Aged care

Australia’s aged care system comprises a range of services from basic supports to enable people to remain independent at home, through to living in a residential aged care facility with access to full-time care. The majority of aged care is provided to people in their homes (or elsewhere in a community setting), reflecting people’s preferences to remain living in their community for as long as possible, but the greatest proportion of aged care spending is on residential aged care.

People often need assistance with domestic tasks, such as gardening and shopping, but as people grow older their care needs may become more complex. Aged care services are available to people both temporarily and permanently, and at different levels depending on their needs.

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

How many people use aged care?

Aged care services provide support to a large and growing number of older Australians. During 2019–20, over one million people received support from aged care services in Australia (Department of Health 2020), although some people used multiple programs more than once during the year.

Around 840,000 people used the Commonwealth Home Support Programme (home support). This program provides entry-level services to help people remain independent at home and in the community. The next largest program was permanent residential aged care – around 245,000 people lived permanently in a residential aged care facility at some point during 2019–20.

The Home Care Packages Program (home care), which provides a tailored, coordinated package of care services to enable people to remain living at home, supported around 175,000 people. Respite residential aged care – short-term stays in residential aged care – supported around 67,000 people. The smallest programs, transition care and short-term restorative care, assisted just under 25,000 people and 4,500 people, respectively.

In the 10-year period since 2010–11, the number of people using home care has tripled (AIHW 2021b). Other aged care programs have also grown, albeit to a lesser extent. For more information on the number of people using aged care and trends over time see the People using aged care GEN topic page.

The people using aged care

Most people who use aged care services are older women. At 30 June 2020, around 2 in 3 (65%) people using aged care services were women. The age profile of people using the main aged care programs also varies across the programs (Figure 1). On average, people living in residential aged care were somewhat older than those using home care or home support (85 years, 82 years, and 80 years, respectively).

Almost two-thirds (64%) of women and almost half (47%) of men living in permanent residential care were aged 85 years and over. Even so, some younger people also access these support services. Nearly 4,900 people living in permanent residential aged care (2.6% of people), and around 2,700 people using home care (1.9% of people), were aged under 65 years. For more information on young people using aged care see the related YPIRAC dashboard on GEN.

International comparisons

Australia’s population is growing, particularly the older population. There have been improvements in health, wellbeing and life expectancy, and people born in the post-World War II period (the ‘baby boomer’ generation) are now reaching older age, see Profile of Australians for more information on Australia’s population. For example, the proportion of Australia’s population aged 65 and over has risen from 12% in 1997 to 16% in 2019 (ABS 2014; ABS 2019). Similar trends exist in many countries. For example, 20% of the European Union’s population were aged 65 and over in 2019 (The European Commission 2019). These proportions are expected to grow over the coming decades.

There are both similarities and differences between Australia’s aged care system and those in other countries. For illustrative purposes, some characteristics of residential aged care systems in comparably developed countries and with similar life expectancies to Australia are shown in Table 1. However, these statistics are difficult to compare directly, as countries supply data to the Organisation for Economic Co-operation and Development (OECD) using different definitions, data sources and methods. The AIHW is working with the Department of Health to explore ways to improve this comparability.

Table 1: International comparison of aged care systems in 2018

1. 2017 data.

Note:  Data on the number of people living in residential aged care facilities was supplied by Australia as an over-the-year count, by Canada and Germany at a single point in time (30 June), by New Zealand as a count over a full month, and Sweden did not specify their method.

Source: OECD 2020.

Impact of COVID-19 on people using aged care

Australia has faced significant challenges during the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 can be more serious for people who have pre-existing health conditions, including older Australians. People living in residential aged care are a particularly vulnerable group of Australians, and have been disproportionately affected.

The COVID-19 pandemic affected health care services in many ways and residential aged care services were at times locked down and restricted visitors in 2020. Older people living in the community were encouraged to seek health care remotely through telehealth services, and a number of temporary Medicare items were added. There were also changes within aged care services. For example, people in residential aged care could temporarily return to community-living through ‘emergency leave’ that provided up to eight weeks of home support.

During the COVID-19 pandemic, the wellbeing of people living in residential aged care was adversely impacted (see ‘Chapter 3, The impact of COVID-19 on the wellbeing of Australians’ in Australia’s welfare 2021: data insights). People with dementia were particularly affected, although mortality rates among people with dementia were lower during the pandemic than among recent years (AIHW 2021a). Overall, three-quarters (75%) of COVID-19 deaths in Australia by May 2021 occurred in people living in residential aged care (678 deaths) (Department of Health 2021).

In 2020 compared with in 2019 or 2018, the number of people admitted to residential aged care (either their first or a subsequent admission) declined (Figure 2):

• nearly 5,300 fewer people were admitted to permanent residential aged care in 2020 compared with 2019 (there were around 65,100 admissions in 2020 and nearly 70,400 in 2019)
• around 11,100 fewer people were admitted to respite residential aged care in 2020 compared with 2019 (there were around 75,800 admissions in 2020 and nearly 86,900 admissions in 2019)
• these differences in admissions were most apparent in the second and third quarters of 2020 (April through September), which coincided with the period where stringent restrictions were first imposed in Australia.

