Report on Government Services 2024

As people age, they may need care and support to maintain health, social connectedness, wellbeing and independence to remain in their homes and communities. Around two in five older people reported being in need of assistance as they aged (ABS 2019). Family members, friends and neighbours provide much of the care and support for older people (ABS 2019). However, not everyone’s care needs can be met through informal care and support. Around 80% of older people will access some form of government funded aged care service before death (AIHW 2018).

Government funded aged care services are provided to older people who would like them and who have been assessed as in need of them. Services assist people who can no longer live without support to access appropriate care in their home, in the community or in a residential care facility. Approved aged care service providers receive government funding to provide these services and are required to meet minimum standards as well as demonstrate commitment to continuous improvement in quality of care.

Regulation and policy oversight of aged care services are predominantly the role of the Australian Government. The Aged Care Act 1997 (Cth) and the accompanying Aged Care Principles are the main regulatory instruments establishing the framework for aged care services in Australia. Provisions of the Act cover service planning, user rights, eligibility for care, funding, quality assurance and accountability and other matters. There are also a number of independent statutory bodies that have important responsibilities in relation to aged care services: the Aged Care Quality and Safety Commission, the Independent Health and Aged Care Pricing Authority, and the National Aged Care Advocacy Program. In addition, the Aged Care Sector Committee advises the Australian Government on aged care policy development and implementation, including quality in aged care (Aged Care Sector Committee 2020).

The Australian Government funds state and territory governments to provide comprehensive assessment services through the day-to-day operation and administration of Aged Care Assessment Teams (ACAT). While ACAT undertakes comprehensive assessments for services under the Aged Care Act, Australian Government-funded Regional Assessment Services (RAS) assesses lower entry-level service needs.

The Australian Government funds residential aged care, home care and home support, with state, territory and local governments also funding and/or delivering some of these services directly – for example, a small proportion of residential aged care facilities are owned by state and territory governments. However, most services are delivered by non-government providers (tables 14A.10−11), such as private-for-profit, religious and charitable organisations.

The Australian Government and state and territory governments jointly administer and fund the Transition Care and Multi-Purpose Service (MPS) programs.

While the Australian Government subsidises a significant portion of the cost of providing aged care, clients and residents are expected to contribute where they can and may be charged fees by service providers.

In 2022-23, government recurrent expenditure on aged care services was $28.3 billion or $6,097.0 per older person (table 14A.4 and figure 14.1). Residential and flexible care services accounted for the largest proportion of expenditure in 2022-23 ($17.3 billion, or 61.1%). Home care and home support services accounted for much of the remainder ($9.5 billion) (table 14A.3).

The Australian Government provided 98.6% of government funding for aged care services in 2022-23. State and territory governments provided the remainder (table 14A.3). Detailed expenditure data by program is contained in tables 14A.3-8.

Aged care target population

The size and health of the older population drive demand for aged care services. The Australian population is ageing rapidly, with the share of the population aged 65 or over expected to increase by 6.1 percentage points to reach 23.4% between 2022-23 and 2062-63 (Australian Government 2023). Although the Aboriginal and Torres Strait Islander population is also ageing, life expectancy at birth for Aboriginal and Torres Strait Islander people is lower when compared with the non-Indigenous population (ABS 2018).

The aged care target population is defined as all people aged 65 years or over and Aboriginal and Torres Strait Islander people aged 50–64 years (this aligns with the funding arrangements as specified under the National Health Reform Agreement). The aged care target population differs from the Australian Government’s aged care ‘planning population’ of people aged 70 years or over which is used, along with the population of Aboriginal and Torres Strait Islander people aged 50–69 years in some cases, to allocate places under the Aged Care Act. See the 'Explanatory material' tab for a definition of the aged care planning population.

Types of care and support

Home care and home support

Governments provide services to help older people remain or return to their homes. Carers can also access respite care through home care and home support programs:

