Transitions to residential aged care after hospital for people living with dementia

Variables not included here were reported using variables available in the APC data.

Place of death

Place of death is reported using information from the RAC dataset to determine whether the person lived in residential aged care at the time of their death, and information from the APC and ED datasets to determine whether the person attended the ED on the day of their death or was in hospital on the day of their death.

Urgency of admission

Urgency of admission to hospital relates to whether a hospitalisation can be delayed by 24 hours or not, in the opinion of the treating clinician (AIHW 2018). Emergency admissions should occur within 24 hours due to risk of serious illness or death, whereas elective admissions can be delayed by 24 hours or more. A very small number of people in the study had a hospitalisation with no urgency status assigned, typically meaning they had a change in care type or a planned readmission. For the purposes of this report, they have been reported together with people with an ‘elective’ urgency of admission.

Clinical complexity of care

Clinical complexity of care is recorded for each episode of care for each person and is estimated using the Australian Refined Diagnostic Related Group (AR-DRG). Episodes with major complexity tend to have higher healthcare costs compared with episodes of care with intermediate or minor complexity. For people that had more than one episode of care, the complexity of the most complex episode of care is reported.

Care type

Care type broadly reflects the nature of the clinical service that the person received during their care, and is here categorised as acute care, geriatric evaluation and management, maintenance care, palliative care, rehabilitation care, psychogeriatric care, mental health care, or other. Full descriptions of each care type are available (AIHW 2019). For people who had more than one episode of care and used more than one care type, each distinct type of care is reported.

Use of respite care after hospitalisation

For people who used RAC before and after their hospitalisation, information on (randomised) facility ID and respite care use in the RAC activity data was used to determine whether the person changed to a different RAC facility, and if so whether they used residential respite care to change to a different RAC facility.

For people who moved from living in the community to living in RAC after their hospitalisation, information on residential respite care use in the RAC activity data was used to determine whether the person entered residential aged care using respite residential aged care.

ED prior to admission

People who had an ED episode in the ED data that started before their first hospitalisation and ended on or after the first day of their first hospitalisation were characterised as using ED prior to their admission.

Length of stay

Length of stay is calculated as the difference in days between the admission date of the first episode of care and the separation date of the final episode of care.

Principal diagnosis

A person’s principal diagnosis is the specific reason that they were hospitalised and is recorded using the ICD-10-AM 3-character diagnosis codes.

In this report the principal diagnosis of people’s first episode of care is summarised into one of 22 broad categories of diseases or health problems which corresponds to the ICD-10-AM chapters (AIHW 2020, Table 6). These are reported alongside the most common principal diagnosis in each group.

Table 6 ICD-10-AM chapters and report classification

Diagnoses of interest

Dementia as a principal or additional diagnosis during hospitalisation was reported where the person had any of the codes present in Table 2 during their first hospitalisation. 

Potentially preventable complications were selected from the Australian Commission on Safety and Quality in Health Care’s list of hospital-acquired complications (Australian Commission on Safety and Quality in Health Care 2022). Complications most relevant to people living with dementia were selected in consultation with the AIHW’s Dementia Expert Advisory Group, these included: delirium, in-hospital falls, pneumonia, pressure injuries and urinary tract infections.

People who were reported to be ‘eligible and awaiting entry to residential aged care’ during their hospitalisation were of interest because these people are at the interface between the hospital and aged care systems.

People who were hospitalised due to a fall that occurred outside of hospital were also of interest because people living with dementia are known to be at higher risk of falls and to be more likely to have a serious injury or to die after a fall compared with people without dementia.

Table 7 Codes to identify diagnoses of interest in APC data

Medicare-subsidised services

MBS group code, MBS item number or Registered specialty codes in the MBS data were used to determine people’s use of Medicare-subsidised services in the 3-months and 12-months after discharge from their first hospitalisation.

Table 8 Codes to report use of Medicare Benefits Scheme services

1. MBS item numbers for attendances in a residential care facility are also included in broad type of service group A/101 or B/103, 
2. includes general medicine, cardiology, haematology, neurology, geriatric medicine, medical oncology (including radiation oncology and gynaecological oncology), general surgery, urology, dermatology, ophthalmology, psychiatry and other specialties.