The annual Report on Government Services (ROGS) produced by the Steering Committee for the Review on Government Service Provision (SCRGSP) provides an overview of expenditure and delivery of government services. The most recent
report reflects the new terms of reference for the ROGS reporting framework agreed
at COAG in December 2009. For aged care, this means that there is additional information such as: information about compliance with service standards for all community care packages (including National Respite for Carers Program), selected adverse events in aged care and the number of hospital patient days for patients waiting for residential aged care (these are indicators for aged care in the National Healthcare Agreement) and time series data to enable comparisons across years from programs such as the Home and Community Care program (HACC).
Commentators and advocates often suggest that additional funding is required for aged care. The chapter
on aged care details expenditure on aged care and comparisons can be made on a yearly basis (although these are not always provided in the Report for all programs). The time taken for an aged care assessment by the Aged Care Assessment Team (ACAT), a key issue of concern to the community, is included in the report. The report also attempts to quantify the time taken from an ACAT assessment to the provision of the care recommended by ACAT, but this data is heavily qualified. In many respects, the report serves an accountability purpose, in that consumers, aged care providers and government officials alike can, with the information being made available measure, or measure as best as possible, the performance of the aged care system.
Some of the key points presented in the chapter on aged care were:
- Recurrent expenditure on aged care has increased from $10.1 billion in 2008-09 to $11 billion in 2009-10. This does not include expenditure by State and Territory governments, capital expenditure and some post acute care packages
- The average annual subsidy for a residential aged care place is around $39 516, an increase from $36 387 in the previous year
- The total number of older Australians living in residential aged care facilities has increased in the last year by about four thousand people to 166 395 (30 June 2010)
Australians in residential aged care are either categorised as ‘high’ or ‘low’ level of dependency. This is determined by the ACAT assessment and verified by residential aged care providers
- During 2009-10 the total number with a ‘high’ level of dependency decreased slightly from 116 358 to 115 547. It may be significant that the definition of ‘high’ changed on 1 January 2010 which may have had some effect on the number of residents classified in the ‘high’ category
- The number of residents with ‘low’ levels of dependency increased from 45 904 to 50 848
- The draft Productivity Commission (PC)’s report Caring for older Australians noted that the elderly entering residential aged care facilities are often older and more frail (see p. xxx). The data presented in the ROGS chapter on aged care supports this as the overall number of residents with ‘high’ complex health needs and ‘high’ behavioural needs (such as those associated with advanced dementia) increased by about five per cent in each category from 2008-09
- Expenditure by the Australian Government on capital infrastructure dropped from $40.6 million in 2008-09 to $35.2 million in 2009-10
- Consistent with consumer preferences for aged care services to be provided in the home, expenditure on community care programs has increased across all community care packages: Home and Community Care (HACC), Community Aged Care Package (CACP), Extended Aged Care at Home (EACH) and Extended Aged Care at Home-Dementia (EACH-D). Expenditure also increased on the National Carers Respite Program
- The total number of service hours provided under the HACC program also increased, albeit marginally (12 803 per 1000 aged 70 years and over and Indigenous people aged 50-69 in 2008-09 to 12 909 in 2009-10)
- Expenditure on the Veterans Home Care program and veterans community nursing services also increased during 2009-10
The recent release of the draft PC’s report, Caring for older Australians
has stimulated debate about the financing of aged care. The ROGS chapter on aged care highlights that total government expenditure on the provision of aged care services is increasing across both the residential and community care sector on account of the growing numbers of people accessing aged care and the number of services provided. It does not, however, provide any insight to the costs associated with the provision of aged care or the extent to which individuals are paying for the cost for aged care, independent of any government subsidy. It also does not quantify unmet need. This absence of data about the costs associated with the provision of aged care is highlighted in many of the submissions (see here
for an example) to the PC inquiry into aged care.
The ROGS chapter also attempts to quantify access to aged care by Indigenous Australians. Indigenous Australians are eligible for government subsidised aged care packages from the age of 50 (non-Indigenous Australians are eligible from the age of 70). As at 30 June 2010, the Department of Health and Ageing (DoHA) estimates that there around 67 107 Indigenous people aged 50 years and over, a slight increase from the previous year (65 300). The ACAT assessment rate for Indigenous Australians (per 1000 people over the age of 50) has steadily been increasing from 34.2 in 2005-06 to 42.7 in 2007-08 (the most recent data). In terms of numbers, 2 551 Indigenous Australians received an ACAT assessment in 2007-08, compared to 194 071 non-Indigenous Australians. As Indigenous status is self reported, and the status of 3 163 older Australians was not specified there may be some under-reporting of Indigenous status in the data. Furthermore, ACAT assessments only determines eligibility for a government subsidised residential or community care package, they do not necessarily translate into receiving aged care services. Therefore, although not directly comparable, the disparities in these figures would suggest that there are a number of older Indigenous Australians not being assessed for Commonwealth subsidised aged care places and are consequently likely to be missing out on appropriate aged care.
One of the issues raised by both the National Health and Hospital Reform Commission
(NHHRC) and the PC’s draft report was the number of older Australians staying in hospital while waiting for appropriate aged care services. The SCRGSP attempted to quantify the proportion of older patients that were in hospitals for more than 35 days and waiting for appropriate residential or community bases care. Several caveats were applied to the data namely that there were differences among jurisdictions in coding and reporting, there was no linkage with ACAT data and that patients who have not completed their period of acute care were not included. Of all the hospital separations for people aged 70 years or over and Indigenous people aged 50-69, around 16.3 per cent were for hospital stays longer than 35 days. This was a slight decrease from the previous year (19.2 per cent). The number of overnight stays for older Australians waiting for residential aged care was also measured. The findings were that 13.6 of every 1000 patient days (2008-09) were accounted for by older Australians waiting for residential aged care. This would suggest that there is a shortfall in supply for residential aged care and that extra capacity for the hospital sector might be freed up, were these aged patients to receive timely access to residential aged care.
In addition to the issues highlighted in this post, there is a wealth of other information contained in this report that should not be overlooked by those investigating aged care in Australia. In the context of PC’s draft report and government’s commitment to reform
aged care, the chapter on aged care highlights the significant scope of the challenges ahead, not the least consistency in reporting.Picture source: http://www.canstockphoto.com/senior-man-being-visited-by-a-nurse-at-3334556.html