PEOPLE WITH A NEED FOR ASSISTANCE

ABSTRACT

Some people in the community require assistance with basic activities of daily living, such as cooking, washing, dressing, mobility and communication. Using data from the 2006 Census, this article describes the prevalence rates of the population needing assistance by age and across the states and territories. It also looks at the circumstances of people with a need for assistance, including their living arrangements and participation in education and employment.


INTRODUCTION

Some people within the community require assistance with tasks associated with daily life, such as caring for themselves, household chores and transportation. There are a number of reasons why an individual may need assistance, including congenital conditions, disability from accidents and injuries, old age or chronic ill health.

Due to a growing and ageing population, increases in life expectancy and continued medical advances, the number of people with a need for assistance is expected to increase in the future. It is important, therefore, to understand the rates of need for assistance throughout the population as this can help identify where additional resources and services may be required. There are also important policy implications related to the social arrangements and conditions in which people with a need for assistance live. These concern the levels of care provided by families, availability of institutional care, and the extent of participation by people with a need for assistance in education, employment and the wider community.

In 2006, 822,000 Australians were reported as needing some assistance with core activities such as self-care, communication or mobility, due to a long-term health condition, disability or old age. This was equivalent to 4.4% of the population for whom the question was answered in the 2006 Census.


AGE AND SEX

Overall, children and much of the adult population tend to have low rates of disability. As people age, the proportion of people needing assistance becomes much higher. Among all people aged less than 65 years, the rate of need for assistance was 2.3%. This ranged from 1.0% among children aged less than five years to 6.0% for those aged 60-64 years. The rates of need for assistance increased sharply around age 70-74 years, where 10% required some assistance. By age 80-84 years the rate was 29%, and among people aged 90 years and over, around 68% were in need of assistance. The higher rates among older people resulted in a disproportionate share of disability being in older age groups - 55% of all people with a need for assistance were aged 65 years and over, yet people that age made up just 13% of the population.

At younger ages, males have higher rates of need for assistance than females. For children aged 5-14 years, 2.7% of boys had a need for assistance but the rate in girls was only 1.4%. This difference reflects the higher incidence of birth and intellectual/learning disorders in boys. 1 However, females required more assistance in old age - 21% of women aged 65 years and over reported a need for assistance compared with 15% of men in the same age group. This reflects the fact that older men are more likely to experience acute illnesses followed by a short period of ill health before death, whereas older women are more likely to have a longer period of chronic ill health before death. 2


REGIONAL DIFFERENCES

Because of the strong association between age and disability, the most important factor in determining an area's overall rate of need for assistance is the age structure of the population. Differences in rates of need for assistance among the states and territories therefore reflect the differences in age structure. Tasmania and South Australia each had 15% of their populations aged 65 years or over in 2006, compared to 13% nationally. The rates of need for assistance in these states were 5.2% in Tasmania and 5.1% in South Australia, compared with 4.4% nationally. In contrast, the younger jurisdictions of the Northern Territory and Australian Capital Territory had 2.7% and 3.4% of their respective populations requiring assistance.

In general, the populations of areas outside Major Cities such as Inner Regional and Outer Regional areas have older age structures than the Major Cities and Remote/Very Remote areas (see Australian Social Trends 2008, Population distribution). This is associated with people's migration patterns upon retirement, and the migration of younger people to Major Cities for educational and work opportunities. The higher proportions of older people in Inner and Outer Regional Australia give these areas the greater relative need for assistance. Inner Regional areas had the highest rate of need at 5.0%, followed by Outer Regional areas (4.5%). People in Remote and Very Remote areas had rates of 3.3% and 2.6% respectively, reflecting the younger age structure of these areas. The national pattern of need for assistance by Remoteness Area was generally reflected at the state and territory level.

	Major Cities	Inner Regional	Outer Regional	Remote	Very Remote	Total
State	%	%	%	%	%	%
New South Wales	4.3	5.2	5.1	4.1	3.6	4.6
Victoria	4.4	4.9	4.9	5.8	. .	4.5
Queensland	4.1	5.1	4.1	3.3	2.6	4.2
South Australia	5.2	4.8	5.3	4.0	3.6	5.1
Western Australia	3.9	4.0	3.7	2.5	2.4	3.8
Tasmania(a)	. .	5.3	5.1	4.9	3.5	5.2
Northern Territory(b)	. .	. .	2.8	2.8	2.5	2.7
Australian Capital Territory	3.4	. .	. .	. .	. .	3.4
Australia	4.3	5.0	4.5	3.3	2.6	4.4

(a) Hobart is classified as Inner Regional.
(b) Darwin is classified as Outer Regional.
Source: ABS 2006 Census of Population and Housing.


