The new dynamics of residential aged care in Australia: continuity and change.

ObjectiveThis paper tests the hypothesis that increases in recorded dependency levels of permanent residential aged care clients are associated with reduced length of stay and higher turnover. A secondary objective is to compare the Aged Care Funding Instrument with its predecessor, the Resident Classification Scale, on a common schema.MethodsAdministrative data for all Commonwealth-subsidised residential aged care services in Australia from 2008-09 to 2018-19 were obtained from the National Aged Care Data Clearinghouse. More than 750000 episodes of permanent residential aged care were analysed. The categories from the two rating systems were mapped to a six-level schema, primarily based on the dollar value of the categories at the time of transition.ResultsThere was a strong trend towards higher dependency ratings across admissions, residents, and separations. However, contrary to expectation, measures of system activity showed a slowing of the system: length of stay increased and turnover decreased.ConclusionsThe mapping of dependency rating schemes to a common rating enables the analysis of long-term trends in residential care dynamics. There is no evidence that the marked increases in reported dependency ratings led to accelerated system activity, consistent with an earlier study. This analysis forms a solid base for ongoing analysis of care appraisals in the context of a possible new rating scheme. It highlights the interplay between policy changes and provider behaviour, and the need for robust data to monitor care appraisals and system dynamics.What is known about the topic?Residential aged care subsidies are determined by care needs in relation to assessed dependency levels, using the Aged Care Funding Instrument since 2008, and before that, the Resident Classification Scale. Between 2008-09 and 2018-19, there was considerable growth in residents classified at more dependent levels, and this would be expected to result in greater turnover in the system.What does this paper add?This paper maps the rating schemes to a simplified, common rating that enables the analysis of long-term trends in residential care dynamics. It shows that the system is slowing, contrary to the trends expected if residents were more frail as the reported ratings imply. The paper examines possible explanations of these trends, and addresses policy implications.What are the implications for practitioners?In the context of a potential new client-dependency classification, this study shows the importance of robust measures of the dynamics of the system-and the underlying data-vis-à-vis the means by which client dependency is assessed.

How strong is the housing assets pillar of funding for residential aged care?

OBJECTIVE: To explore reasons for the gap between the perception that high home ownership provides a strong pillar of funding for aged care accommodation and the actuality of half of those in residential care having this cost met by the Accommodation Supplement. METHODS: Review of data from Australian Bureau of Statistics and administrative sources, and recent research studies. RESULTS: Trends in payment methods show continuing reliance on the Accommodation Supplement. Reasons are found in patterns of home ownership at older ages, changes in tenure and living arrangements over the age range, and increasing use of the exchange value of housing assets. Policy tensions arise between protecting access for low means residents and requiring those who are able to pay to do so. CONCLUSIONS: The housing assets pillar at advanced ages is not as strong as early in retirement and makes it increasingly unreliable as a source of funding.

The role of the Australasian Journal on Ageing in the Asia-Oceania region.

The role of the Australasian Journal on Ageing (AJA) in the Asia-Oceania region has been developing over the 30 years of the journal's publication, and review of its current and potential future roles is timely in the context of a number of developments in the region. This review describes the regional reach of the AJA, presents an analysis of regional content published over the 5 years to 2012, discusses the regional context with reference to other journals published in the region, and proposes several strategies for advancing the AJA's regional role. Pursuing these strategies would realise the AJA's potential as a vehicle for promoting the exchange of multidisciplinary knowledge on ageing.

Stabilising the aged care workforce: an analysis of worker retention and intention.