• the Commonwealth Home Support Programme (CHSP) helps older people to access entry-level support services to remain living independently and safely at home and in their community. Services available under the CHSP include domestic assistance, personal care, social support, allied health and respite services. Table 14A.19 provides a full list of CHSP services.
• the Home Care Packages Program helps people with complex care needs live independently in their homes. Four levels of care range from low-level care needs (Home Care Package Level 1) to high-care needs (Home Care Package Level 4). Services provided under these packages are tailored to the individual and might include personal care (such as showering), support services (such as cleaning) and clinical care (such as nursing and allied health support). As at 30 June 2023, 258,374 people were recipients of Home Care Packages, of which 40.1% received a Home Care Package Level 2 (table 14A.9).
• Department of Veterans’ Affairs (DVA) community care for eligible veterans – Veteran Home Care (VHC) services provide domestic assistance, home and garden maintenance, and respite for people with low care needs; DVA community nursing services provide acute, post-acute support, maintenance and palliative care for people with high care needs or disability. In 2022-23, 32,874 veterans aged 65 years and over were approved for VHC services (a decrease of 1.0% compared to 2021-22), and 9,248 veterans aged 65 years and over received community nursing services (a decrease of 13.8% compared to 2021-22). VHC and community nursing service user numbers represent approximately 30.1% and 8.5% of older eligible veterans respectively (table 14A.7-8).

In 2022-23, there were 808,439 older CHSP clients nationally, equivalent to around 174.3 older clients per 1,000 older people (figure 14.2). There were a further 313,991 older clients of Home Care Packages, equivalent to around 67.7 older clients per 1,000 older people (table 14A.2).

Residential care services

Residential aged care is provided in aged care homes on a permanent or respite basis. Residents receive accommodation, support (cleaning, laundry and meals) and personal care services (such as assistance with showering and toileting). Residents who have been assessed as requiring it may also receive mobility aids, continence products and tailored therapy services, as well as more complex nursing care.

For permanent residents, the Aged Care Funding Instrument (ACFI) is used to appraise care needs and the annual subsidy available through the Australian Government. Residents can be reappraised as their care needs change. Respite residents are not appraised under the ACFI but are classified as high or low care based on their ACAT approval. Information about the ACFI and the Average annual Australian Government subsidy can be found in table 14A.12. On 1 October 2022, the Australian National Aged Care Classification (AN-ACC) residential care funding model replaced the ACFI (Department of Health and Aged Care 2022a).

Information about usage rates per 1,000 people by age and sex in permanent residential aged care and home care can be found in table 14A.17. Information on the proportion of permanent new residents and permanent resident care days by concessional, assisted, supported or low means can be found in table 14A.18.

The planning framework for services provided under the Aged Care Act aims to keep the growth in residential aged care places in line with growth in the older population and to ensure a balance of services across Australia, including services for people with lower levels of need and in rural and remote areas. Until February 2017, home care places were also allocated under this framework. Under the Increasing Choices initiative introduced on 27 February 2017, home care packages are allocated to consumers rather than providers (consumers then choose a provider). At the same time, short-term restorative care places were introduced and are important in ensuring access to services across geographic locations.

Nationally at 30 June 2023, there were 70.3 residential care places per 1,000 people in the aged care planning population (that is, aged 70 years or over) (table 14A.14). If the population of Aboriginal and Torres Strait Islander people aged 50–69 years is taken into account, the rate is 67.4 per 1,000 older people (table 14A.15). This rate is higher in major cities (72.2) compared to regional areas (59.9) and remote or very remote areas (38.2) (tables 14A.16).

The rate of residential aged care places per 1,000 people in the aged care planning population has been trending downwards over the past 10 years (82.6 per 1,000 people in 2014) (table 14A.14). This might suggest that available residential aged care places are not keeping up with growth in the population of older people. Alternatively, it might indicate a preference for home-based care. Nationally, the number of home care package recipients increased by around 223.7% between 30 June 2016 and 30 June 2023 (table 14A.9).

During 2022-23, 247,878 older people were in permanent care (53.4 per 1,000 older people) and 79,307 in respite care (17.1 per 1,000 older people) (table 14A.2 and figure 14.3).

Flexible care services

Where mainstream residential or home care services are unable to cater for an older person’s specific needs, flexible care options are available:

• Transition Care provides goal-oriented and therapy-focused care on a time-limited basis to older people after a hospital stay, to help maximise their independence and minimise functional decline, thereby avoiding premature entry into residential aged care. During 2022-23, there were 16,588 older clients of Transition Care, with 3,092 people receiving care at 30 June 2023 (table 14A.2 and Department of Health and Aged Care 2023).
• Short-term restorative care (STRC) is similar to transition care. It aims to improve the physical functioning, wellbeing and independence of older people, but without the need to have been in hospital. In 2022-23, 8,999 people aged 65 years or over received STRC services, with 1,371 people receiving care at 30 June 2023 (Department of Health and Aged Care 2023).
• The Multi-Purpose Services (MPS) program delivers flexible and integrated health and aged care services to older Australians living in small communities in regional and remote areas. The MPS program provides health and aged care services in areas that cannot support both a hospital and a separate aged care home. At 30 June 2023 there were 3,741 operational MPS program places (Department of Health and Aged Care 2023).
• The National Aboriginal and Torres Strait Islander Flexible Aged Care Program funds services to provide flexible, culturally appropriate aged care to older Aboriginal and Torres Strait Islander people close to their home or community. Services funded under this program can deliver a mix of residential and home care services. At 30 June 2023, there were 1,384 operational flexible allocated places under this program, with 489 in Flexible Residential Aged Care (Department of Health and Aged Care 2023).