LIVING ARRANGEMENTS

As with the wider population, the living arrangements of people with a need for assistance varies with their age group and life cycle stage. Living arrangements may also be influenced by the age of onset, for example whether this occurs at a young age or later in life after partnering, and the severity of the condition leading to a need for assistance. Within age groups, there were some notable differences in living arrangements between people with and without a need for assistance.

Children and young people

While a majority (68%) of children aged less than 15 years with a need for assistance lived with two parents, they were considerably more likely to live in one-parent families (29%) than those without a need for assistance (18%). This is consistent with studies suggesting that caring for a child with a disability may have a negative impact on couple relationships. 3 Consequently, the rate of need for assistance was higher for children in one-parent families (2.7%) compared with couple families (1.5%). (For more information see Australian Social Trends 2008, Families with a young child with a disability).

Young people (aged 15-24 years) with a need for assistance were also more likely to be living with one parent (26%) than young people without a need for assistance (14%). Nine out of ten of the one-parent families where the person needing assistance was aged less than 25 years were lone mother families.

Young people needing assistance were less likely to be living with a partner than those without a need for assistance (3% and 11% respectively) and only 4% lived in group households. This compares with 8% living in group households for those without a need for assistance.

People aged 25-44 years

People in this age group with a need for assistance were around half as likely to be living with a partner as those without a need for assistance (32% compared with 65%). Around 23% of 25-44 year olds with a need for assistance lived with their parent(s), over three times the proportion (7%) for those not needing assistance. A higher proportion were also living alone (14%) compared with people that age without a need for assistance (8%).

In contrast to the younger people (aged 15-24 years), the 25-44 year olds who had a need for assistance were twice as likely to be living in a group household as people without a need for assistance (9% compared with 4%). This may reflect the provision of group home accommodation (with supervision by disability workers) by government and private agencies, to promote opportunities for people with disabilities to live independently in the community. 4

Non-private dwellings, which include nursing homes and hostels, housed 7% of 25-44 year olds with a need for assistance.

People aged 45-64

The majority (55%) of people aged 45-64 years with a need for assistance were partners in a couple family, higher than any of the other age groups. However, this was still a smaller proportion than the people without a need for assistance (71%). The proportion of those with a need for assistance who were living alone (15%) was slightly greater than those without a need for assistance (12%). A further 8% of people this age who had a need for assistance were living in non-private dwellings.

People aged 65 and over

Of people aged 65 years and over with a need for assistance, 31% lived with their partner - just over half the rate of those without a need for assistance (58%). On the other hand, single older people with a need for assistance were over twice as likely to live with their child (either as a lone parent, or with that child's family) as those without a need for assistance (14% and 6% respectively).

Nearly one in five (19%) people this age with a need for assistance lived alone, and 30% were residents in non-private dwellings. Older women had higher rates of residency in non-private dwellings (34%) than older men (24%).

		Age group of person (years)
		0-14	15-24	25-44	45-64	65 and over	Total
		%	%	%	%	%	%
Has need for assistance
	Child living in couple family	68.3	52.2	14.4	0.9	-	9.3
	Child living in one-parent family	28.8	25.7	8.9	2.1	-	4.8
	Partner living in a couple family without children	-	2.2	8.6	33.6	26.5	23.1
	Partner living in couple family with children	-	1.3	23.8	21.7	4.8	10.1
	Lone parent	-	1.0	7.3	6.5	6.9	6.1
	Parent living with adult child in couple or one-parent family	-	-	0.1	1.5	7.1	4.2
	Lone person household	-	3.1	13.9	14.7	19.4	15.6
	Group household	-	4.5	8.6	4.9	1.2	2.9
	Resident in a non-private dwelling	1.4	3.5	7.4	7.8	30.5	19.5
	Total(a)	100.0	100.0	100.0	100.0	100.0	100.0
Does not have need for assistance
	Child living in couple family	79.1	47.8	4.9	0.4	-	24.3
	Child living in one-parent family	18.2	14.1	2.3	1.2	0.2	6.7
	Partner living in a couple family without children	-	7.8	16.9	32.6	50.7	20.0
	Partner living in couple family with children	-	3.1	48.4	38.7	7.2	25.1
	Lone parent	-	1.6	6.9	6.4	3.6	4.2
	Parent living with adult child in couple or one-parent family	-	-	-	0.6	2.2	0.4
	Lone person household	-	3.4	8.5	11.9	26.7	9.0
	Group household	-	8.0	4.5	1.8	1.5	3.1
	Resident in a non-private dwelling	0.8	3.4	1.9	1.8	2.3	1.9
	Total(a)	100.0	100.0	100.0	100.0	100.0	100.0

