Timeliness of access to aged care services in Australia

Median elapsed time to receipt of approved care service

There are many reasons why time might elapse between approval for an aged care service and receipt of that service. These include, for example, waiting for a service to become available, organising personal financial arrangements necessary to accept care, or choosing not to accept care at that time. Not all aspects of this elapsed time are measurable with existing administrative data. As such, only the overall elapsed time from receiving approval for a service to receiving that service was reported in this report. Median elapsed time is the length of time that falls in the middle of all elapsed times for each approval group in aged care service use outcome 1 (received the approved care service), dividing the group into two equal halves – half of the group had shorter elapsed time and half had longer elapsed time.

Figure 4 shows the median elapsed time in days and the proportion of those who received a care service at their approved level by 30 June 2022 (about 75,800 people, 73%) among all people who had their first approved comprehensive assessment in 2019–20 (about 104,000 people). The median values presented here are only for those individuals that received their approved care during the analysis period. People who were approved for ‘both a home care package and permanent residential aged care’ experienced the longest elapsed time (a median of 267 days, just under 9 months), followed by people approved for ‘a home care package only’ (median 249 days, about 8 months), and people approved for ‘permanent residential aged care only’ (median 41 days, just under 6 weeks). In all three approval groups, 73% received their approved service on or before 30 June 2022, with a median elapsed time of 222 days (about 7 months).

A lengthy elapsed time to receive an approved service is generally experienced in those approved for ‘a home care package only’ or ‘both a home care package and permanent residential aged care’. However, those given a high priority across the three approval groups had a much shorter elapsed time (see Table 1) than those assigned a low or medium priority. Most individuals who received their approved service in the two approval groups ‘a home care package only’ and ‘permanent residential aged care only’ were assigned a medium priority, and their longer elapsed time were more representative of those approval groups. Regarding to the Guidance on Priority for Home Care Services, the default priority is medium priority with only a small percentage of people who are at immediate risk being approved as high priority.

HCP: home care package; PRAC: permanent residential aged care

* For those approved for ‘both a home care package and permanent residential aged care’, the priority level presented in this table relates to the priority level assigned for entry into permanent residential aged care (the higher care needs service), which is different from the priority level assigned for home care package in the same assessment.

Receipt of interim care while waiting for approved service

Among all three approval groups (about 104,000 people), most people (91,900, 88%) received a lower-level home care package than their approved level or home support while waiting for their approved service.

Of the 78,700 people approved for ‘a home care package only’ or ‘both a home care package and permanent residential aged care’, about 19,900 (25%) received an interim (lower level) home care package before eventually receiving their approved care service. The median elapsed time to receive an interim home care package before eventually receiving approved care service was 214 days, or about 7 months (interquartile range: 1–732 days) for those approved for ‘a home care package only’, and also 214 days, or about 7 months (but interquartile range: 3–526 days) for those approved for ‘both a home care package and permanent residential aged care’.

Among 78,700 people approved for a home care package (including ‘a home care package only’ and ‘both a home care package and permanent residential aged care’), about 48,700 people (62%) had a median elapsed time of over 6 months for an interim package only (aged care service use outcome 2) or for their approved care service (aged care service use outcome 1). 

As mentioned above, it is not possible to identify from the available data how many people opted not to join the National Priority System or accept a home care package when it was offered to them.

Cumulative incidence of people who received an approved care service

Figure 5 is a cumulative incidence function (CIF) graph showing the probability of receiving the approved care service over time, and before having experienced a ‘competing risk event’. A ‘competing risk event’ is an alternate event in a person’s life that would prevent the outcome of interest from happening. For more details on competing risk events, please refer to the Time-to-event analysis section in the Technical Notes.

• For those approved for ‘permanent residential aged care only’ or ‘both a home care package and permanent residential aged care’, the only competing risk event is death. That is, for a person who dies prior to entry into permanent residential aged care or before receiving their approved home care package, they can no longer experience the outcome of interest – receiving the approved care service. Receiving a home care package does not preclude the outcome of receiving permanent residential aged care from occurring; therefore, it was not considered a competing risk event for those approved for ‘permanent residential aged care only’.
• For those approved for ‘a home care package only’, in addition to death, admission to permanent residential aged care is included as a competing risk event. If a person was admitted to permanent residential aged care, they are not eligible to receive that home care package while residing in the service. Only a very small number of individuals left residential aged care service and returned to the community to receive a home care package in the analysis period (n=69 out of 32,100 or 0.2%). That is, for almost all practical purposes, entry into residential aged care precludes the home care package outcome from occurring, and for this reason, entering permanent residential aged care was treated as an additional competing risk event.

Figure 5 shows the stacked probability overtime of all competing risk events (outcomes) by approval group:

• The lower part shows the probability of receiving the approved care service 
• The middle part shows the probability of dying before receiving the approved care service. In those approved for ‘a home care package only’, probability of entering permanent residential aged care was additionally included for the reason discussed above. 
• The upper part shows the probability of remaining alive without receiving the approved care service.

As shown in Figure 3 earlier, though, a large portion of those who did not receive their approved care service had received home support service or a home care package at a lower level during this period of time.

A separate model was run for each of the three approval groups (‘a home care package only’, ‘permanent residential aged care only’, or ‘both a home care package and permanent residential aged care’), and the three incidence functions for the primary outcomes – receiving the approved care service – are presented together for comparison purpose in Figure 6. Cumulative incidence function does not simply reflect proportions as seen in the crude incidence but provides a more comprehensive view of the likelihood (i.e. probability) of receiving an approved service over time in the presence of other competing risk events. Figure 6 shows that:

• Analysis by cumulative incidence function found that people approved for ‘permanent residential aged care only’ had the probability of the quickest time of entry into approved care, often within around 100 days or just over 3 months. This suggests that those who were approved for ‘permanent residential aged care only’ may have done so because they could no longer live at home, and they entered care as soon as a place became available. This group often comprises individuals with the highest needs or complexity at the time of assessment, sometimes requiring care to such an extent that no other type of care would suffice. As a result, their entry into permanent residential care is more likely to be prioritised over cases where there is an element of choice – either between different residential providers or between different care types. Additionally, there is an emergency placement process that can be fast-tracked, potentially even before approval, though this falls outside the scope of this analysis.
• In contrast, people approved for a home care package (in both approval groups for ‘a home care package only’ or ‘both a home care package and permanent residential aged care’) had a slower increase in the probability of receiving their approved care:
  • Especially for people approved for ‘a home care package only’, they initially experienced the longest elapsed times to receipt of their approved care service. After about 180 days (approximately 6 months), there was a surge in the probability receiving approved care service, from 6% at 180 days to 40% at 285 days (about 9 months). This corresponds with the timing of the release of new home care packages by the Australian Government in 2020–21.
  • People approved for both services initially received their care at a faster rate than people approved for ‘a home care package only’.
• After about 285 days (approximately 9 months), the two groups – ‘a home care package only’ and ‘both a home care package and permanent residential aged care’ – shared the same increasing probability of receiving their approved service. The probability of receiving the approved service plateaued at around over 40% from 285 to 400 days (approximately 9 to 13 months), followed by a surge in receiving approved care service from 400 to 500 days (approximately 13 to 16 months). This corresponds with the timing of the releases of new home care packages by the Australian Government in 2020–21 and 2021-22.