AGED CARE

This section provides information on government services that give care and support to frail older people who are living in the community or who are in a residential aged care facility. Entry to many of the programs requires assessment and approval by an Aged Care Assessment Team (ACAT), but ACATs also refer clients to other services which do not require formal approval. The Home and Community Care Program (HACC) is one such program and is the largest community care program, both in terms of expenditure and numbers of clients receiving care in any given year.

HACC is jointly funded by the Australian and state and territory governments. It provides community-based support services, such as home nursing, personal care, respite, domestic help, meals, and transport to people who can be appropriately cared for in the community and can therefore live at home.

ACAT approval is required to access Community Aged Care Packages (CACPs), Extended Aged Care at Home (EACH) packages, EACH Dementia packages and residential aged care (including residential respite care), all of which are subsidised by the Australian Government. In addition, ACAT assessment is required for entry to the Transition Care Program, and may be required by some states and territories for entry to the Multi-purpose Service program, both of which are funded jointly with the states and territories.

CACPs provide support and care to people who prefer to remain at home rather than enter low level residential aged care for which they are also eligible. EACH is a relatively new program which provides home care for people who are otherwise eligible for high level residential aged care. A recent innovation in provision of high care packages has seen the introduction of the EACH Dementia program with packages that are specifically targeted at people with dementia and associated behaviour and psychological symptoms (EACH Dementia). Use of the EACH and EACH Dementia programs by Indigenous people has been relatively low.

Residential aged care is subsidised by the Australian Government and provides accommodation and other support services such as personal care, help with performing daily tasks, and nursing care.

Although these services are mainly used by older people, a proportion of younger people utilise such services. This occurs relatively more often among Indigenous Australians because of the higher prevalence of chronic diseases among young people. For example, Type 2 diabetes, cardiovascular diseases and kidney disease typically occur at younger ages among Indigenous people and can result in a need for care at younger ages.

When planning service places and packages for older people, the Australian Government uses population estimates for the general population aged 70 years and over. However, in the allocation of places and packages across the country the Government also takes into account the number of Indigenous Australians who are 50 years and over (as a proxy for old age) (DHAC 2001). A research project, funded under the National Health and Medical Research Council/Australian Research Council Ageing Well, Ageing Productively program is underway in the School for Social and Policy Research at Charles Darwin University to examine the robustness of this planning assumption.

In developing programs to meet the care needs of older people, particular consideration is given to issues of access and equity for groups with special needs - such as Indigenous Australians. The Aboriginal and Torres Strait Islander Aged Care Strategy was developed in 1994 after consultation with Indigenous communities and organisations involved in the provision of aged care services. This Strategy tackles issues of access to services, including those related to the rural and remote location of many Indigenous communities. The Strategy established Aboriginal and Torres Strait Islander Flexible Services, which provide aged care services with a mix of residential and community care places that can change as community needs vary. Many of these services have been established in remote areas where no aged care services were previously available. The flexible services developed as part of the Strategy are now funded under the National Aboriginal and Torres Strait Islander Flexible Aged Care Program.

In rural and remote locations that are too small to support the standard systems of aged care provision, Multi-purpose Services provide a more workable care and treatment model by bringing together a range of local health and aged care services, often including residential aged care, under one management structure. Multi-purpose Services provide flexible care places.


Home and Community Care Program

Data about client characteristics and services provided through the HACC program are collected on a quarterly basis and records are linked across quarters to form the annual HACC Minimum Data Set (MDS). Although a set of demographic, circumstance and assistance totals is held in the data repository for each agency reporting a client's data, only one set of demographic data is included in the combined linked data set. These demographic data are not a compilation from multiple data records but rather a selection of the demographic data record with the most recent assessment date. Consequently, not all valid demographic values may be captured and some invalid or missing values may be included. This may have an impact on the consistency of reporting of Indigenous status over time within the linked data. In 2005-06, Indigenous status was not recorded or not known for nearly 16% of HACC clients, compared with 11% of clients in 2004-05.

