morbidity data collection systems in Australian public and private hospitals.

nervous system: refers to the system in the body that controls internal functions of the body and receives, interprets, and responds to stimuli, namely the brain, spinal cord and nerves.

non-admitted patient care: care for a patient who does not undergo a hospital's formal admission process. Emergency department presentations are one type of non-admitted patient care.

occupancy rate: total number of days that all people spent in a type of aged care over a year, divided by the total number of places that were available in that type of care over the year.

older people: generally defined as all people (Aboriginal and Torres Strait Islander and non-Indigenous) aged 65 and over, plus Aboriginal and Torres Strait Islander people aged 50–64 years. However, for planning and assessing the places in aged care, the population of people aged 70 and over is considered.

operations: an MBS broad type of service capturing surgical operations (ranging from simple independent procedures such as repairing small wounds and taking biopsies to major surgical procedures under general anaesthetic).

opioid medicines: these medicines have a morphine-type action in the body (relieving pain and relaxing muscles). They are commonly used for pain relief, but they are addictive and can lead to dependence.

organisation type: the ownership structure of the provider organisation that manages a residential aged care facility. These are classified as not-for-profit (includes charities, religious organisations and community-based organisations), government (includes state government, territory government and local government organisations) and private (includes publicly listed companies and organisations that are registered as private companies).

other allied health: an MBS broad type of service covering a range of items relating to services such as occupational therapy, physiotherapy and psychology.

overnight separation: a patient who, following a clinical decision, receives hospital treatment for a minimum of 1 night (that is, who is admitted to and separated from the hospital on different dates).

pathology collection items: an MBS broad type of service also known as ‘patient episode initiation’, generally referring to collecting specimens for pathology tests.

pathology tests: an MBS broad type of service for the examination and assessment of collected specimens.

permanent care: see permanent residential aged care.

permanent residential aged care: an Australian Government-funded aged care program which provides round-the-clock personal care and nursing services to people living long-term in a residential aged care facility.

personal care: services to assist with everyday tasks such as bathing and getting dressed, assistance with eating, going to the toilet, grooming, getting in and out of bed, and moving about.

Pharmaceutical Benefits Scheme (PBS): a national, government-funded scheme that subsidises the cost of a wide range of pharmaceutical drugs for all Australians to help them afford standard medications. The Schedule of Pharmaceutical Benefits (schedule) lists all the medicinal products available under the PBS and explains the uses for which they can be subsidised. Repatriation Pharmaceutical Benefits Scheme (RPBS) provides a range of pharmaceuticals and wound dressings at a concessional rate for the treatment of eligible veterans, war widows/widowers, and their dependants. Both PBS and RPBS were in scope here.

places: each Australian Government-funded aged care facility have a certain number of operational places (sometimes called ‘beds’) that are either occupied, or available to be occupied.

preferred language: language that a person using aged care services prefers to communicate in. If a person knows more than one language, their preferred language when receiving care is recorded.

prescription: medical practitioners such as GPs or specialists write instructions that authorises pharmacies to issue a patient with a medicine. See also the Pharmaceutical Benefits Scheme.

primary care services: these are health care services delivered in many settings, such as general practices, community health centres, Aboriginal health services and allied health practices (for example, physiotherapy, dietetic and chiropractic practices) and come under numerous funding arrangements. The data source here is limited to MBS claims; specialist services are included as part of ‘primary health care’ here but these may be better described as ‘secondary health care’ (generally people are referred to them by primary health care providers). 

principal diagnosis: in hospital data, this is the diagnosis established after study to be chiefly responsible for occasioning an episode of admitted patient care. In emergency department data, this is the diagnosis established at the conclusion of the patient’s attendance in an emergency department to be mainly responsible for occasioning the attendance following consideration of clinical assessment. Colloquially speaking, principal diagnoses are the reason a person attended ED or was admitted into hospital.

private hospital: these are privately owned and operated hospitals where patients are charged fees. These fees can include the cost of services provided by the hospital and relevant medical and paramedical practitioners and the cost of accommodation. Acute care and psychiatric hospitals are included, as are private free-standing day hospital facilities.

