Indigenous Australians accessing government-subsidised aged care services tend to be younger and use these services at higher rates as a proportion of the population than non-indigenous Australians (AIHW 2019). Differences in use are due to various factors, including (but not limited to):
- government policies: Indigenous Australians are identified as 1 of 10 ‘special needs groups’ under the Aged Care Act 1997. As a result of the specific needs of Indigenous Australians, planning for aged care services focuses on Indigenous Australians aged 50 and over rather than age 65 and over for non-Indigenous Australians. However, ultimately, access to aged care services is based on the care needs of each individual. In 2019, the Australian Government published an action plan to support the Aged Care Diversity Framework and address barriers faced by older Indigenous Australians when accessing aged care. For a brief overview of Australia’s aged care system, see Overview of Australia's aged care system.
- preferred care types and availability of services: Eligible older Australians have access to a variety of government-subsidised services. However, Indigenous Australians may face challenges with accessing services that provide culturally appropriate care. Older Indigenous Australians generally wish to remain in their communities and on Country for as long as possible, and to have access to culturally safe health and aged care services in their own communities, as well as away from their communities when needed. While all government-subsided aged care services are available to Indigenous Australians and should be designed to provide them with appropriate care, there are Indigenous-specific services available (and often preferred) such as the National Aboriginal and Torres Strait Islander Flexible Aged Care Program (NATSIFACP). The aim of this program is to provide quality, flexible aged care for older Indigenous Australians, in a culturally safe environment. Associated NATSIFACP providers work mainly in regional, remote, and very remote areas, and help Indigenous Australians with home care, emergency or planned respite, short-term care and permanent residential care. At 30 June, 2020, NATSIFACP offered almost 1,300 places. It is also important to note that Stolen Generations survivors will all be aged 50 and over and eligible for aged care services by the year 2022 – refer to Box 12.1 for more information on this group and how their life experiences could impact their care needs.
- population age structures: both Indigenous and non-Indigenous Australians are experiencing population ageing, but Indigenous Australians have a younger age structure compared to non-Indigenous Australians.
- health status: health conditions associated with ageing and with an increased risk of developing dementia are often more common and begin at younger ages among Indigenous Australians. Rates of aged care use are also generally higher for Indigenous Australians than for non-Indigenous Australians.
This page presents information on how Indigenous Australians use aged care services based on data on comprehensive assessments undertaken for people wanting to access government-subsidised aged care services and for those receiving government-subsidised permanent residential aged care. These data have limitations that should be kept in mind when interpreting the information presented, including that there is incomplete information on Indigenous-specific aged care services. For example, data from the National Aboriginal and Torres Strait Islander Flexible Aged Care Program are not included.
Box 12.1: Providing effective health and aged care to Stolen Generations survivors
There were about 33,600 survivors of the Stolen Generations in 2018–19, and by 2022, all will be aged 50 and over and eligible for aged care services (AIHW 2021).
Under racially motivated policies, between 1910 and the 1970s, as many as 1 in 3 Aboriginal and Torres Strait Islander children were forcibly removed from their families and placed in institutions or adopted by non-Indigenous Australian families, where they often experienced trauma and human rights violations (AIHW 2021). These children have become known as the ‘Stolen Generations’.
Stolen Generations survivors are more likely to experience a range of health, cultural and socioeconomic adverse outcomes compared to other Indigenous and non-Indigenous Australians. Childhood stress and trauma has also been linked as a risk factor for developing dementia in later life among Aboriginal Australians (Radford et al. 2019).
While Stolen Generations survivors often prefer health and aged care services tailored to Indigenous Australians and to receive care in their own homes and communities, these options are not always available. Leading advocacy and expert organisations have called for urgent government action to provide culturally appropriate support and aged care options to survivors (Healing Foundation and Aboriginal and Torres Strait Islander Ageing Advisory Group of the Australian Association of Gerontology 2019). Residential aged care and clinical settings that resemble childhood institutions where removed children were placed can re-trigger trauma (Smith and Gilchrist 2017), so it is essential that health and aged care providers understand the effects of trauma and that care is culturally appropriate and safe (Healing Foundation 2019).
In its final report, the Royal Commission into Aged Care Quality and Safety (Royal Commission) echoed the importance of providing Stolen Generations survivors with appropriate aged care options and further highlighted the importance of ‘…accessible pathways linking Aboriginal and Torres Strait Islanders to the care that they need. To deliver culturally safe pathways to aged care…the Australian Government should ensure that care finders serving Aboriginal and Torres Strait Islander communities are local Aboriginal and Torres Strait Islander people’ (Royal Commission 2021).
Assessment for use of aged care services
Access to government-subsidised aged care services is co-ordinated through the My Aged Care system, in which, after an initial screening to determine eligibility, a person’s needs and types of services are assessed using the National Screening and Assessment Form (NSAF). There are 2 main types of aged care assessments depending on the level of care needed:
- home support assessments – face-to-face assessments provided by Regional Assessment Services for people seeking home-based entry-level support that is provided under the Commonwealth Home Support Programme
- comprehensive assessments – provided by Aged Care Assessment Teams for people with complex and multiple care needs to determine the most suitable type of care (home care, residential or transition care). Dementia is a condition commonly prompting a comprehensive assessment (Ng and Ward 2019).
See Aged care assessments for more information on aged care assessments and the types of services available.
Information on people with dementia who completed a comprehensive and/or home support assessment in 2019–20 is available from NSAF data as part of the National Aged Care Data Clearinghouse. Note that further work is needed to develop the NSAF dataset into a comprehensive resource for statistical reporting. Pending further development of the NSAF data set, the statistics presented here may be subject to change.
Aged care assessments
In 2019–20, just over 8,900 people, or 2.1% of all people who completed an aged care assessment (either a comprehensive or home support assessment) identified as being an Indigenous Australian. Dementia was recorded as a condition contributing to the care needs of over 500 Indigenous Australians, or 5.6% of all Indigenous Australians who completed an aged care assessment in 2019–20.
Among Indigenous Australians who completed an aged care assessment in 2019–20, those with dementia were older than those without dementia. Over half (55%) of Indigenous Australians with dementia were aged 75 and over compared with 24% of Indigenous Australians without dementia (Figure 12.12).