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4102.0 - Australian Social Trends, 2003  
Previous ISSUE Released at 11:30 AM (CANBERRA TIME) 03/06/2003   
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Contents >> Population >> Population characteristics: People in institutional settings

Population characteristics: People in institutional settings

From 1981 to 2001, the number of people in psychiatric hospitals or psychiatric institutions decreased from 21,700 to 6,100, while the number in accommodation for the retired or aged increased from 27,400 to 147,700.

People stay in institutional settings for a variety of reasons, such as frailty associated with old age, disability, ill health, homelessness, economic hardship, rehabilitation, family breakdown or dysfunction, detention, correction, study, employment, and religious observance. This article focuses on reasons related to disability and aged care, breakdown in the functioning of primary social support networks such as the family, and issues of crime and justice. Medical advances and changes in society's demographic structure, economic prosperity, social values and attitudes, government policies, and available housing options have influenced the number of Australians living in institutional settings, and are likely to do so into the future.


Institutional settings
Most of the data presented in this article were collected in various Censuses of Population and Housing, using census definitions, classifications, collection methodologies and coding procedures. This article mainly looks at people who spent census night in one of the following 10, of 19 types of non-private dwelling (i.e. dwellings other than private houses, flats, units or apartments etc.) defined and classified by the census:
  • Nursing homes (nursing homes are public or private establishments providing mainly nursing care for inpatients, including sanatoria, convalescent homes and hospitals with mainly nursing facilities for the aged and terminally ill, but excluding cared accommodation for the retired or aged.)
  • Cared accommodation for the retired or aged (cared accommodation for the retired or aged are hostel type structures with common living and eating facilities for people who, in general, are in good health and capable of looking after themselves including hostels for the aged, ANZAC / war veterans homes, and homes for retired members of religious orders, but excluding institutions providing mainly medical or nursing care, establishments owned by retirement trusts, and self-care accommodation for the retired or aged - defined below)
  • Hostels for the disabled
  • Psychiatric hospitals or institutions
  • Hostels for the homeless, night shelters, refuges
  • Child care institutions
  • Corrective institutions for children
  • Other welfare institutions
  • Prison, corrective or detention institutions for adults
  • Convents, monasteries.

People in self-care accommodation for the retired or aged are also discussed in this article but are not considered to be living in an institutional setting as they provide their own meals and are regarded as being self sufficient. This type of accommodation includes retirement villages that offer life tenure arrangements.


Disability and aged care institutions
Over recent decades, population growth and increased life expectancy has had the potential to increase the number of institutionalised older people and people with a disability. Between 1981 and 2001, there was a 67% increase in the number of people aged 65 years and over. Related to this increase, the number of Australians aged five years and over living with severe or profound restriction due to disability more than doubled between 1981 and 1998.

At the same time, the effect of these changes was partly offset by changes to disability and aged care policy. Since the mid-1980s, government policy has increasingly emphasised the need to support older people and people with a disability to live in the community with some degree of independence, receiving help when needed from family, friends, neighbours, and formal service providers (government, private non-profit, and commercial). Since its inception in 1985, the Home and Community Care Program has provided a range of services to people who might otherwise have required institutional care. There has also been an increase in self-care-style accommodation for older people. Consequently, the number of people in nursing homes and other traditional disability and aged care institutions has not increased at the same rate as the populations of older people and people with a disability.

...change since 1981
In 2001, 75,400 people spent census night in a nursing home. Most of these people (73,800) lived in the nursing home as a recipient of nursing care while the remainder usually lived elsewhere or were living in the nursing home as an owner, proprietor, staff or family member. Over the preceding two decades, the number of people who spent census night in a nursing home grew more slowly than the aged population.

Growth between 1981 and 2001 in other types of accommodation for older people may partly explain this comparatively slow growth in the number of people in nursing homes. For example, the number of people in accommodation for the retired or aged increased from 27,400 to 147,700 over this period. In 2001, most (80,400) of these 147,700 people were in self-care accommodation such as retirement villages, a 37% increase in number since 1996. In comparison, growth over this five-year period in the number of people in cared accommodation for the retired or aged was much lower at 2%.

The rate of growth in the number of people in nursing homes between 1981 and 2001 is likely to have also been influenced by a range of policies aimed at reducing the proportion of low-dependency residents living in nursing homes.1 In 1998, 96% of people living in a nursing home or aged care hostel had a disability with specific restriction(s). The vast majority (92%) were severely or profoundly restricted in performing one or more tasks related to communication, mobility or self care.2

NUMBER OF PEOPLE IN SELECTED TYPES OF ACCOMMODATION FOR OLDER PEOPLE
Graph - Number of people in selected types of accommodation for older people

(a) Comprises cared accommodation for the retired or aged and self-care accommodation for the retired or aged.

Source: ABS 1981-2001 Censuses of Population and Housing.


