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Current Issues
'Caring for the Elderly' - an Overview of Aged Care Support and Services
in Australia
E-Brief: Online Only issued 27 February 2003; updated 30 April 2003
Greg McIntosh, Analysis
and Policy
Janet Phillips, Information/E-links
Social Policy Group
This e-brief aims to give an overview of the array of services and support
provided to the elderly in Australia. The terms 'elderly' and 'aged' are
taken here to mean people aged over 65 years of age. It should be noted
however, that some support for the aged is given to people who are younger
than that, for example, some concessions for transport and entrance fees
are provided to people over 60 years or even 55 years of age. Given the
number and breadth of the various programs that are available to the aged
and, given the fact that all three levels of government and the non-government
sector are involved in the provision of these programs, it is only possible
to outline the main support and services provided. The main emphasis is
on the role of the Commonwealth in terms of support and assistance for
the aged, but brief details of the role of the non-government sector and
that of State/Territory and local governments are also given.
One section of this brief gives some background on the very important
issue of the ageing of the Australian population and contains links to
contrasting views on just how policy makers now, and into the future,
should respond to this ageing phenomenon.
Included are an extensive number of links to web sites across Australia
and, where appropriate, brief introductory comments that put the various
links in context are included. Some examples of relevant overseas links
are also included.
General
Resources on Aged Support and Services 
- Australian Institute of Health and Welfare, Australia's Welfare
2001, Chapter
6 - provides a comprehensive coverage of aged care support and services.
- Productivity Commission, Report on Government Services 2003,
Chapter 12
- also contains detailed information on aged care services across Australia,
including a State/Territory breakdown of information and data. A statistical
attachment on ageing is also published in the report.
- The Commonwealth Government provides a Seniors
Portal site for consumers, professionals and community members to
search on-line for care related government and agency information services
and policies.
- Reference Information
on Older People is a comprehensive reference guide compiled
by Helen Scott of the Council on the Ageing (Australia).
- Commonwealth Department of Health and Ageing, Aged
Care in Australia, 2002, provides an overview of the aged care system
in Australia.
- A general overview
of support for residential and community care is available from the
Department of Health and Ageing web site.
Overview
of Aged Care Support and Services in Australia
Introduction
Support and services for the aged in Australia are provided by a large
number of government programs (Commonwealth, State/Territory and local)
as well as programs/support from the community and voluntary sectors (particularly
families and carers), the private for profit sector and the private not-for-profit
sector. Because the aged are able to access 'mainstream' support and services
(for example, health care, housing support and income support) that are
available to the whole population, it is not possible to precisely quarantine
exactly what is provided to the aged and what it costs.
Most assistance and support is provided to that section of the aged population
in most need the frail and the disabled. For many aged over 65 years
of age there is no need for specific assistance. With the general trend
towards people living longer and being healthier for longer, the main
emphasis in terms of assistance and support is towards the 'older' aged
that is those aged over 7580 years of age. It is generally understood
that the greatest need for support is in the last two years of a person's
life.
In recent years the tendency in policy terms is for an increased emphasis
on early intervention and 'healthy' ageing combined with 'ageing in place',
that is, keeping older people out of health and residential facilities
for as long as possible. This is not only more cost effective from a government
point of view, (for example, it costs the Commonwealth, on average, approximately
$30 000 per annum to fund an average residential aged care bed compared
to the average cost of a Community
Aged Care Package of approximately $10 000 per annum), it also
conforms to the wishes of the vast majority of aged people themselves.
Development of Aged Care Support and Services
By the early 1900s both the New South Wales and Victorian governments
were providing age pensions to citizens in their jurisdictions aged over
65. Queensland also introduced an age pension in 1908. In April 1909 the
Commonwealth government took over the payment of these pensions. The Commonwealth
'old age pension' was paid to people aged over 65 years of age or who
were aged 60 years and over and permanently incapacitated for work. The
pension was means tested and from 1910 the pension became available to
eligible women aged over 60 years of age. In 1910 there were 65 492
recipients of the age pension.
(For an overview of the main social security payments and benefits paid
to the aged, people with disabilities and carers since 1909 see the Parliamentary
Library publication Social
Security Payments for the Aged, People with Disabilities and Carers 1909
to 2003.)
Prior to the 1950s the majority of non-income support and assistance
for the elderly was in the hands of State governments and the charitable
sector. Before that time the emphasis in terms of government non-income
support was the provision of basic health facilities and 'asylums' that
helped care for the most needy of the aged population.
From the 1950s and 1960s onwards the Commonwealth has become increasingly
involved via the provision of funding for nursing homes and community
care services for the aged (see later sections of this e-brief for additional
details on this).