Concerns about the capacity of the aged care industry to attract and retain a workforce with the skills required to deliver high quality care are widespread, but poor conceptualisation of the problem can result in strategies to address turnover being poorly targeted. A census of residential and community aged care services conducted by the National Institute of Labour Studies (NILS) in 2007 provided a comprehensive empirical account of the workforce, and estimated turnover on the basis of retention: that is, the proportion of the workforce who had been in their job for 1 year or less. This paper adds the dimension of intention: that is, workers' expectations as to whether in 1 year's time, they would still be working in the same aged care service. The dual driver model that takes both retention and intention into account was applied in further analysis of the 2007 NILS data. Investigation of relationships between workforce instability and 13 variables covering worker attributes, organisational attributes and structural attributes of the industry demonstrated the usefulness of the dual driver model for reconceptualising and analysing stability and, in turn, refining strategies to address turnover.

Migrant care workers or migrants working in long-term care? A review of Australian experience.

Discussion of the role of migrant care workers in long-term care (LTC) that has gained increasing attention in the United States and other developed countries in recent years is of particular relevance to Australia, where 24% of the total population is overseas-born, two-thirds of them coming from countries where English is not the primary language. Issues of interest arise regarding meeting LTC workforce demands in general and responding to the particular cultural and linguistic needs of postwar immigrants who are now reaching old age in increasing numbers. This review begins with an account of the overseas-born components of the aged care workforce and then examines this representation with reference to the four factors identified as shaping international flows of care workers in the comparative study carried out for the AARP Public Policy Institute in 2005: migration policies, LTC financing arrangements, worker recruitment and training, and credentialing. The ways in which these factors play out in Australia mean that while overseas-born workers are overrepresented in the LTC workforce, migrant care workers are not identifiable as a marginalized group experiencing disadvantage in employment conditions, nor do they offer a solution to workforce shortages. The Australian experience is different from those of other countries in many respects, but it does show that the experience of migrant care workers is not unique to LTC and points to the need to extend the search for solutions to workforce shortages and improving conditions of all care workers well beyond LTC systems to wider policy settings.

Is bigger better when it comes to defining target populations for aged care programs?

OBJECTIVES: To compare the Home and Community Care Program (HACC) target population defined on the basis of the ABS Survey of Disability, Ageing and Carers (SDAC) with 2006 census data on need for assistance. METHODS: The number of people with different levels of core activity limitation as defined in the SDAC was estimated for the 2006 population aged 65 and older and compared with the number reporting a need for assistance in the 2006 census. RESULTS: The two target populations differ in size, age and disability levels, but the differences are reconciled when components within the total SDAC-defined target population are taken into account. DISCUSSION: Assessment of different definitions of target populations in terms of validity in identifying program beneficiaries, accuracy in measurement and usefulness in monitoring program performance leads to the conclusion that the bigger SDAC-defined population is better aligned with the goals of the HACC program.

Does assessment make a difference for people with dementia? The effectiveness of the Aged Care Assessment Teams in Australia.

The needs of individuals with dementia and other psychiatric problems of old age have received increased attention in Australia over the last decade. This paper reports on the role of Aged Care Assessment Teams (ACATs) in managing these clients, and the extent to which they are differentiated from other clients in the assessment process and outcomes recommended. Data on some 26,500 clients seen by ACATs in Victoria in the second half of 1999 are analysed to show (1) the relationship between a diagnosis of dementia and reporting of disability in orientation, (2) characteristics of clients with and without a diagnosis of dementia and (3) outcomes for groups of clients defined on the basis of a diagnosis of dementia and disability in orientation.

Informing policy and service development at the interfaces between acute and aged care.

This paper argues that policies to address the interfaces between acute care and aged care should view older people as members of the wider Australian population entitled to a range of health services under Medicare rather than focusing only on supposed "bed blockers". In seeking to explain the current level of policy interest in this area, three areas are canvassed: pressures on acute hospital care, particularly those attributed to population ageing; shrinking provision of residential aged care; and the proliferation of post acute services. If policy development is to maintain a wider rather than narrower perspective, attention needs to be given to improving collection and analysis of critical data that are currently unavailable, to developing system-wide funding arrangements for post acute care, and to reassessing what constitutes appropriate hospital activity for younger and older age groups alike.