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).
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.
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.
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.