OLDER Australians have many options for aged care, depending on their care needs, health status, service accessibility and personal preferences.

In 2013–14, 61 300 people across Australia entered permanent residential aged care for the first time. Collectively, this group of people used more than 1000 different combinations of other aged care programs and services before entering permanent care. According to a new report from the Australian Institute of Health and Welfare, Pathways to permanent residential aged care in Australia 2013-2014:

  • for three-quarters (76%) of these older Australians, home support was their first contact with the aged care system;
  • one in 10 people had not used any aged care before entering permanent residential aged care; and
  • many of the pathways showed that people needed progressively higher levels of support as they moved through the aged care system.

Aged care in Australia is increasingly being provided through community-based programs to support people to live at home for longer. Aged care service use is often seen as a progression — from low level community or temporary care, to high level or permanent care; however, this is not necessarily the case. Some people may never use aged care services, and if they do, their progression through the care system may not be linear (from lower to higher support) and they may enter at any level of care.

Understanding the most common pathways and factors influencing these transitions can help medical practitioners and others to inform and advise people who are going through this journey, or who are considering their aged care options.

Pathways to permanent residential aged care in Australia 2013–14 focused, in particular, on the program used last before the transition to permanent care, and the factors that shaped these pathways. It found that the study cohort had used one or more of the following:

  • home support (formerly known as Home and Community Care);
  • community-based packages;
  • transition care; and
  • respite residential aged care.

The level of support provided generally increases with each program — home support provides “entry-level” support (including some home nursing services) and the other programs provide progressively more services, or services of a time-limited but more intensive nature. Permanent residential aged care completes the picture by offering the highest level of support.

Key findings

The two most common pathways to permanent residential aged care were home support to permanent residential aged care (26%), and home support to respite residential care then to permanent residential aged care (18%).

The most common programs last used before entry into permanent residential aged care were respite residential aged care (39%) and home support (36%). Much less common were transition care (8.2%) and community-based packages (7.0%).

People who had last used transition care were more likely to have lived alone, been diagnosed with heart or cerebrovascular disease, or experienced frequent falls than people who had last used other aged care programs. This aligns with the nature of transition care, which provides short term rehabilitation and support services for people who have recently been discharged from hospital, and who are otherwise suitable for permanent residential aged care.

The 10% of people who had not used any other aged care program before entering permanent care were more likely to be men, aged under 65 years and have limitations in all four core areas (ie, self-care, moving, movement and communication), and were less likely to have lived alone.

Health conditions and care needs

Health conditions are common triggers for people to enter a higher level of aged care, particularly for people with chronic or progressive conditions who require ongoing nursing care and assistance. People approved for permanent residential aged care in 2013–14 had an average of eight health conditions each. The most common disease groups were diseases of the circulatory system (78%), the musculoskeletal system and connective tissue (56%) and mental and behavioural disorders (50%). Looking at specific conditions, the five most common conditions impacting on people’s need for assistance were heart disease (46%), arthritis (38%), dementia (31%), abnormal gait or mobility (28%) and falls (28%).

Increasing care needs is another trigger for people to transition to higher care. A person’s care needs are assessed across three domains (ie, activities of daily living, behaviour and complex health care) when they enter and throughout their time in permanent residential care. There are 81 possible combinations for these care needs ratings, and the most common combination at entry for the cohort was “high” in all domains (13%). A person’s care needs tend to increase with time in care, and nearly three in 10 (28%) people had a high rating by their last assessment. More than four in 10 (44%) of the cohort had dementia at entry, rising to 49% at the last assessment, and 47% had a mental health condition, rising to 54%.

End-of-care pathways

By September 2015, 44% of the cohort had died. One-fifth (20%) of those who had died were rated high in the three care needs domains, compared with 8% for those who did not die during the study period. One in 15 people (6%) were identified as requiring palliative care at their first care needs assessment, and 96% of this group had died by September 2015.

Where to next?

The Australian Institute of Health and Welfare will explore end-of-care pathways in its upcoming report, Cause of death patterns and use of aged care, including how the numbers and causes of death vary across different aged care programs.

To find out more about aged care options in your area, visit the Australian Government website MyAgedCare.

Jenni Joenperä and Juliet Butler work at the Disability and Ageing Unit at the Australian Institute of Health and Welfare, and were the lead authors of the Pathways to permanent residential aged care in Australia 2013–14 report.

 

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