Supporting programs

Governments fund ‘Workforce and Quality’ and ‘Ageing and Service improvement’ programs to monitor compliance with accreditation and quality frameworks and ensure appropriately skilled staff are available to deliver home and residential care services (including appropriate training to address a predicted rise in the prevalence of dementia). Staff providing home and residential care, and the physical environment at residential facilities, are critical to the health, safety and client experience of care and support. In 2022-23, the Australian Government spent $974.6 million on 'Workforce and Quality' and 'Ageing and Service Improvement' supports (table 14A.3).

The Aged Care Act does not prescribe the qualifications required by staff nor the number of staff required to be employed by an aged care service (Department of Health and Aged Care 2018), but the Aged Care Quality Standards include a mandatory human resources standard for all government funded aged care providers. Standard 7 requires aged care providers to employ staff with the right skills and qualifications to provide care, and that aged care client interactions should be kind, caring and respectful of an older person's identity, culture, and diversity. Table 14A.41 provides data on the proportion of assessed aged care providers that met the Aged Care Quality Standards.

The physical environment at residential facilities is assessed as part of ongoing accreditation processes by the Aged Care Quality and Safety Commission (tables 14A.37–40).

Providers are responsible for ensuring that their workforce upholds the rights of clients and residents as outlined in the Charter of Aged Care Rights.

In 2020, 27.9% of full-time equivalent (FTE) direct care staff at aged care homes were either nurses or allied health professionals, down from 28.5% in 2016 (Department of Health and Aged Care 2017a, 2021a).

Accessing care

Information services

Services such as ‘My Aged Care’ provide older people, their families and carers with information to help them access timely and appropriate care and find approved aged care services in their local area.

Assessment services

An assessment of need by an ACAT (Aged Care Assessment Service in Victoria), is mandatory for admission to residential care, to receive a Home Care Package, or enter STRC or Transition Care. ACATs also make recommendations regarding the most appropriate long-term care arrangements for clients (table 14A.22). Since 2014, care approvals from most assessments do not lapse. Assessments for other aged care programs are primarily conducted by other assessment services (for example, Regional Assessment Services (RAS) for CHSP).

Not everyone assessed by an ACAT is approved for care, and some people are approved for more than one type of care. Nationally in 2022-23, there were 206,572 completed ACAT assessments (equivalent to 44.5 per 1,000 older people) (table 14A.20) and 253,493 approvals for residential aged care and the Home Care Package program for people aged 65 years and over (tables 14A.20–21). ACAT approval rates increase significantly with client age (table 14A.21).

Elapsed times – timely access to aged care services

The time between an ACAT approval and an older person’s access to aged care services (e.g., assignment of a home care package, receipt of home care services, or entry into residential aged care) can be influenced by a range of factors (both service- and person-related) including:

• availability of places/packages and services (which can increase waiting times)
• an older person’s:
  • preference to remain at home for as long as possible, going into approved residential aged care at a later date or not at all (choosing instead to access formal home care, or support from family, friends or the community)
  • need to delay entry into residential aged care due to personal circumstances, such as selling their home
  • decision to reject an offer due to the cost or location.

Occupancy rates

The occupancy rate at 30 June 2023 was 86.1%. The occupancy rate has been trending downwards over the past 10 years (93.0% in 2014), notwithstanding an increase in the number of operational residential aged care places over the same period (189,283 in 2014 to 221,467 in 2023) (table 14A.13). There were 62,226 admissions to residential aged care in 2022-23 (table 14A.33).

Care providers

Nationally, in 2023, private for-profit organisations provided the largest proportion of operational home care packages (36.5%) and residential aged care places (40.7%). Results varied across jurisdictions (table 14A.11-14A.12).

‘Use by different groups’ is an indicator of governments’ objective to subsidise aged care services in an equitable manner.

‘Use by different groups’ is defined as the proportion of service clients from a selected equity group, compared with the proportion of the aged care target population from that selected equity group.