Current Government Support
Commonwealth
In summary, the Commonwealth provides the following payments and support
either specifically to the aged community or through mainstream programs
that the aged can access:
- age pensions
- rent assistance and disability payments
- residential services (for example, the funding of residential aged
facilities and veterans residential facilities)
- medical and pharmaceutical benefits
- public housing (with the States and Territories via the operation
of the Commonwealth-State Housing Agreement)
- acute care (with the States and Territories)
- disability services (with the States and Territories via the operation
of the Commonwealth-State/Territory Disability Agreement)
- hospital and home and community care support (with the States/Territories
and local government)
The Commonwealth also provides support and assistance to carers of the
elderly, both in the form of support payments (for example, the Carer
Payment and the Carer Allowance) and support services (for example, funding
for carer respite centres and carer resource centres).
As well, a range of other support services are funded by the Commonwealth
that directly or indirectly help and support the aged population, for
example in the provision of:
- financial counselling
- health promotion programs
- rehabilitation services
- retirement assistance for farmers
- advocacy services
- support for consumer organisations
- a range of information related to government programs
Much of the Commonwealth's general expenditures in the fields of health,
disability support and housing/accommodation goes to Australians aged
over 65 years of age.
State/Territory
The States and Territories also provide a range of health, housing and
welfare services for the aged. Most States operate a number of residential
aged care facilities and provide, often with joint Commonwealth funding,
services and support such as:
- respite care
- carer assistance
- dementia support programs
- transport assistance
- home help
- information services
- Seniors' Cards that allow discounts on a range of products and services
For an example of the types of support and services provided by the States
and Territories see this link to the NSW
Department of Ageing, Disability and Home Care.
Local
Local or municipal governments provide various aged specific support
and services, some of which are funded by the Commonwealth and the States
and Territories. As well as providing various levels of rate relief for
aged pensioners, local governments are also directly involved with land
management matters relating to health and aged specific accommodation
and the provision of services such as home help and the running of Senior
Citizen's clubs. Much of the effort at this level is involved with helping
co-ordinate aged care services such as residential provision and various
health and lifestyle support.
For an example of the types of support and services provided by local
governments to the elderly see the following link to the Bayside
Council (Melbourne).
Non-Government Support
As well as government support there is a large range of services and
support provided to the elderly by the non-government sector. Many residential
aged care facilities, support organisations and aged care programs are
directly run by the community and charitable sector. It has been estimated
that across the whole welfare area of the economy the non-government community
sector funds, from its own resources, about 20 per cent of the total cost
of welfare services and support (Australian Institute of Health and Welfare,
Australias Welfare 2001, p. 38). The private for
profit sector is also involved with the provision of support and services
for the aged, particularly with respect to residential aged care and health
services.
Some Links to Non-Government Sector Associations and Organisations
The Role and Importance of Carers
Perhaps the greatest support of all to the aged in Australia comes from
family and friends. Much of this support is in the form of being a carer
or helper to an aged relative. Many of these carers receive little or
no support from either government or non-government sources. For more
information on the important role of carers see:
Selected
Statistical Resources on Ageing in Australia
Resources
Related to Specific Areas of Aged Support
The following links give additional details on the support provided to
the elderly in identifiable areas.
Social Security
The main forms of social security assistance for older (and retired)
people are the aged pension, wife pension, the partner allowance and the
mature age allowance. Some support is also given to retired farmers and
a Pension Bonus Scheme allows the elderly who want to work past the eligible
pension age to do so and still be eligible for a pension benefit at a
later stage in the form of a lump sum.
According to the latest Department of Family and Community Services Annual
Report 200102 the Commonwealth, in 200102, outlaid in excess of
$17 billion on social security payments to the aged. Age pension outlays
account for the majority of this expenditure in excess of $16.5 billion.
The report also notes that about 80 per cent of the population
over the qualifying age for the age pension received at least some age
pension as at June 2002. Thus, it can be seen that the age pension is
a very important component of income for a majority of older Australians.
Residential
The Commonwealth Government is essentially responsible for funding and
regulating the formal residential aged care sector in Australia. The two
main strands of residential aged care are:
- high care places (formerly nursing home beds)
- low care places (formerly hostel beds).
Contrary to popular belief only a very small proportion (about 6 per
cent) of the population aged over 65 reside in residential aged care facilities.
However, that 6 per cent (along with those in hospitals), are the most
frail and the most in need of care.
The following links give more information on residential care:
- For an overview of changes in residential aged care over the last
20 to 30 years and also an analysis of more recent changes to the sector
see Richard Gray's (Catholic Health Australia) paper The
Third Wave of Aged Care Reform (1999).
- For a brief overview of the 1997 structural reform changes including
the new fees and charges regime to apply to the residential aged care
sector see the Parliamentary Library Research Note Residential
Aged Care New Fees and Charges (Greg McIntosh, 1998).
- The Department of Health and Ageing web site gives details of the
current (March 2003) level
of accommodation fees/charges and daily care fees that residents
in residential aged care facilities are charged.