The aged care workforce

In 2016, the latest year for which comprehensive data are publicly available, there were more than 366,000 aged care workers, including 240,000 direct care workers (Mavromaras et al. 2017). Almost 9 in 10 workers in aged care were female (87% of those in residential care, and 89% of those in home care or home support), and the aged care workforce was generally older than the average across all industries (Mavromaras et al. 2017).

The next census of residential, home care and home support providers was undertaken by the Department of Health during December 2020 and January 2021. Results are expected to be available in 2021.

The Royal Commission into Aged Care Quality and Safety

The Royal Commission was established in October 2018 to explore a wide range of issues relating to the quality and safety of aged care in Australia. The Royal Commission’s final report was delivered 1 March 2021 and highlighted the inadequacies of the current aged care system. These concerns are shared by the Australian public: in the April 2021 ANUpoll, more than half (55%) of respondents indicated that they had ‘not very much confidence’ in the aged care system, and 12% had ‘no confidence at all’ (Biddle & Makkai 2021).

The Royal Commission noted barriers to navigating and entering the aged care system; a lack of available information to inform people’s decisions on which aged care services will meet their needs; inadequate access to health care for people using aged care services – particularly those living in residential aged care; and substandard care and abuse. In total, the Royal Commission made 148 recommendations, proposing a detailed strategy to change and improve the aged care system.

The Royal Commission also specified what high-quality care involves: that older people are assisted to live self-determined and meaningful lives; that educated and skilled workers provide compassionate care; and that a high quality of life is obtained. For immediate improvement, the Royal Commission singled out food and nutrition, dementia care, the use of restrictive practices, and palliative care.

The need for accessible, comprehensive and meaningful data on aged care use and outcomes underpins many of the Royal Commission’s recommendations. It also recommended the development of new standards, guidelines and indicators relating to aged care quality and safety, including a star rating system for comparing the performance of different aged care providers.

For more information on how aged care data can currently be used to understand a person’s pathway through different aged care services (and the quality of the care they receive), and future opportunities for improvement, see ’Chapter 8, Understanding older people’s journey through aged care—the story in the data’ in Australia’s welfare 2021: data insights.

On 11 May 2021, the Australian Government published their response to the Royal Commission’s recommendations. The Government accepted or accepted in principle 126 recommendations, supported alternatives for four recommendations, noted further consideration for 12 recommendations, and did not accept six recommendations. This response coincided with the release of the 2021–22 Federal Budget, which included a $17.7 billion aged care reform package. Central to the Government’s response was a commitment to replace the Aged Care Act 1997 with a new consumer-focused Aged Care Act, planned to commence from 1 July 2023.

 Where do I go for more information?

For more information on aged care, see:

• AIHW’s dedicated aged care data website—GEN aged care data
• Report on Government Services data tables
• Aged Care Quality and Safety Commission website—Aged Care Quality
• International data on characteristics of aged care systems are available from members of the OECD through OECD.Stat
• Summary documents from the Royal Commission into Aged Care Quality and Safety—as well as the final report published through 5 volumes—can be accessed here.

References

ABS (Australian Bureau of Statistics) 2014. Australian historical population statistics, 2014. ABS cat. No. 3105.0.65.001. Canberra: ABS.

ABS 2019. Australian Demographic Statistics, Jun 2019—Twenty years of population change (Feature Article). ABS cat. No. 3101.0. Canberra: ABS.

Aged Care Financing Authority 2020. Eighth Report on the Funding and Financing of the Aged Care Industry—July 2020. Canberra: Department of Health.

AIHW (Australian Institute of Health and Welfare) 2021a. Dementia deaths during the COVID-19 pandemic in Australia. Canberra: AIHW. Viewed 22 April 2021.

AIHW 2021b. GEN—People using aged care. Canberra: AIHW. Viewed 22 April 2021.

Biddle N & Makkai T. 2021. Views and experience of the aged care system in Australia –April 2021. ANU Centre for Social Research and Methods.

Department of Health 2021. COVID-19 outbreaks in Australian residential aged care facilities. Canberra: Department of Health.

Department of Health 2020. Aged care data snapshot 2020—third release. Canberra: Department of Health.

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.

OECD (Organisation for Economic Co-operation and Development) 2020. OECD.Stat. Organisation for Economic Co-operation and Development. Viewed 6 April 2021.

SCRGSP (Steering Committee for the Review of Government Service Provision) 2021. Report on Government Services 2021—part f, section 14. Canberra: Productivity Commission.

The European Commission 2020. Eurostat—Population structure and ageing. The European Commission. Viewed 6 April 2021.