Timeliness of access to aged care services in Australia

Demographic and clinical factors associated with the time between service approval and the receipt of that service. Understanding who experiences longer elapsed time to receiving an approved care service can help identify barriers and opportunities to improve care delivery to those most in need. Figure 7 shows that the median elapsed time from service approval to service receipt varies by age and sex for people approved for aged care services in 2019–20.

The median elapsed time was similar for men and women aged 65 to 89 across all approval groups. For those aged 90 and over, the median elapsed time varied between men and women and had different patterns across approval groups. It is important to note that this variation is influenced by the smaller numbers of people in these age groups.

To examine which demographic and clinical features most strongly impacted elapsed time to receiving an approved aged care service, we conducted multivariate competing risk modelling (Fine and Gray 1999). This does not directly measure elapsed time, but rather the incidence, or probability, of receiving the approved level of care, at any point in time after the approval, and before a competing risk event. A higher incidence is associated with a shorter elapsed time, and a lower incidence with a longer elapsed time. More information about the data and methods used here are available in the Technical notes.

The forest plot (Figure 8) shows the results from competing-risks time-to-event multivariate regression models to explore the association between demographic and clinical factors and the incidence, or probability, of receiving their approved service in the three approval groups.  This type of model produces an event rate ratio, and on average, after controlling for all other factors, a higher rate ratio means a higher probability of receiving approved care at any point in time, and would result in a shorter elapsed time, and a lower rate ratio means a lower probability of receiving the approved care at any point in time, and would result in a longer elapsed time.

Across the three cohorts, longer elapsed times (lower rates) of receiving their approved service tended to be experienced by:

• men (compared to women)
• people who had never used any aged care service before (compared to people who had previously used an aged care service)
• people who had lower priority level on the National Priority System. Shorter elapsed time was associated with increasing level of priority. This aligns with the raw data presented earlier (see Table 1). Especially for those approved for ‘a home care package only’, people with a high priority had markedly shorter elapsed times to receipt of their approved care service than their counterparts with low or medium level of priority.

Other factors associated with the elapsed time to receipt of the approved care service were:

• For those approved for ‘permanent residential aged care only’, shorter elapsed times were experienced by individuals with dementia, those living alone, those assessed in hospital, and those in the oldest age group, compared to their counterparts. These people likely reflect a higher urgency and prioritisation of care for those individuals approved for ‘permanent residential aged care only’. Conversely, the opposite was observed for those approved for ‘a home care package only’.
• For those approved for ‘a home care package only’, all other things being equal, on average younger individuals had a shorter elapsed times to receipt of their approved care service than older individuals. This difference may be due to a higher proportion of people without informal carers in the younger age groups, which gradually decreases from 40.3% in those aged 50-69 to 21.7% in those 90 and over. The proportion of approved home care packages for level 3 and 4 varied across age groups: 35% (aged 50-69), 27% (aged 70-79), 25% (aged 80-89), and 30% (aged 90+).
• People living in rural and remote areas experienced slightly shorter elapsed times when approved for ‘a home care package only’, but longer elapsed times when approved for ‘permanent residential aged care only’, compared to those in metropolitan areas and regional centres. This may reflect service availability and unmet needs in regional and remote areas.
• People with an informal carer tended to have longer elapsed times to receipt of their approved care service than people without an informal carer in those approved for ‘a home care package only’ and for ‘both a home care package and permanent residential aged care’. Elapsed time to receipt of approved care service did not differ by informal carer status for those approved for ‘permanent residential aged care only’.
• People with culturally and linguistically diverse backgrounds experienced shorter elapsed times in those approved for ‘a home care package only’ and for ‘both a home care package and permanent residential aged care’, but longer times for ‘permanent residential aged care only’. Similarly to remoteness, this may reflect variation in service availability for culturally and linguistically diverse services.
• First Nations people experienced slightly longer elapsed times, compared to non-Indigenous people, in those approved for ‘permanent residential aged care only’ and ‘both a home care package and permanent residential aged care’. Elapsed times did not differ by Indigenous status in those approved for ‘a home care package only’.

People assessed in hospital and people with dementia can have higher care needs than those assessed outside hospital and those without dementia. The result that these approval groups experienced different average elapsed times may be partly explained by the different services for which they were approved. For example, people with dementia were more likely than people without dementia to be approved for a higher-level home care package (Level 3 and Level 4).

Among those approved for the higher levels of care (Level 3 and 4 packages), people with dementia were also more likely to move into permanent residential aged care before receiving their approved home care package. Among those approved for ‘a home care package only’, people with dementia (compared with people without dementia) were more likely to have an informal carer and less likely to live alone. Among people approved for ‘a home care package only’ who had an informal carer, people with dementia had a longer elapsed time to receipt of approved care service compared to people without dementia.