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Housing Assistance: Home care, hostels & nursing homes
LIVING ARRANGEMENTS OF OLDER PEOPLE, 1998
(b) Comprises establishments which are for the care of older people, and retirement homes, which include a hostel and/or nursing home component such as nursing or medical care.
(c) Includes persons living in other non-private dwellings, such as boarding houses and hostels for the homeless (4% of total population).
Source: Unpublished data, 1998 Survey of Disability, Ageing and Carers.
There are many factors which influence whether older people stay at home or eventually transfer to other forms of accommodation with different levels of care provided, such as hostels or nursing homes. These factors include their level of disability, their current living arrangements, access to support from family, friends or from government and/or private organisations, and their financial situation. Income levels can determine their ability to pay for services they can no longer do for themselves.
Results from the 1998 Survey of Disability, Ageing and Carers indicated that most older people lived in private dwellings with their spouse or other relatives (62%). As the likelihood of having a disability or becoming widowed increases with age, people aged 80 and over were more likely to be living in a hostel or nursing home (20%) or living alone (35%) than those aged 65-79 (2% and 25% respectively).
The living arrangements of people aged 80 and over also varied for men and women. In 1998, there were greater proportions of women in this age group than men who lived alone (38% and 30% respectively). This reflects the fact that women of this age are less likely than men to have a partner (77% of women aged 80 and over were widowed compared to 36% of men of this age). There were also greater proportions of women aged 80 and over than men who lived in hostels or nursing homes (23% and 13% respectively). Women in this age group were also more likely than men to have severe or profound core activity restrictions (51% and 37% respectively). These patterns underline the fact that more women live to advanced old age (over 90 years) than men.
PERSONS AGED 65 AND OVER IN HOUSEHOLDS, 1998
(b) Total includes other family members.
(c) Comprises people who need help with self-care, mobility, communication activities, health care, housework, property maintenance, meal preparation, paperwork or transport.
Source: Unpublished data, 1998 Survey of Disability, Ageing and Carers.
Level of independence
In 1998, less than half of people aged 65 and over in households required help with everyday activities (42%), most commonly property maintenance (30%), transport (22%) and housework (19%). Many received help from more than one person or organisation, depending on the type of assistance needed. However, most older people received help from family or friends (83% of those who received help), usually from a partner (35%) or an adult child (29%), rather than from formal sources (59%).
DISABILITY STATUS OF ALL PERSONS AGED 65 AND OVER, 1998
Formal care in the home
Most older people who need assistance are able to remain at home, provided they can obtain enough help of the type and level they feel they need. Formal organisations provide an important avenue of assistance, either as a supplement to informal help from family or friends or when no informal help is available. Formal services are provided by government and private (for-profit and not-for-profit) organisations. Access by older people to these services is dependent on their knowledge of the existence of the services, their availability and cost, and the financial circumstances of the recipient- whether they can afford to pay for private services if necessary.
In 1998, there were 853,300 people aged 65 and over who received assistance in the home (41% of all persons aged 65 and over in households). Of these, 59% received help from formal sources. Help was commonly received from more than one formal source, with 41% receiving help from private for-profit organisations, 9% from private not-for-profit organisations, and 28% from government organisations. For most people, help was more likely to have been received from family and friends than from formal sources, although many used both avenues of assistance. However, for those reporting a need for assistance with health care (a more specialised form of help), 67% obtained some assistance from formal sources and 49% from family and friends.
For people living at home, the major services funded by the Commonwealth, State and Territory governments included the Home and Community Care (HACC) program and Community Aged Care packages.3 The majority of these services are provided by government or community non-profit organisations.6,7
DISTRIBUTION OF GOVERNMENT AGED CARE EXPENDITURE, 1985-86 AND 1995-96
(a) Available data suggested that 20-25% of HACC clients were under 65 during this period, as well as a small proportion of nursing home and hostel residents. Expenditure on Community Aged Care packages and assessments is included in HACC expenditure (2% of total expenditure in 1995-96).
Source: Australian Institute of Health and Welfare 1995: Services and Assistance; Australian Institute of Health and Welfare 1997: Services and Assistance.