During 2005-06 approximately 3,200 organisations (around 82% of HACC-funded organisations) submitted data on the services they provided to clients across Australia. Among participating agencies, HACC services were provided to about 777,500 clients of all ages. Of these, just over 2.5% (about 19,100 after pro-rating of clients with missing Indigenous status) were reported to be Indigenous clients, ranging from 45% in the Northern Territory to 1% in Victoria and the Australian Capital Territory (DoHA 2007a).

Age profile

Analysis of HACC MDS data shows that Indigenous HACC clients had a younger age profile than other clients (graph 11.16). About 57% of Indigenous clients were aged less than 65 years, compared with 18% of non-Indigenous clients. About 20% of Indigenous clients were aged 75 years or over, compared with 63% of non-Indigenous clients. The proportion of both Indigenous and non-Indigenous clients who were aged 75 years or over has increased slightly for both groups since 2003-04 (18% and 57% respectively), reflecting the ageing of the Australian population overall (DOHA 2007a).

Usage rates

An examination of age-specific usage rates for Indigenous HACC clients in 2005-06 suggests the existence of some data quality problems. For some groups (e.g. Indigenous women aged 75 years and over) and for some states, the number of HACC clients identified as Indigenous were close to or greater than the ABS estimates of the corresponding Indigenous population. There may be a number of factors contributing to this. Repeat HACC clients may provide different name or birth date information to different HACC agencies, resulting in them being counted more than once. Over-estimation of the clients' ages could also result in higher age-specific usage rates for older clients. The usage rate might also be inflated if people were more inclined to identify themselves as Indigenous in the HACC collection than in the 2001 Census.

Because of these concerns about Indigenous identification in the HACC MDS, further information by Indigenous status is not presented for the Home and Community Care Program.


The Aged Care Assessment Program

The Aged Care Assessment Program (ACAP) is jointly funded by the Australian Government and the states and territories to support the network of multidisciplinary Aged Care Assessment Teams (ACATs) which operate in each state and territory within Australia. The primary purpose of ACATs is to comprehensively assess the care needs of frail older people and assist them to gain access to the types of available services most appropriate to meet their care needs. The assessment of care needs takes into account a person's physical, medical, psychological and social needs and assists them in gaining access to appropriate care services.

Aged Care Assessment Teams (ACATs) may be hospital or community-based. The main professional groups represented in teams are doctors, nurses, social workers, physiotherapists and occupational therapists. The target populations for assessment by an ACAT are non-Indigenous people aged 70 years or over and Indigenous people aged 50 years or over. Data about ACAT clients and services are recorded at a national level in the ACAP MDS. Indigenous status was not known or not recorded for 3.4% of completed assessments in 2004-05 (ACAP NDR 2006).

In 2004-05, there were 2,075 referrals to ACAP for Indigenous clients. Nationwide, 5% of the Indigenous population aged 50 years and over were referred to the ACAP and 1,862 received a complete assessment (ACAP NDR 2006). Nationally, the proportion of referrals to the ACAP for Indigenous clients was only 46% of the expected number, given the proportion of people in the target population (ACAP NDR 2006).

Both waiting times for assessment and the duration of the assessment process were generally shorter for Indigenous than non-Indigenous clients. The report from the ACAP National Data Repository notes that 'ACATs seem to have made an effort to complete assessments for Indigenous clients quickly, even though Indigenous clients often live in isolated communities and their assessments may require assistance from an interpreter or culturally appropriate assessor'.


National Aboriginal and Torres Strait Islander Flexible Aged Care Program

At 30 June 2006, there were around 30 services delivering 580 flexible places for Indigenous clients under the National Aboriginal and Torres Strait Islander Flexible Aged Care Program. These services are funded to deliver culturally appropriate aged care, close to home and country, mainly in rural and remote areas.

As part of the 1994 National Strategy, services were established to provide aged care using a flexible model. Communities are encouraged to participate in every aspect of service provision, from the very early planning stages right through to the operation of the services. These services are now funded under the National Aboriginal and Torres Strait Islander Flexible Aged Care Program.

The funding is 'cashed-out' and can be used flexibly so that a mix of residential and community aged care services can be provided. The mix of services may change as aged care needs vary. Funding is based on an agreed allocation of places, and not on the occupancy of those places. This provides a constant income stream so that service providers have both stability of income from the funding and flexibility to manage the delivery of aged care services. No demographic data are available for clients of these services.