In the provision of care for people with a disability, non-institutionalisation has been accompanied by de-institutionalisation. Consistent with the large-scale closures of mental health and intellectual disability institutions during the 1970s and 1980s,3 the number of people in psychiatric hospitals or institutions declined substantially between 1981 (21,700) and 1991 (9,200). The fall in numbers continued at a slower rate over the next decade, dropping to 6,100 by 2001.

Between 1981 and 1991, the number of people staying in hostels for the disabled more than trebled (from 3,300 to 11,800). Over the subsequent decade however, the number of people staying in this particular institutional setting decreased to 9,300 in 2001. This decrease occurred despite an estimated increase between 1993 and 1998 of approximately 40% in the number of Australians aged less than 65 years with a severe or profound communication, mobility or self care restriction.4

PEOPLE IN HOSTELS FOR THE DISABLED AND PSYCHIATRIC HOSPITALS OR INSTITUTIONS
Graph - People in hostels for the disabled and psychiatric hospitals or institutions

Source: ABS 1981-2001 Censuses of Population and Housing.


...demographic profile
At the time of the 2001 Census, 94% of people in nursing homes and 95% of people in accommodation for the retired or aged were aged 65 years and over. In contrast, 27% of people in hostels for the disabled were aged 65 years and over. The majority (55%) were aged between 35 and 64 years, and around one in five (19%) were aged less than 35 years. People in psychiatric hospitals or institutions tended to be younger still. While around half (51%) were aged between 35 and 64 years, 26% were less than 35.

In addition to being older, people in nursing homes and cared accommodation for the retired or aged were predominantly female (71% and 74% respectively) and widowed (60% and 67%). This demographic profile relates to the longer life expectancy of women compared with men. In comparison, there were more males (53%) than females in hostels for the disabled, and nearly three-quarters (71%) of people in this type of institutional setting had never married. People in psychiatric hospitals or institutions were even more likely to be male (55%), but were less likely to have never married (57% compared with 71%). Of people in psychiatric hospitals or institutions who had married at some time in their life, more than half were separated, divorced or widowed.

CHARACTERISTICS OF PEOPLE IN SELECTED INSTITUTIONAL SETTINGS - 2001
Nursing homes
Cared accommodation for the retired or aged
Hostels for
the disabled
Psychiatric hospitals
or institutions
%
%
%
%

Age group (years)
Under 35
0.4
0.3
19.0
25.8
35-64
5.5
5.0
54.5
50.6
65 and over
94.1
94.6
26.5
23.6
Sex
Male
29.1
26.5
52.6
55.0
Female
70.9
73.5
47.4
45.0
Marital status
Never married
11.9
12.7
71.3
57.2
Widowed
59.8
67.2
14.4
9.7
Divorced
4.4
5.4
6.3
10.4
Separated but not divorced
1.3
1.7
1.7
4.5
Married
22.7
13.1
6.4
18.2

Total
100.0
100.0
100.0
100.0

'000
'000
'000
'000

Total
75.4
67.3
9.3
6.1

Source: ABS 2001 Census of Population and Housing.

Welfare institutions
People staying in institutional settings which provide mainly protective care include orphans, homeless people, women seeking refuge, and people undergoing rehabilitation from drug addiction. These institutional settings are commonly funded by governments and run by non-government agencies.

There has been a large decline in numbers in child care institutions in recent decades. The number of children in this type of institutional setting fell from 5,000 to 200 between 1981 and 2001. Influenced by research in the early 1950s that linked emotional adjustment and mental health to maternal love and care in childhood, in the late 1950s and 1960s child protection services began to steadily move away from institution-based services. Child welfare agencies preferred children to be cared for in their own home, in the home of other family members, or in foster care.3 For more information see Australian Social Trends 2003, Child protection.

In line with this preference to not institutionalise children, the number of juveniles in corrective institutions for children has also declined over recent decades. On census night in 2001, there were about 500 children in these corrective institutions, representing the continuation of a gradual decrease in number from around 1,500 in 1981.

On census night in 2001, there were 5,200 people staying in hostels for the homeless, night shelters and refuges. The number of people in these institutional settings rose markedly between 1986 and 1991, but declined over the following decade.

PEOPLE IN WELFARE INSTITUTIONS
Graph - People in welfare institutions

(a) Includes adults counted in child care institutions on census night.

Source: ABS 1981-2001 Censuses of Population and Housing.


Members of religious orders
Not everyone living in an institutional setting does so compulsorily or because of a need for care. Some people choose to live communally for religious, educational or other reasons. People living in institutions providing mainly group accommodation for members of religious orders (such as convents and monasteries) are an example of this preference for living in an institutional setting.