Home and Community Care
The HACC program is a jointly funded Commonwealth and State government program which provides services to people in their homes. HACC services are administered by government departments (usually health or community services, but sometimes local government) in each State and Territory.4 The program targets people of all ages who, due to disability, have difficulty or require assistance with self-care, mobility or communication tasks - 26% of people aged 65 and over in 1998. Services provided include personal (for example, washing and dressing), health and respite care, home and centre-based meals, home help and home maintenance, centre day care and transport.2 It is estimated that up to 240,000 people receive one or more HACC services in an average month (based predominantly on 1997 patterns of use).7
As the population continues to age, there are likely to be large increases in absolute numbers in the HACC target group. In 1993, there were 437,500 persons aged 65 years and over in the target group. By 1998, this had risen to 550,400. If current levels of need for assistance or difficulty with personal care tasks are maintained, and the proportion of that group currently living in households remains the same, then in 2031 (based on current population projection assumptions) there will be over 1.2 million people in this group, an increase of 692,500 or 126% from 1998. If levels of informal assistance are maintained, most of these people will receive their main support from family or friends. However, changes in female workforce participation and in levels of volunteer labour in the welfare industry, together with increases in divorce and single-person households, may reduce the amount of informal support available.2
Between 1985-86, when the aged care reform process started, and 1995-96, expenditure on HACC services increased from $233.8 million to $601.9 million (in real terms, i.e. constant 1989-90 values), an increase of 157%. HACC services also increased their share of total recurrent aged care expenditure during this time from 15% to 22%, reflecting the shift away from funding for supported accommodation.2,8
Community Aged Care Package
An additional area of home-based care is the Community Aged Care Package, which is a Commonwealth-funded program, initiated in 1992, providing an alternative to residential hostel care. The scheme provides an intensive level of home care. The aim is to enable as many older people as possible, even those with more complex care needs, to remain at home.6
Between 1993 and 1998, the number of people receiving the Community Aged Care Package increased from 211 to 8,831. Most of the recipients were female, although during this time their proportion of total recipients decreased from 83% to 72%.7 In 1997-98, the annual government outlay for each Community Aged Care Package was $9,923 - similar to the subsidy for a hostel place which was $9,360.3
PERSONS AGED 65 AND OVER IN NURSING HOMES AND HOSTELS, 1993 AND 1998(a)
(b) Includes 1,480 residents classified under new scheme and allocated to nursing homes if rated high dependency, and to hostels if rated low dependency.
(c) Per cent of all persons in each age/sex group.
Source: Australian Demographic Statistics, June Quarter 1998 (cat. no. 3101.0); and unpublished data, DHAC.
Hostels and nursing homes
Reflecting the change in emphasis from intensive forms of residential care, such as nursing homes, to community care programs and hostel accommodation, hostels increased their share of total aged care expenditure between 1985-86 and 1995-96. Their share increased from 5% to 13% over this period, while nursing home expenditure declined as a proportion of the total (from 80% down to 63%). By 1997-98, the annual cost to government (excluding capital funding) was $29,648 for a utilised place in a nursing home and $9,360 for a hostel. The cost to an individual varied according to their income and assets.
Since 1997, funding for hostels and nursing homes has been based on the dependency level of residents rather than accommodation type, and entry to a nursing home or hostel is governed by an assessment process. This process, for example, enables residents in a hostel to receive a higher level of care in the hostel as they become more dependent, rather than having to move to a nursing home to receive this level of care.3
At 30 June 1998, there were about 57,500 people in hostels and 67,900 in nursing homes. In 1998, the likelihood of living in either a nursing home or a hostel was greater for people aged 80 and over (9% and 8% respectively) than for those aged 65-79 (1% in each case). Women aged 65 and over were also more likely than men of this age to live in these two types of care (4% and 3% compared to 2% and 1% respectively).
Since 1993, the proportion of people aged 65 and over in nursing homes has dropped slightly from 3.3% to 3.0% in 1998, and there has been a corresponding small increase for hostel residents, from 2.3% to 2.5%. Long-term targets have been set for the year 2011 to reduce the proportion of nursing home beds and increase the proportion of hostel beds and care packages.3 Between 1985 and 1998, substantial progress (based on the number and type of residential beds and care packages available for those aged 70 and over) was made towards these targets. For example, the number of hostel beds increased from 32 per 1,000 persons aged 70 and over in 1985 to 41 per 1,000 by 1998. The reduction in the number of nursing home beds was greater than the increase in hostel beds, and the supply of care packages had not yet made up the shortfall. The level of need for assistance (as measured by proportions with severe to profound core activity restrictions) did not decline during this time.9 However, there has been an increase in the level of funding of HACC services over this period, which may have been providing increased community-based support in the interim.
RESIDENTIAL BEDS AND COMMUNITY CARE
(b) Number of beds or Community Aged Care Packages per 1,000 people aged 70 and over. Rates may not add to total due to rounding.
Source: DHFS Annual Report 1997-98.
1 Kendig H. and Gardner I. 1997, 'Unravelling housing policy for older people', in A. Borowski, S. Encel and E. Ozanne (eds) Ageing and Social Policy in Australia, Cambridge University Press, Cambridge.
2 Australian Institute of Health and Welfare 1997, Australia's Welfare 1997: Services and Assistance, AIHW, Canberra.
3 Commonwealth Department of Health and Family Services 1998, Annual Report 1997-98, DHFS, Canberra.
4 Mathur, S. 1996, Aged Care Services in Australia's States and Territories, Australian Institute of Health and Welfare, Canberra.
5 Australian Institute of Health and Welfare and Commonwealth Department of Health and Family Services August 1998, Hostels in Australia, 1995-96, AIHW and DHFS, Canberra.
6 Australian Institute of Health and Welfare and Commonwealth Department of Health and Family Services August 1997, Community Aged Care Packages. How do they compare?, AGPS, Canberra.
7 Commonwealth Department of Health and Aged Care 1998, unpublished data, DHAC, Canberra.
8 Australian Institute of Health and Welfare 1995, Australia's Welfare 1995: Services and Assistance, AGPS, Canberra.
9 Australian Bureau of Statistics 1999, Disability, Ageing and Carers: Summary of Findings, Australia, 1998, cat. no. 4430.0, ABS, Canberra.