(a) Total includes persons from households who were otherwise related or unrelated within the household.
Source: ABS 2006 Census of Population and Housing.


Carers in the household

Carers play a key role in the lives of many people with a need for assistance, as they may provide help for tasks such as bathing, dressing, moving around and communication with others. Depending on the severity of disability, people living outside institutions and without a carer in their household may be more reliant on government and non-government providers and may be at greater risk of having an unmet need for care.

In 2006, 56% of people who needed assistance and who lived in a household had someone in their household who provided unpaid assistance to a person with a disability (although the recipient of that assistance was not necessarily the person with a need for assistance in that household as the link between recipient and carer was not explicitly collected in the census).

The proportion of people with a need for assistance who had a carer in their household varied by their age group and largely reflected their living arrangements. Those most likely to have a carer in the household were children aged less than 15 years (86%) and young people aged 15-24 years (76%). Around 50-60% of the household population with a need for assistance in each of the ten-year age groups from 25-34 years to 75-84 years lived with someone who was a carer. There was a lower proportion among those aged 85 years and over (43%), reflecting the high likelihood of people of this age to live alone (42% of people with a need for assistance).




PARTICIPATION IN EDUCATION

In 2006, 97% of children aged 5-17 years with a need for assistance attended an educational institution. Government schools were attended by 79% of children with a need for assistance who went to school.

In comparison, 65% of the children attending school without a need for assistance were at a government school. This may in part be due to education costs and differences in incomes between families with and without children who have a disability (for more information, see Australian Social Trends 2008, Families with a young child with a disability). However, even after adjusting for differences in household income, children with a need for assistance were significantly more likely to attend a government school. This may reflect a structural difference between the school sectors, with selected government schools being resourced to cater for children with disabilities.




For young adults (aged 18-24 years) with a need for assistance, 31% were attending an educational institution in 2006, compared with 40% of people that age without a need for assistance. The most commonly attended institution type for young adults with a need for assistance was technical colleges (12%), slightly higher than for those without a need for assistance (10%). By contrast, people with a need for assistance were only one-fifth as likely to be currently attending university as those without a need for assistance (5% and 25% respectively).




Non-school qualifications

Reflecting the lower rate of educational participation of young adults with a need for assistance, people with a need for assistance aged 25-64 years were around half as likely to have a non-school qualification (28%) as those without a need for assistance (54%).


LABOUR FORCE CHARACTERISTICS

In 2006, the majority (81%) of people of working age (15-64 years) with a need for assistance did not participate in the labour force. This proportion was similar for males (80%) and females (82%). In contrast, 23% of people of the same age without a need for assistance did not participate in the labour force.

Of the 19% (or 57,000) people aged 15-64 years with a need for assistance who were participating in the labour force, 49,000 were in paid employment. There was a significant number of employed people with a need for assistance who were away from work in the week prior to the 2006 Census (12%), double the rate for people without a need for assistance (6%). Nearly 8,000 people with a need for assistance were unemployed, which was equivalent to an unemployment rate for this group of 13.4%.

People with a need for assistance who did work were more likely to work shorter hours: 42% worked less than 20 hours per week, compared with 17% of workers without a need for assistance. Similarly, just 21% of workers with a need for assistance worked more than 40 hours per week, compared with 49% of all other workers.

	People aged 15-64 years
	Has need for assistance	Does not have need for assistance
	%	%
In the labour force	18.9	76.7
Unemployment rate(a)	13.4	5.3
Absent from work in reference week(b)	12.3	6.0
Working less than 20 hours per week(c)	41.9	17.1
Working more than 40 hours per week(c)	20.6	49.0
	'000	'000
Total persons	308.8	12 155.6

(a) The number of unemployed persons as a proportion of all persons in the labour force.
(b) Of employed persons.
(c) Of those people who worked in the reference week.
Source: ABS 2006 Census of Population and Housing.