- A recent report (Professor Len Gray, Two
Year Review of Aged Care Reforms) commissioned by the Federal Government,
looked at the effects of the 1997 reforms on the residential aged care
sector. This report also provides detailed background on the operation
of the residential aged care system in Australia. The response by the
government to the 'Gray Report' can also be found at this site.
- The Annual
Report on the Operation of the Aged Care Act 1997 (Department of
Health and Ageing) provides a 'yearly' look at the operation of the
residential aged care system. The latest report is for 200102.
- The key body that maintains a 'watching brief' on the residential
aged care sector is the Aged
Care Standards and Accreditation Agency. This agency is charged
with monitoring standards in residential facilities and has the power,
where necessary, to impose various sanctions on service providers in
cases where standards are not met.
- A useful series of facts sheets on residential aged care (Quality
Care for Older Australians) is published, and regularly updated,
by the Department of Health and Ageing. The sheets included full details
on fees and charges as well as information on the type of care options
available and what measures are in place to help ensure appropriate
care is provided.
- A reference that gives full details of the framework under which residential
aged care services operate is the Residential
Care Manual published by the Department of Health and Ageing
(2001).
- The Australian Institute of Health and Welfare publishes a range of
data on residential aged care. The following links take you to two of
the Institute's key publications in this area, one dealing with statistics
on residents and services in the residential
sector (200001) and the other on Community
Aged Care Packages (200001).
- An overview of residential aged care funding and bed/place supply
over the period 1985 to 2000 is contained in a Parliamentary Library
E-Brief The
Funding and Supply (19852000) of Residential Aged Care Beds (Greg
McIntosh, 2001).
- The Department of Health and Ageing in its Annual Report gives
details of the number of aged care beds and places available (as well
as those approved but not yet 'on stream') per 1000 of the population
aged over 70 years of age for each of the aged care planning regions
across Australia. The latest Annual Report (200102) gives such
data as at June 2002. The following link takes you to the relevant chapter
in that Annual Report (see Table 3.1 pages 10 to 12 in the electronic
document). Other useful information is contained also contained in the
chapter, including the main government initiatives in aged care in 200102.
- In 1998 the Australian Audit Office released an Audit Report on The
Planning of Aged Care. This report gives useful background
on the detailed processes involved in planning and allocating aged care
beds and places across Australia.
Community Care
In recent years successive Commonwealth and State governments
have pursued a general policy direction of 'ageing in place'. This has
essentially involved a greater emphasis on keeping elderly and frail people
in their home or family settings for as long as possible via the provision
of home care services. The main strands of community care are:
- the Home and
Community Care Program (HACC) was established in 1985 and is jointly
funded by the Commonwealth and the States/Territories. It provides frail
older (and other) people with support and services such as meals on
wheels, home help, health support and the like. In 200102 the HACC
Program provided services to 594 000 people.
- Community
Aged Care Packages (CACPs) are individually tailored care services
provided to the elderly in their homes. They are fully funded by the
Commonwealth and in 200102 over 26 000 CACPs were provided.
- The Extended
Aged Care at Home Program Pilot (EACH) provides home services to
elderly people who have been assessed as being eligible for entry into
a high care (nursing home level) residential facility. The EACH program
is still in its formative stages only 290 packages were provided in
200102.
Health and Disability
Much of the health care for older Australians is provided via mainstream
programs such as the hospital systems, the services of medical practitioners
and the pharmaceutical benefits scheme. Medicare, Australia's universal
health system, provides older people with equitable access to medical
and hospital services at little or no cost. Eligible older people with
hearing problems are provided with vouchers by the Commonwealth to enable
them to access various hearing services at either Australian Hearing Services
or the relevant private provider. As well, private health insurance premiums
are community rated, which ensures that older people cannot be charged
a higher premium because they are older or chronically ill.
Indigenous Aged Care
It is an unfortunate fact of Australian life that the majority of indigenous
people do not reach 'old age'. According to ABS data (Australian Social
Trends 2000) the average life expectancy at birth for male
indigenous people is 56.9 years and 61.7 years for female indigenous people.
These low life expectancy figures are also highlighted by the fact that
approximately 12 per cent of the general Australian population is aged
over 65, whilst for the indigenous population the equivalent figure is
only 3 per cent.
Ageing in Rural and Remote Areas
- The following link is to an American article
('Aging in Rural and Regional Australia', Rural America, Fall
2002) on how the ageing of the population may impact on the rural and
regional areas of Australia. The article includes data on ageing in
rural and regional Australia and discusses some of the implications
for agriculture, natural resource management and the viability of smaller
communities.
- Department of Health and Ageing rural
and remote information page.
