|
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 Back to top
- 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 Back to top
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 75 80
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,
Australia s 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 Back to top
Resources
Related to Specific Areas of Aged Support Back to top
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 2001 02 the Commonwealth, in 2001
02, 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 2004) 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 2001
02.
- 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 (2000 01) and the other on Community
Aged Care Packages (2000 01).
- 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 (1985 2000) 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 (2001 02) 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 2001 02.
- 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 2001 02 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 2001 02 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 2001 02.
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 Back to top
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, 2002 03
- 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 Back to top
Commonwealth Government Links
State and Territory Government Links
New South Wales
Department of Ageing, Disability and Home Care - Ageing
Information
Seniors Information
Service
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 Health 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.
Back to top
|