The aged care system in Australia comprises a spectrum of services ranging from basic supports to enable people to remain independent at home, through to full-time care in a residential aged care facility (also called ‘nursing home’). The vast majority of aged care services are provided to people in their home, or elsewhere in a community setting; however, the greatest proportion of aged care spending is on residential aged care.

People may receive services from different levels of service, depending on their needs, and some services may only be used temporarily. The AIHW has reported more than 1,000 ‘pathways’ through the aged care system, with most people using a small number of common pathways (AIHW 2011, 2017).

Most statistics on this page are drawn from gen-agedcaredata.gov.au, AIHW’s dedicated website for aged care statistics.

Who is aged care for?

There is no minimum age to be eligible to receive government-subsidised aged care in Australia; rather, access is determined by assessed needs. Although the age of 65 is often considered a threshold to be an ‘older person’, nearly 19,000 people under the age of 65 used an aged care service in 2017–18. Around 1 in 3 (34%) of these were in permanent residential aged care. Note that for planning and reporting purposes, the concept of ‘older’ is extended to Aboriginal and Torres Strait Islander Australians aged 50–64, reflecting their generally higher care needs at younger ages relative to other Australians. Approximately 9,600 Indigenous Australians aged 50–64 used an aged care service in 2017–18, 6% of whom were in residential aged care. See Disability support for Indigenous Australians and Aged care for Indigenous Australians.

How many people use aged care?

More than 1.2 million people received aged care services during 2017–18, with most (77%) receiving support in their home or other community-based settings. Putting this in context, of Australians aged 65 and over in 2017–18:

  • 7% accessed residential aged care
  • 22% accessed some form of support or care at home
  • 71% lived at home without accessing government-subsidised aged care services.

The largest aged care program is the Commonwealth Home Support Programme (CHSP), with around 783,000 clients during 2017–18. This program provides entry-level services to help people remain independent at home and in the community. The next largest program involves residential aged care, supporting around 270,500 clients during the year (including nearly 62,000 people who received temporary, respite care). The Home Care Packages Program—which provides a tailored, coordinated package of care services to enable people to remain living at home—is the fastest-growing program. It supported around 116,800 people in 2017–18, up from 97,200 in 2016–17. Additionally, a small number of people received care through a group of flexible care programs, including the new Short-Term Restorative Care Programme.

The age profile of clients accessing the main care programs varies considerably across the programs (Figure 1). As at June 2018, clients accessing residential age care were generally older (59% of care recipients were aged 85 or older), and clients accessing CHSP were younger (29% were aged 85 or older).

This is a horizontal bar chart with a pair of bars (males to the left, females to the right) for each age group (0–49, then 5-year groups up to 100+). The values are the percentage that each age group makes up of the total client group, across 3 different care types, where the care type is selected via a drop-down box. The figure shows that the age profile of clients in residential aged care is relatively old, and the profile of clients receiving home support is relatively young. The figure also shows that the male:female ratio is mostly balanced for all age groups across each care type.

Figure 1 data table (118KB XLSX)

Managing access to a Home Care Package

In 2017, along with other changes to the Home Care Packages Program (such as shifting the package of funding from a service provider to the client), the National Prioritisation System (NPS) was introduced, which is designed to provide a consistent and equitable process for allocating home care packages based on people’s individual needs and circumstances, regardless of where they live. Apart from informing the allocation of packages, the NPS also allows reporting on the number of people waiting for a package at their approved level (there are four levels of package available), and the typical wait time. For example, at 31 December 2018, there were around 123,000 waiting for a package at their approved level, of which nearly 54,000 had been offered a lower-level package. The estimated (typical) wait time for someone to enter a Level 1 package (the lowest level) was 3–6 months, but for all other levels was more than 12 months (Department of Health 2019).

There is no equivalent queue information for the other aged care programs.

How big is the aged care system?

More than 3,000 aged care providers in Australia deliver care through nearly 9,000 services (outlets) (Figure 2). The sector comprises private (for-profit) providers alongside community-based and charitable providers, and state and territory and local government providers. The mix of ownership type varies across programs, with the largest proportion of for-profit services in the residential care program (41% of residential aged care places are managed by for-profit providers).

Collectively, these services supported the care needs of more than 1.2 million people in 2017–18, at a total cost to governments of $18.4 billion. Consumers may also be asked to contribute to the cost of care. In residential aged care, for example, the cost to governments in 2016–17 was $12.1 billion, and residents contributed a further $4.7 billion (ACFA 2018).

This is a map of Australia showing a small circle for the location of each aged care service; the dots are coloured according to type of aged care program. The map shows that most aged care services are located in major urban areas, and that there is relatively low supply of residential aged care in Very remote areas of Australia.

