Residential Aged Care

Apart from various income support measures (most notably, the age pension) and the funding of mainstream services such as health, the Commonwealth’s main role in aged care is residential aged care. During the course of the 41^st Parliament, various residential aged-care issues were prominent, including concerns about the number of places and the adequacy of community care provision.

The three main strands of residential aged care are:

• ‘high-care’ places (formerly nursing home beds)
• ‘low-care’ places (formerly hostel beds), and
• Community Aged Care Packages (CACPs) and Extended Age Care at Home (EACH) packages—these packages provide an alternative to residential aged care and allow the elderly to stay in their home or family environment.

Availability and distribution of aged care places

In many parts of Australia there are shortages of aged-care places, particularly high-care places. Notwithstanding additional allocations of places in recent years, shortages are still occurring. A key issue is the time lags between the allocation of places and the beds actually coming ‘on stream’, and the somewhat complicated land regulatory processes involved. Much of this is in the domain of state and territory governments.

Community care availability

An increased emphasis has been placed in recent years on keeping the elderly in their own homes for as long as possible. As with the situation in terms of aged-care beds, there is an evident shortage of community-care options. Additional resources for community packages (and the related Home and Community Care Program) would help to take pressure off the need for more high-care and low-care beds.

Planning arrangements

The key planning mechanism for allocating aged-care and community-care places is the aged-care planning ratio. This ratio allocates aged-care places according to the number of people aged over 70 years of age in the various aged-care planning regions. The number of places allocated to high-care, low-care and community-care options has been varied over time. However, the basic ‘number of people aged over 70 years’ rule has not changed since the planning mechanism was introduced in the early 1980s. It may be time to review the current rather ‘blunt’ planning mechanism. A move towards allocating places on, for example, the number of people with disabilities in each planning region would be one approach. This may better target the relatively scarce number of aged-care places on offer.

Aged-care workforce

There is a shortage of appropriately skilled and trained aged-care workers and nurses. While there have been various Commonwealth and state initiatives in recent years, there is still much to be done. In an economy that has near to full employment, this is going to be a difficult problem for the various levels of government to overcome.

Aged-care/hospital interface

The states and territories have responsibility for running hospitals and the Commonwealth provides significant funds to help with the costs of doing this. A key area of tension between the two levels of government occurs at the so-called aged-care/hospital interface. In particular:

• there are many cases when older people are ‘inappropriately’ in a hospital bed. In these cases, the states tend to argue that the Commonwealth is not providing enough aged-care beds so that these people can be moved to nursing homes, and
• there are also many cases when older people are ‘inappropriately’ in an aged-care bed. In these cases, the Commonwealth argues that the states are not funding enough hospital beds to cater for very sick older people.

A recent Howard Government innovation to help overcome this problem was the introduction of transition-care places. These provide short-term support and management for older people who have been in hospital, but who require more time and help in a non-hospital environment to complete their recovery. Transition-care places help take pressure off the need for hospital beds for the elderly. During the election campaign, the Australian Labor Party promised to introduce, over a five-year period, an additional 2000 transition-care places.

Documentation
Steering Committee for the Review of Government Service Provision, Report on Government Services 2007, Productivity Commission, Canberra, 2007. See Chapter 12 and attachment.
Australian Institute of Health and Welfare, Residential Aged Care in Australia 2005-06, AIHW, Canberra, 2007.
Australian Institute of Health and Welfare, Australia’s Welfare 2005, AIHW, Canberra 2005. See Chapter 4.
W.P. Hogan, Review of Pricing Arrangements in Residential Aged Care, Department of Health and Ageing, Canberra, 2004.