INCOME

Overall, people with a need for assistance are more likely to have lower household incomes than people without a need for assistance. This is influenced by the fact that over half (55%) of all people with a need for assistance were aged 65 years or over, compared with 11% of the population without a need for assistance.

For people aged less than 65 years, the lower levels of labour force participation and higher proportion of one-parent families among those with a need for assistance results in their household incomes being markedly lower. Taking account of differing household size and household composition (through equivalising), the average household income of people with a need for assistance was 29% lower than that of people without a need for assistance.

Around two-thirds (68%) of people with a need for assistance aged less than 65 years were in the bottom two quintiles (or bottom 40%) of households ordered by equivalised income. This was almost double the proportion (35%) of people without a need for assistance.




INDIGENOUS PEOPLES

While the overall rate of need for assistance in the Aboriginal and Torres Strait Islander population (4.6%) was similar to that of the non-Indigenous population (4.4%), the younger age structure of the Indigenous population obscured a more marked difference. The age standardised rate ratio shows the need for assistance among the Indigenous population to be twice that of the non-Indigenous population in 2006.


CONCLUSION

People with a need for assistance are at risk of disadvantage in a number of areas. This group of people is less likely to have non-school qualifications and to participate in the labour force than other people. People with a need for assistance are also more likely to be unemployed, and to have relatively low household income, than people without a need for assistance.


FURTHER INFORMATION

Data sources and definitions

The data in this article are drawn from the 2006 Census of Population and Housing.

People with a need for assistance are those with a profound or severe disability. They need help or assistance in one or more of the three core activity areas of self-care, mobility and communication, because of a long-term health condition or disability (lasting six months or more), or old age. This population is a subset of the broader population with a disability. For more information see the 2006 Census Dictionary (cat. no. 2901.0).

Remoteness Area (RA) is a structure of the Australian Standard Geographical Classification (ASGC). It classifies areas sharing common characteristics of remoteness into six broad geographical regions (Remoteness Areas). The remoteness of a point is measured by its physical distance by road to the nearest urban centre. As remoteness is measured nationally, not all Remoteness Areas are represented in each state or territory. The six Remoteness Areas are: Major Cities of Australia; Inner Regional Australia; Outer Regional Australia; Remote Australia; Very Remote Australia; and Migratory Australia. The Remoteness Area names used in this article are abbreviated versions of these names with 'Australia' omitted. For further information see Australian Standard Geographical Classification (ASGC) - July 2007 (cat. no. 1216.0) and ABS Views on Remoteness Information Paper, 2001 (cat. no. 1244.0).

Measuring disability prevalence

In addition to the 2006 Census, estimates of the prevalence of disability are also available from the Survey of Disability, Ageing and Carers (SDAC). The conceptual basis for identifying people with a core activity need for assistance in the census closely matched that for identifying people with a profound or severe core activity limitation in the SDAC. Both the census and SDAC aimed to identify people who, due to a health condition or disability lasting or likely to last for six months or more, always or sometimes need help in at least one of the core activities of daily living - self-care, mobility or communication.

While the prevalence rate measured in the 2006 Census for people with a need for assistance was 4.4%, the 2003 SDAC found 6.3% of the population had a profound or severe core activity limitation. This discrepancy can be mostly attributed to the different collection methods of the two collections, particularly the SDAC's use of a larger number of screening questions which more accurately identify people with a disability and their level of restriction. For more information on the differences between census data and data derived from the Survey of Disability, Ageing and Carers, refer to the 2006 Census Dictionary (cat. no. 2901.0) and the Disability, Ageing and Carers: User Guide (cat. no. 4431.0.55.001).


ENDNOTES

1 Australian Bureau of Statistics 2002, Year Book Australia, 2002, cat. no. 1301.0, ABS, Canberra.

2 South Australian Department of Human Services and the South Australian Network for Research on Ageing, 1999, Fact Sheets on older South Australians: Gender Differences.

3 Edwards, B, Higgins, DJ and Zmijewski, N, 2007, 'The Families Caring for a Person with a Disability Study and the Social Lives of Carers', Family Matters, no. 76, pp. 8-17.

4 New South Wales Department of Ageing, Disability and Home Care, 2008, Accommodation: Group Homes.


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