Over the past two decades the number of people in convents and monasteries has more than halved. Numbers increased slightly between 1981 (10,600) and 1986 (10,700) but were progressively lower in 1991 (7,500), 1996 (5,900) and 2001 (5,100). In 2001, most people in this type of institutional setting (84%) stated a Christian religion, and 62% were female.


Prisons
Set against the general trend towards non-institutionalisation and de-institutionalisation, one type of institutional setting that has seen its population increase over recent years has been prisons and corrective or detention institutions for adults (i.e. aged 18 years and over). Around 24,000 people spent census night 2001 in such institutional settings. After increasing marginally between 1981 and 1991, the number of people who spent census night in these institutions increased more markedly between 1991 and 2001.

PEOPLE IN PRISONS, CORRECTIVE INSTITUTIONS AND DETENTION INSTITUTIONS
Graph - People in prisons, corrective institutions and detention institutions

(a) Includes adults counted in corrective institutions for children on census night.

Source: ABS 1981-2001 Censuses of Population and Housing.


This rise in the number of prisoners and detainees is consistent with increases in some types of recorded crime. For example, between 1993 and 2001, there were increases in the number of victims of robbery (108%) and sexual assault (37%), while between 1995 and 2001 there was a 49% increase in the number of victims of assault.5 The rise is also consistent with increases between 1991 and 2001 in the median aggregate sentence length (from 3.0 years to 3.3 years), and in the number of unsentenced prisoners remanded in custody (from 1,983 to 4,334).6

Changes in other institutional settings may be contributing to increases in crime and in the number of prisoners and detainees. In particular, there is a widespread belief that one consequence of the de-institutionalisation of people with an intellectual or psychiatric disability has been an increase in the rate of imprisonment of such people.3

Despite the increased numbers, only a small proportion of people in Australia (well under 1%) spent census night 2001 in a prison, corrective institution or detention institution. However, this rate of incarceration varied considerably between age groups, between males and females, and between Indigenous and non-Indigenous Australians.

At the end of June 2001, males were more likely than females of the same age group to be in prison. This was particularly true for young adults. For example, the imprisonment rate of men aged 20-24 years (610 per 100,000) was 11 times higher than the imprisonment rate of women of the same age (55 per 100,000). The likelihood of imprisonment was also greatest among relatively young adults (20-24 years for females and 25-29 years for males). Beyond these age groups, increasing age was accompanied by diminishing likelihood of being imprisoned.

The high rate of Indigenous Australians' contact with the criminal justice system and the prison system is an issue of concern to governments and communities. On 30 June 2001, approximately one in five prisoners (4,445) were of Aboriginal or Torres Strait Islander origin. Indigenous Australians were much more likely to be imprisoned than other Australians, with an imprisonment rate of nearly 2% (1,829 prisoners per 100,000 Indigenous peoples aged 17 years and over). This rate of imprisonment was 15 times higher than among non-Indigenous Australians (123 prisoners per 100,000 non-Indigenous people aged 17 years and over).6

For both males and females, and for all age groups, imprisonment rates tended to be considerably higher among Indigenous than non-Indigenous Australians, with the differences being most pronounced among people aged between 20 and 34 years. In particular, among Australians aged 25-29 years, the rate of imprisonment of non-Indigenous women was 33 per 100,000. The rate was 15 times higher among non-Indigenous men (490 per 100,000), 16 times higher among Indigenous women (537 per 100,000), and 175 times higher among Indigenous men. Nearly 6% of Indigenous men aged 25-29 years (1,015 men) were in prison on 30 June 2001.

The comparatively high imprisonment rates of Indigenous Australians may be associated with disadvantage experienced across a range of socioeconomic aspects of life (see Australian Social Trends 2000, Social conditions of Aboriginal and Torres Strait Islander people).

IMPRISONMENT RATES - 2001
Graph - Imprisonment rates - 2001

Source: Prisoners in Australia, 30 June 2001 (ABS cat. no. 4517.0).


Endnotes
1 Australian Institute of Health and Welfare (AIHW) 1993, Australia's Welfare 1993: services and assistance, AIHW Cat. No. AIHW-044, AGPS, Canberra.
2 Australian Bureau of Statistics 1999, Disability, Ageing and Carers, Australia: Summary of Findings, 1998, cat. no. 4430.0, ABS, Canberra.
3 Australian Institute of Health and Welfare (AIHW) 2001, Australia's Welfare 2001, AIHW Cat. No. AUS-24, AIHW, Canberra.
4 Australian Bureau of Statistics 2001, Accounting for change in disability and severe restriction, 1981-1998, Working papers in Social and Labour statistics, No. 2001/1.
5 Australian Bureau of Statistics 2002, Recorded Crime, Australia, 2001, cat. no. 4510.0, ABS, Canberra.
6 Australian Bureau of Statistics 2002, Prisoners in Australia, 30 June 2001, cat. no. 4517.0, ABS, Canberra.

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