(aged care) program type: the program under which a place in aged care is funded (home support, home care, residential care, transition care, short-term restorative care, Multi-Purpose Service, the National Aboriginal and Torres Strait Islander Aged Care Program, and Innovative pool).

provider (organisation): these are the organisations that own and operate aged care services (outlets or facilities).

public hospital: these are hospitals controlled by a state or territory health authority. Public hospitals offer free diagnostic services, treatment, care and accommodation to all eligible patients.

rate: this is one number (the numerator) divided by another number (the denominator). The numerator is commonly the number of events in a specified time. The denominator is the population ‘at risk’ of the event.

recipient: any person who receives care and support, either in their own home or in a residential aged care facility.

remoteness area: A classification of the remoteness of a location using the Australian Statistical Geography Standard Remoteness Structure that defines locations in terms of remoteness, that is, the physical distance of a location from the nearest urban centre. The categories used here are Major cities, Inner regional, Outer regional and Remote or Very remote areas.

residential aged care facility: these are facilities that provide Australian Government-funded residential aged care either on a permanent or short-term (respite) basis to people. The service must meet specified standards in the quality of the built environment, care, and staffing levels in accordance with the Aged Care Act 1997. Some people refer to these services as ‘nursing homes.’

residential care: A program that provides personal and/or nursing care to people in a residential aged care facility. As part of the service, people are also provided with meals and accommodation, including cleaning services, furniture and equipment.

respiratory diseases: chronic respiratory conditions affecting the airways and characterised by symptoms such as wheezing, shortness of breath, chest tightness and cough (such as asthma and COPD).

respite care: an alternative care arrangement for dependent people living in the community, giving people – or their carers – a short break from their usual care arrangements. Friends, family or the community may provide informal respite. Formal respite services are provided by residential aged care facilities and by the Commonwealth Home Support Programme. Residential respite care requires ACAT approval, and generally is allocated at the rate of 63 days per person per financial year.

same-day separation: An admitted patient who is admitted and separates on the same date.

service: a care facility that provides aged care, such as a residential aged care service or an outlet that delivers home care. The Australian government provides funding for those services that it has approved as set out in the Aged Care Act 1997. Services are owned by provider organisations (or providers), and one provider can operate more than one service.

service group: assigning permanent residential aged care facilities into groups based on the size and ownership structure of the facility. See also places and organisation type.

Short-Term Restorative Care: an early intervention program that aims to delay admission into residential care or home care. Care is provided for up to 56 days in a coordinated package of services, which can be delivered in a residential setting, the home, or a combination of both.

specialist: A doctor who has completed advanced education and clinical training in a specific area of medicine. In many cases, a formal referral is required for an individual to be able to access the recommended specialist service. Specialists may work in private clinics or within the hospital system or across different settings. See also specialist attendance.

specialist attendance: A specialist attendance is a referred patient-doctor encounter (with Medicare funding benefits), such as a visit, consultation and attendance (including a video conference) with a medical practitioner who has been recognised as a specialist or consultant physician for the purposes of Medicare benefits.

target population: the target population for aged care services is all people aged 65 and over and Aboriginal and Torres Strait Islander people aged 50–64. When places in aged care services are funded and managed, a more general target population is used, which is all people aged 70 and over. These do not refer to age limits for access to aged care (access is based on need, rather than age).

transition care: on discharge from hospital, eligible people can receive rehabilitation care and support services either in a residential aged care facility or at home to assist in their recovery and rehabilitation. To receive transition care, an ACAT must assess a person as otherwise eligible for residential aged care. Generally, care is provided for a maximum of 84 days per person per financial year.

usage rate: the number of people in aged care services for every 1,000 people in a comparable general population. In most cases, this population is the target population for aged care services. Sometimes the target population for calculating a usage rate can be more specific, such as the people of a certain age group in a particular region.

World Health Organization (WHO): a part of the United Nations that deals with major global health issues. They set international standards for disease control, health care and medicine.