Community Aged Care Packages

Out of a total of 31,803 people receiving Community Aged Care Packages (CACP) at 30 June 2006, 1,204 (4%) identified as being of Aboriginal or Torres Strait Islander origin. Indigenous status was not known for 0.4% of care recipients.

Age profile

Of people receiving assistance, proportionately more Indigenous recipients were in younger age groups (graph 11.17). About 36% of Indigenous CACP recipients were aged less than 65 years of age, compared with fewer than 4% of other CACP recipients. About 29% of Indigenous care recipients were aged 75 years and over, compared with 82% of other care recipients.

Usage rates

Use of Community Aged Care Packages is higher for Indigenous Australians compared with other Australians in all age groups examined. At 30 June 2006, there were 16 per 1,000 Indigenous clients aged 50-74 years, compared with 1 per 1,000 other Australian clients in the same age group (table 11.18). There were 85 per 1,000 Indigenous Australians aged 75 years and over using Community Aged Care Packages, compared with 20 per 1,000 other Australians in this age group.

11.18 COMMUNITY AGED CARE PACKAGE RECIPIENTS(a), by Indigenous status and age(b) - 30 June 2006
	Recipients			Usage rate per 1,000(c)
Age group (years)	Indigenous	Other	Total	Indigenous	Other	Total
Less than 50	58	128	186	0.1	-	-
50-74	806	5 431	6 237	15.7	1.1	1.2
75 and over	345	25 035	25 380	84.8	19.6	19.8
Total	1 209	30 594	31 803	0.2	1.5	1.5
- nil or rounded to zero (including null cells)
(a) Recipients of packages provided by multi-purpose services and services receiving flexible funding under the National Aboriginal and Torres Strait Islander Flexible Aged Care Program are not included, as age-specific figures are not available for these programs.
(b) There were 134 recipients whose Indigenous status was not stated. Within age groups, these recipients have been distributed between the ‘Indigenous’ and ‘Other’ categories in accordance with the proportion that occurred for recipients with a known Indigenous status.
(c) Rates per 1,000 are based on the ‘low series’ ABS population projections based on the 2001 Census.
Source: AIHW analysis of the DoHA Aged and Community Care Management Information System Database

Residential aged care services

There were 154,872 people using residential aged care services at 30 June 2006. Of these, 872 permanent residents (0.6% of all permanent residents) and 35 people in respite care (1.1% of all people in respite care) identified as being of Aboriginal or Torres Strait Islander origin. Indigenous status was not recorded or not known for 10,967 residents (5%) (AIHW 2007m).

Age profile

Of those who were admitted to permanent or respite care during 2005-06, proportionately more Indigenous people were in younger age groups (graph 11.19). Almost 35% of Indigenous Australians were less than 65 years of age on admission to residential aged care, compared with 4% of other Australians. In contrast, about 41% of Indigenous Australians were aged 75 years or over on admission, compared with 85% of other Australians.

Usage rates

Age-specific usage rates show that Indigenous Australians make higher use of residential aged care services than other Australians at all ages (table 11.20). At 30 June 2006, 8 per 1,000 Indigenous people aged 50-74 years were residents in residential aged care, compared with 4 per 1,000 other Australians. At ages 75 years and over, 109 per 1,000 Indigenous people were in residential care, and 105 per 1,000 other Australians were in residential care. However, total usage rates for Indigenous Australians are lower than for non-Indigenous Australians due to the small proportion of the Indigenous population aged 75 years and over, the age group in which usage rates are highest.

