Measuring variation in timeliness of access to aged care services
While Australian aged care services and programs have been regularly reformed to meet the care needs of the population, there are areas where needs may not be met. One source of unmet need, documented in the Royal Commission into Aged Care Quality and Safety’s Final Report (2021), is timeliness and equity in access to services, including variation in the amount of time people wait to access aged care.
Some of the time that elapses between approval for care and receiving that care may be elective, where the person chooses not to or is unable to take up care when it is offered. However, prolonged elapsed time due to system or service-level barriers to care can cause distress, lost work income for the person’s family members, and increased carer burden (McCallum et al. 2018). A study (Visvanathan et al. 2019) found that prolonged waiting times for home care package were associated with a higher risk of long-term mortality as well as transition to permanent residential aged care. Understanding waiting times, the factors that are associated with longer waiting time, and how these have changed over time and with aged care reform, can help to target policy and quality improvement initiatives.
The same methods and specification outlined in the previous report were applied for this report with more recent data – Pathways in Aged Care (PIAC) 2022 link map (see Technical notes). This report focuses on people approved for a home care package or permanent residential aged care (or both) in the 2019–20 financial year, examines their outcomes up to 30 June 2022, and describes the elapsed time between their assessment approval and receipt of the service at the approved level.
The Australian aged care system offers a continuum of care with 3 main types of service:
- Home support – Commonwealth Home Support Programme (CHSP) and its pre-2015 predecessor Home and Community Care (HACC)) – which provides entry-level services focused on supporting individuals to undertake tasks of daily living to enable them to be more independent at home and in the community
- Home care (Home Care Packages Program), which is a more structured, more comprehensive package of home-based support, provided over 4 levels ranging from basic care (Level 1) to high care (Level 4) needs
- Residential aged care, which provides support and accommodation for people who have been assessed as needing higher levels of care than can be provided in the home, and the option for 24-hour nursing care. Residential care is provided on either a permanent or a temporary (respite) basis.
There are also several types of flexible care and services for specific population groups available that extend across the spectrum from home support to residential aged care. The focus of this report is on Home Care Packages Program and permanent residential aged care. For more information on aged care services in Australia see the Report on the Operation of the Aged Care Act, GEN aged care data website, or visit the Department of Health and Aged Care website.
There are two assessment types to determine whether an older person is eligible for government-subsidised aged care: comprehensive assessments and home support assessments.
Comprehensive assessment for aged care services is conducted to determine a person’s care needs and eligibility to receive selected Australian Government-subsidised aged care services, including permanent residential aged care and home care packages. Assessments are conducted by Aged Care Assessment Teams (ACAT) which operate in all states and territories.
At the time of assessment, assessors note the level of priority of care needs for each type of care approved for the individual (low, medium, high) based on the individual’s care needs and situation. For example, high priority for a home care package is defined as ‘client is considered at urgent and immediate risk in terms of their personal safety or at immediate risk of admission into residential care. The client may have a carer and the carer arrangements are unsustainable or the carer is at crisis point.’ For home care packages, based on the date of approval and recommended priority for care in the assessment, approved individuals are placed on the National Priority System until a package becomes available and is assigned to them. Individuals are assigned a package when they are the next eligible recipients on the National Priority System at a particular level and priority.
For residential aged care, assessors provide approval if appropriate and a referral code to gain entry to a service of the individual’s choice where a bed is available. There is no centralised priority system for assigning residential aged care places.
There is also a home support assessment, generally conducted face-to-face by Regional Assessment Service (RAS) assessors. These assessors provide evaluation, information, and advice to individuals needing low-level support and determine eligibility for the Commonwealth Home Support Programme (CHSP). If a higher level of support is identified, the RAS may refer the individual for a comprehensive assessment. However, as this report focuses on individuals with higher care needs – those in need of a home care package or permanent residential aged care – the home support assessment was not included in identifying the cohort of interest in this report.
For more details on the two assessments, please refer to the Department’s website about the aged care assessment programs.
In this report, ‘receipt of approved care service’ was defined according to the type of service for which a person was approved in their first comprehensive assessment.
- For people approved for ‘permanent residential aged care only’, receiving their approved service occurs when they begin living in permanent residential aged care.
- For people approved for ‘a home care package only’, receiving their approved service occurs when they begin receiving a home care package at the level for which they were approved.
- For people approved for ‘both a home care package and permanent residential aged care’, receiving their approved service occurs when they begin receiving a home care package at the level for which they were approved, OR they begin living in permanent residential aged care (whichever occurs first)
In this report, due to the limitations in the home care package data, the date for receipt of approved home care package is based on the date on which the provider was funded to deliver the approved level of care, rather than the actual start date of that care. This presents the shortest possible elapsed time for the care recipient. For more information on the data sources and their limitation, please see the Technical notes.
The time between receiving an approval for care and taking up that care can vary. After a person receives approval for a care service they may:
- receive the service at the approved level
- receive an ‘interim’ care service for which they are also approved (that is, a lower-level service until a service at the approved level becomes available). It should be noted that since May 2022 interim home care packages were no longer released. However, care recipients can still be in a lower package while waiting for their approved level packages.
- choose not to receive care when it is offered to them
- receive another comprehensive assessment and approval for a different service, including moving to permanent residential aged care when not initially approved for permanent residential aged care
- die.
Other factors that may impact on the elapsed time between approval and receiving care include waiting for a service to become available and organising financial arrangements necessary to accept care.
McCallum J, Rees K, and Maccora J (2018) Accentuating the positive: consumer experiences of aged care at home, National Seniors Australia, Brisbane, Queensland, accessed 19 June 2023.
Royal Commission into Aged Care Quality and Safety (2021) Final report: Care, dignity and respect, Royal Commission, Australian Government, accessed 19 June 2023.
Visvanathan R, Amare AT, Wesselingh S, Hearn R, McKechnie S, Mussared J & Inacio MC 2019. Prolonged Wait Time Prior to Entry to Home Care Packages Increases the Risk of Mortality and Transition to Permanent Residential Aged Care Services: Findings from the Registry of Older South Australians (ROSA). Journal of nutrition, health & aging 23, 271–280 (2019).