The proportion of service clients from a particular selected equity group should be broadly similar to the proportion of the aged care target population from that selected equity group.

Nine selected equity groups were identified by the Aged Care Act 1997 (Cth) (referred to as 'special needs' groups in the Act; see the 'Explanatory material' tab for details). Data is reported for three selected equity groups (Aboriginal and Torres Strait Islander people; people from Culturally and Linguistically Diverse (CALD) backgrounds; and people receiving aged care services in outer regional, remote/very remote areas). People from CALD backgrounds are defined as those born overseas from countries other than the United Kingdom, Ireland, New Zealand, Canada, South Africa and the United States of America.

Measures for veterans (including widows and widowers of veterans) and for people who are financially and socially disadvantaged are currently under development (although data is available on the proportion of all permanent residents’ care days used by financially disadvantaged residents; see table 14A.18). Data is not available for reporting on the remaining selected equity groups.

Several factors should be considered when interpreting this data.

• Selected equity groups may have greater need for aged care services. Compared to the rest of the population, Aboriginal and Torres Strait Islander people have higher rates of disability, lower life expectancy and an increased likelihood of requiring aged care services at a younger age. Because of these factors, the target population for Aboriginal and Torres Strait Islander people is people aged 50 years and over, compared to 65 years and over for other population groups.
• Cultural differences and the availability of care and support from family, friends and neighbours can also affect the use of services across different population groups. Stronger support networks can reduce the need for government funded aged care services, or for particular government funded service types.

Differences in the representation of a selected equity group in services compared to their representation in the aged care target population varied across service types and groups. Nationally in 2022-23:

• Aboriginal and Torres Strait Islander people were underrepresented in all service types but less so for Home Care Packages
• people from CALD backgrounds were overrepresented among people accessing Home Care Packages and the Aged Care Assessment Program but underrepresented in all other service types
• people receiving aged care services in rural and remote areas were overrepresented among people accessing CHSP but underrepresented in all other service types.

‘Unmet need’ is an indicator of governments’ objective to subsidise aged care services that are accessible.

‘Unmet need’ measures aged care service access relative to need. Two measures of unmet need are reported:

• unmet need in the community
• hospital patient days used by aged care type patients.

Unmet need in the community

‘Unmet need in the community’ measures the proportion of older people (aged 65 years and over) living in households who reported being in need of assistance, and whose need for assistance was not fully met.

A low or decreasing proportion of people reporting their need for assistance as not fully met is desirable.

Data for the Northern Territory should be interpreted with caution as the Survey of Disability, Ageing and Carers excludes very remote areas, which comprise more than 20% of the estimated resident population in the Northern Territory living in private dwellings.

Nationally, in 2018, 34.0% of older people who were living in households and in need of assistance reported that their need was not fully met (figure 14.6a). The proportion was higher for older people with a profound or severe disability (41.7%) than for older people without a disability (20.5%) (table 14A.26).

Hospital patient days used by aged care type patients

‘Hospital patient days used by aged care type patients’ is a proxy measure of unmet need defined as the proportion of hospital patient days (for overnight separations only) that were for aged care type patients (see 'Explanatory material' tab for further details).

Hospital inpatient services are geared towards shorter periods of acute care aimed at addressing serious illness or injury, or diagnosis. The needs of older people for maintenance care (particularly for extended periods of time) can be better met in residential aged care services than hospitals.

Understanding the relationship between the aged care and health systems is important as interactions are critical for the performance of both systems. The number of operational residential aged care places can affect demand for public hospital beds, just as the number of older patients in acute and subacute care and the time they spend in hospital can affect demand for aged care services.

A low or decreasing proportion of patient days used by aged care type patients is desirable.

This data should be interpreted with caution, because:

• days for patients who have not completed their period of care in a hospital are not included
• identification in hospital as an aged care patient type may not reflect a person’s eligibility for residential care services (this is determined by an ACAT assessment) or reliably reflect access issues for residential aged care from the acute care sector – linked ACAT and hospital separations data is not available at this time
• the diagnosis codes for aged care patient type may not be applied consistently across jurisdictions or over time
• the denominator (all patient days for overnight separations) does not directly reflect the need for aged care services
• the scope of aged care type patients differs slightly to the equivalent National Healthcare Agreement indicator (see table 14A.27 for details).

