Summary

Coordination of aged care services is important, both to provide services cost-effectively and to provide the appropriate care for people at the appropriate time. Using linked data from the Pathways in Aged Care (PIAC) cohort study, this report presents groundbreaking large-scale analysis of people’s use of aged care services. This analysis includes information on time to key events, changes in use of care programs over time and concurrent use of programs.

The PIAC cohort comprises 105,000 people who had a completed assessment by an Aged Care Assessment Team (ACAT) under the Aged Care Assessment Program (ACAP) in 2003–04. Their ACAP assessment data were linked to data for five key aged care programs: Home and Community Care (HACC), Veterans’ Home Care (VHC), Community Aged Care Packages (CACPs), Extended Aged Care at Home packages (EACH) including EACH (Dementia), and residential aged care (RAC). Program use was identified for 2003–06.

For analytical purposes, the PIAC cohort was divided into groups based on use of aged care programs before the first completed assessment in 2003–04:

  • Continuing path cohort: clients who had used ACAT-dependent services (27,640 people);
  • HACC and/or VHC before cohort: clients who had used only HACC or VHC services (42,974);
  • No previous care cohort: clients who had not previously used aged care services (34,463).

Main findings

  • People do not need an ACAT assessment to access HACC or VHC. However, for many people their first contact with the aged care system is through an ACAT: just over 40% of the cohort with no previous use of aged care programs accessed HACC or VHC following their ACAT assessment (Figure 3.2).
  • Although approval for program use from an ACAT assessment is valid for 12 months, re-assessment within that period is common: 30% of the no previous care cohort had a re-assessment within 12 months, and two-fifths of these had no intervening program use (Table 2.3).
  • Before 1 July 2009, approval to use residential respite care had to be renewed annually to maintain access. This requirement was an important cause of re-assessment (Table 2.6).
  • Assessments do not necessarily result in program use: 25% of the no previous care cohort did not newly access any care programs within 2 years. Nearly one-quarter of these people had died (Table 3.3).
  • The use of care programs by the cohort increased over time (Figure 4.3). In particular, among no previous care cohort members the proportion who were in permanent RAC more than doubled between 3 months and 24 months after their first assessment in 2003–04—from 17% of clients still living to 34% (Table 4.7).
  • Some care programs can be accessed simultaneously. For the no previous care cohort, 6 months after assessment:
    • One in six CACP recipients (16%) were also using services from other programs.
    • Almost 40% of people who were clients of VHC were also accessing services from the large HACC program.
    • Just under 10% of those using HACC were also accessing other programs.
    • Two-fifths of the people in respite RAC were also using a community care program when they were at home.
  • Nearly one-third of the PIAC cohort died within the 2-year study period (Table 4.8).