11.20 RESIDENTS OF RESIDENTIAL AGED CARE SERVICES AND SERVICE USAGE RATES(a), by resident’s Indigenous status and age - 30 June 2006
	Residents			Usage rate per 1,000(b)
Age range (years)(c)	Indigenous	Other	Total	Indigenous	Other	Total
Under 50	85	963	1 048	0.2	0.1	0.1
50-74	428	18 677	19 105	8.3	3.8	3.8
75 and over	444	134 275	134 719	109.0	105.3	105.3
Total	957	153 915	154 872	1.9	7.6	7.5
(a) Places provided by multi-purpose services and services receiving flexible funding under the Aboriginal and Torres Strait Islander Aged Care Strategy are not included, as age-specific figures are not available for these programs.
(b) Rates per 1,000 are based on the ‘low series’ ABS population projections based on the 2001 Census.
(c) There were 6,799 residents whose Indigenous status was not stated. Within age groups, these residents have been distributed between the ‘Indigenous’ and ‘Other’ categories in accordance with the proportion that occurred for residents with a known Indigenous status.
Source: AIHW analysis of the DoHA Aged and Community Care Management Information System Database

Dependency levels

The care needs of residents (dependency levels) are indicated by scores on the Resident Classification Scale (RCS). The RCS has eight categories which represent eight levels of care need in descending order from 1 to 8, with categories 1-4 representing high-care status and categories 5-8 representing low-care status.

Overall, 72% of Indigenous residents were classified as high-care at 30 June 2006, compared with 68% of other residents.


Residential respite care

Respite care supports community living for people who receive assistance from informal providers (family carers), by giving carers a break from providing assistance to see to their own affairs, to visit family and friends, to take a holiday or in instances where carers themselves encounter health, personal or family problems.

Residential respite care is recognised as an important component of the carer support system and provides short-term accommodation and care in residential aged care homes on a planned or emergency basis. Apart from emergencies, ACAT approval is required to access residential respite care and an approval remains valid for 12 months. A person with a valid ACAT approval for residential respite care may use up to 63 days of respite care in a financial year, which can be taken in 'blocks', for example, one or two weeks at a time. An extra 21 days may be available if deemed necessary by an ACAT.

There were 49,727 admissions for residential respite care between 1 July 2005 and 30 June 2006, 490 of which (1%) were for people who identified as Indigenous. Admission rates for Indigenous people in younger age groups were higher than non-Indigenous people, however, over two-thirds (68%) of admissions of Indigenous people were for those aged 65 years and over. At 30 June 2006, there were 3,135 respite residents, 35 (or 1%) of whom were Indigenous.

11.21 INDIGENOUS IDENTIFICATION IN COMMUNITY SERVICES COLLECTIONS Since the 2005 edition of this report, the quality of identification of Aboriginal and Torres Strait Islander clients in eight community services data collections has been examined, by analysing the extent to which Indigenous status is missing or not stated in each of the data collections (AIHW 2007l). The rates of missing/not stated were compared with those reported earlier, and a survey of activities at the national and the jurisdictional level to improve the quality of Indigenous identification in these data collections was also carried out. The eight data collections examined were: Commonwealth-State Disability Agreement Minimum Data Set Residential Aged Care Services Data Collection Home and Community Care Minimum Data Set Community Aged Care Packages Data Collection Supported Accommodation Assistance Program National Data Collection Juvenile Justice National Minimum Data Set Alcohol and Other Drug Treatment Services National Minimum Data Set National Child Protection data collection, incorporating three data collections: Children who are the subject of notifications, investigations and substantiations; Children on care and protection orders; and Children in out of home care. Five out of the eight data collections reported decreases in the national missing/not stated Indigenous status rates, while the other three collections recorded an increase. It should be noted that these increases are not necessarily indicative of a decline in the quality of the data collected - the implementation of methods to promote longer term improvements may also contribute to a short-term increase in the rate of missing/not stated Indigenous status. The extent to which the Indigenous identifier was missing or not stated varied greatly between the datasets. However, any analysis of Indigenous identification data in the community services sector must take into consideration that the preparedness of clients to identify may be influenced by a number of factors related to the nature of the service provided, including the purpose of the service and the voluntary nature of the clients' access to the service. Activities aimed at improving the identification of Aboriginal and Torres Strait Islander clients that have been implemented at the national level include the development of improved data collection forms and software; implementation of the standard Indigenous status question; consultation with jurisdictions and agencies on the use of their data, including the return of data; and edit checks of national and jurisdictional data. Activities implemented in various data collections at the jurisdictional level have included supplying feedback to participating agencies by following up on data quality issues as they arise and providing support to participating agencies through training and data guides, help-desks and data collection software packages.

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