Veterans
Most veterans are aged over 65 years of age and as well as being able
to access mainstream services there are a range of other programs and
support available, mainly via the Commonwealth Department of Veterans'
Affairs. For an overview see;
Age Discrimination and Rights
Lifestyle/Other
Long Term Policy Issues
for an Ageing Australia Selected Resources
Whilst opinions may vary as to just what the effects
of ageing may be on Australian society over the next fifty years and beyond,
there is no doubt that policy adjustments will need to be made. The overseas
experience shows a trend towards tightening eligibility for age care benefits
combined with a greater role for private provision of retirement incomes.
Successive Commonwealth governments have been taking steps aimed at helping
reduce the rate of growth of future outlays on aged care services and
support. For example, various incentives have been provided for self provision
of retirement incomes through the superannuation system; changes have
been made to the preservation age for superannuation; a pension bonus
system has been introduced that provides a cash incentive to those who
delay taking up the age pension and greater user pays has been introduced
to the residential aged care sector. Currently, policy makers are looking
at the provision of incentives aimed at stopping people from retiring
'early'.
In November 1997, the Commonwealth announced a 'National
Strategy for An Ageing Australia'. The aim of the Strategy is to
look at the whole range of long term issues associated with Australia's
ageing population. The Strategy includes provision for a wide range of
consultations with all levels of government and the community and private
sectors. A range of discussion papers have been released as part of the
Strategy. For more information on long term ageing issues see the following
-
- ABS Australian Yearbook 2003, Feature
Article on Ageing
- National
Strategy on Ageing
- Denys Correll, The
Nature of Ageing in the Next Decade, Council on the Ageing, 2002
- The
Intergenerational Report, Budget Paper No. 5, 200203
- The Myer Foundation, 2020
A Vision for Aged Care in Australia
- In 1999 the Productivity Commission and the Melbourne Institute of
Applied Economic and Social Research held a major conference on Policy
Implications of the Ageing of Australia's Population. The conference
proceedings can be found online.
- ACIL Consulting paper commissioned by the Department of Health and
Ageing, Ageing
Gracefully: an Overview of the Economic Implications of Australia's
Ageing Population Profile, 2000.
- Jan Webster, Options
for Financing Long Term Care for Older People in Australia, National
Aged Care Alliance Paper, 2002.
- Greg McIntosh, The
Boomer Bulge: Ageing Policies for the 21st Century Parliamentary
Library Paper, 1998.
- Hal Kendig and Stephen Duckett, Australian
Directions in Aged Care: the Generation of Policies for Generations
of Older People, Australian Policy Health Institute, University
of Sydney, 2001.
- Access Economics, Population
Ageing and the Economy, 2001.
- G. Andrews, et al Ageing
and the Economy, Australasian Journal on Ageing, vol. 21,
no. 3, 1 September 2002.
- Australian Institute of Health and Welfare (AIHW) Projections
of Older Immigrants: People from Culturally and Linguistically Diverse
Backgrounds 1996-2026, Australia, 2001.
- Australian
Population Association
- Department of Immigration and Multicultural and Indigenous Affairs
(DIMIA), Independence
in Ageing: the Social and Financial Circumstances of Older Overseas-born
Australians, 1999.
- Department of Immigration and Multicultural and Indigenous Affairs
(DIMIA), Future
Dilemmas: Options to 2050 for Australia's Population, Technology, Resources
and Environment, 2002.
- Department of Immigration and Multicultural and Indigenous Affairs
(DIMIA), The
Impact of Immigration on the Ageing of Australia's Population, 1999.
- P. McDonald & R. Kippen, (Australian Centre for Population Research),
Population
Projections for Australia, 2000.
- OECD, Coping
with Population Ageing in Australia, 1999.
- OECD, Economic
Policy for Ageing Societies, 2001.
Main Legislation Relating
to Aged Care Support and Services
Links
Commonwealth Government Links
Ageing and Aged
Care Division
Office for an
Ageing Australia
State and Territory Government Links
New South Wales
Department of Ageing, Disability and Home Care - Ageing
Information
Seniors Information Service
FAQ
NSW Committee on Ageing
Victoria
Department of Human Services - Aged
Care in Victoria
Office of Senior Victorians
Queensland
Queensland Health - Aged
and Community Care Reform Unit
Department of Families - Seniors
Interests Unit
Western Australia
Department for Community Development - Office
of Seniors Interests
South Australia
Department of Human Services - Ageing
and Community Care
Seniors Information Service
Tasmania
Department of Health and Human Services - Seniors
Bureau
ADCIS Directory is a
database of services throughout Tasmania.
Northern Territory
Department of the Chief Minister - Office
of Senior Territorians
Department of Health and Community Services - Aged
Disability and Community Care
Australian Capital Territory
ACT Community Care Services
for Older People
Older Persons Portal
Other Aged Care Sites of Interest
Overseas Links
For copyright reasons some linked items are only available to
Members of Parliament.
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