Figure 2 data table (118KB XLSX)

Growth in aged care

Through the use of a ‘target provision ratio’ (a policy that sets the overall number of funded places per 1,000 target population), the aged care sector is set to expand to match the growing older Australian population. This means providing 125 places or packages (in residential care, home care and restorative care) per 1,000 people aged 70 or older in 2021–22. Although most of these places are allocated to the residential care segment, the home care segment is growing rapidly, reflecting consumers’ expressed preference for remaining at home for as long as possible (ACFA 2018).

Workforce

In 2016, more than 366,000 aged care workers operated across the residential and community settings, including 240,000 direct care workers (Mavromaras et al. 2017). Most direct care workers (around 154,000) were in the residential sector, although there has been greater growth in the workforce for the community sector since 2012. This reflects the shifting balance of capacity towards the community sector. The aged care workforce is predominantly female (87% of workers in residential care services are female, as are 89% in home care or home support), is generally older than the average across all industries, and has relatively high levels of post-school education and training compared with other industries (Mavromaras et al. 2017).

What are the aims and outcomes of aged care?

The aim of the aged care system, as described by the Productivity Commission (2018), is to promote the wellbeing and independence of older people (and their carers), by enabling them to stay in their own homes or by supporting their care needs in residential care. This overall aim is implicit in the Aged Care Act 1997. The Act also outlines objectives of equitable access on the basis of need, high-quality care to meet individuals’ needs, and protection of the health and wellbeing of care recipients. Increasingly, policy and practice is encompassing a ‘wellness and reablement’ approach, where people are assisted to regain functional capacity and improve independence (Nous Group 2018). While there are little data on this aspect of aged care, there are data on access to aged care for special needs groups (such as Indigenous Australians, people who are financially or socially disadvantaged, or people who are homeless or at risk of becoming homeless). For more information, see the Report on government services attachment tables (PC 2019).

One source of information on quality of care is accreditation audits of residential facilities (generally every 3 years), in which services are assessed against a set of care standards. As at June 2018, most (97%) re-accredited residential care services had the full 3-year re-accreditation period in effect. Although accreditation does not apply to services in the home care and support sector, they are still required to meet minimum services standards. As at June 2018, 92% of services met all expected outcomes of the ‘effective management’ standard; 94% met all outcomes of the ‘appropriate access and service delivery’ standard; and 97% met the ‘service user rights and responsibilities’ standard (SCRGSP 2018).

Quality of care data are also captured in the form of client experience surveys associated with re-accreditation of residential services. This involves interviews with at least 10% of residents about their experience of care (including feelings of safety and respect, perceived competency of staff, and whether the resident likes the food). Findings from the first year of interviews, published by the [then] Australian Aged Care Quality Agency (2018), show: 

  • 73% of respondents said staff always treated them with respect
  • 81% said they always felt safe in the service
  • 39% said they always liked the food.

Finally, quality of care data are expected to expand during 2019 following the Australian Government’s announcement that mandatory reporting of three clinical indicators (pressure ulcers, use of physical restraint, and unplanned weight loss) for residential aged care services will start from July 2019. Reporting of these indicators has been voluntary, with about 10% of services participating. There are no published results from this voluntary program.

Aged Care Royal Commission

The Royal Commission into Aged Care Quality and Safety—established in October 2018—is exploring a wide range of issues relating to the quality and safety of aged care services and future demand for such services. The final report of the Commission is expected in April 2020.

The AIHW is undertaking several analysis projects that might inform the Commission and generally add to the knowledge base on quality of care. These analyses cover the movements between hospital and aged care services; patterns of pharmaceutical use across different aged care settings; and patterns of doctor (general practitioner and specialist) use across different settings.

Where do I go for more information?

For more information on aged care, see:

See also Aged care for more on this topic.

References

AACQA (Australian Aged Care Quality Agency) 2018. Consumer Experience Reports. Viewed 12 December 2018.

ACFA (Aged Care Financing Authority) 2018. Sixth report on the funding and financing of the aged care sector. Canberra: ACFA.

AIHW (Australian Institute of Health and Welfare) 2011. Pathways in Aged Care: program use after assessment. Data linkage series no. 10. CSI 10. Canberra: AIHW.

AIHW 2017. Pathways to permanent residential aged care in Australia: a Pathways in Aged Care (PIAC) analysis of people’s aged care program use before first entry to permanent residential aged care in 2013–14. Cat. no. AGE 81. Canberra: AIHW.

Department of Health 2019. Home Care Packages Program Data Report, 2nd Quarter 2018–19. Viewed 20 May 2019.

Mavromaras K, Knight G, Isherwood L, Crettenden A, Flavel J, Karmel T et al. 2017. 2016 National Aged Care Workforce Census and Survey—the aged care workforce, 2016. Canberra: Department of Health.

Nous Group 2018. Wellness and Reablement Review: Summary of consultations. Viewed 28 September 2018.

SCRGSP (Steering Committee for the Review of Government Service Provision) 2018. Report on government services 2018. Canberra: Productivity Commission.