Nationally in 2021‑22, the rate of all hospital patient days used by patients waiting for residential aged care was 10.7 per 1,000 patient days (figure 14.6b). Rates were lower for Aboriginal and Torres Strait Islander people compared to other Australians but higher for people from lower compared to higher socioeconomic areas and for people in remote compared to non‑remote areas (table 14A.28). The proportion of separations for ‘aged care type’ patients waiting 35 days or longer was 13.7% nationally in 2021-22, the highest proportion in ten years (table 14A.27).

‘Affordability’ is an indicator of governments’ objective to subsidise aged care services to improve affordability for people who need them.

‘Affordability’ is defined as out‑of‑pocket costs for aged care services (after subsidies), as a proportion of disposable income.

Low or decreasing out‑of‑pocket cost for aged care services as a proportion of disposable income represents more affordable aged care services and is desirable.

Data is not yet available for reporting on this indicator.

‘Elapsed times’ is an indicator of governments’ objective to subsidise aged care services that are accessible. ‘Elapsed times’ are measured in days at the 50th and 90th percentile and reported separately for three measures:

• Measure 1 – aged care assessment times
• Measure 2 – home care elapsed times
• Measure 3 – residential aged care elapsed times.

Low and decreasing days waited are desirable. However, various factors can influence days waited, including system capacity to assess applications and allocate packages, consumer choices, and market/provider supply side factors.

Days waited at the 50th percentile means half the sample will have a shorter elapsed time than this figure and half will have a longer elapsed time. Days waited at the 90th percentile means 90% of the sample will have a shorter elapsed time, while 10% will have a longer elapsed time.

Aged care assessment times

Aged care assessment times are measured in days at the 50th and 90th percentile between referral for an aged care assessment and ACAT approval (excluding incomplete assessments).

Only national data was provided for publication in this report. It is expected that state and territory data will be available for future reports.

Nationally, in 2022-23, 50% of older people who were referred for an aged care assessment waited up to 17 days to receive an ACAT approval (increasing to 98 days at the 90th percentile). The days waiting for ACAT approval have increased since 2017-18.

Home care packages

Home care elapsed times are measured in days at the 50th and 90th percentile between: (1) ACAT approval and the assignment of a home care package; (2) assignment of a home care package to service commencement date; and (3) ACAT approval to service commencement date. Results are reported for medium, high and all priority older people.

Once a home care package has been assigned, an older person has 56 calendar days to enter into a home care agreement with an approved provider. Clients can apply for an extension of 28 days, giving them a total of 84 calendar days in which to enter into an agreement with a provider. If an older person has not entered into a home care agreement by the required time, their home care package will be withdrawn. However, if the older person later decides that they want to receive home care services, they can rejoin the National Priority System (NPS). They will re-enter the NPS based on their approval date and are not disadvantaged (Department of Health and Aged Care 2017b).

Results measure days between ACAT approval to assignment of a home care package and service commencement for any home care package level, whether or not it was at the approved level. Results are also limited to the first time an older person is assigned a home care package and/or services commence for an older person, as this is most indicative of the typical experience; package upgrades and opt back-ins would inflate reported elapsed times.

Nationally in 2022-23, all priority groups waited 132 days at the 50th percentile and 187 days at the 90th percentile to be assigned a home care package following ACAT approval. The elapsed time has decreased from 247 days at the 50th percentile and 335 days at the 90th percentile in 2017-18. Days waited were shorter for high-priority clients (7 days and 12 days at the 50th and 90th percentiles, respectively).

Nationally in 2022-23, all priority groups waited 168 days at the 50th percentile and 236 days at the 90th percentile for services to commence after ACAT approval. The number of days waited has decreased from 281 days at the 50th percentile and 381 days at the 90th percentile in 2017-18. Days waited were shorter for high-priority clients (43 days and 83 days at the 50th and 90th percentiles, respectively).

Residential aged care

Residential aged care elapsed times are measured in days at the 50th and 90th percentile between ACAT approval and residential aged care entry for all permanent residents and for a high priority cohort, defined as older people who enter residential aged care within 12 months of application (on the basis that older people with higher needs are unlikely to delay care entry by choice).

Not everyone assessed by an ACAT is approved for care, and some people are approved for more than one type of care. Additionally, care approvals do not lapse, which means assessments performed some years previously can be used for entry into residential aged care. With no central register of residential care offers, it is unclear if older people were offered a place and decided to delay their entry into care. Also, as an assessment can be for more than one type of care, older people can receive a home care package before they enter residential aged care.

Tables 14A.32 and 14A.33 provide information on all older people who entered into residential aged care. Tables 14A.34 to 14A.36 provide detailed information on people who entered residential aged care by equity groups.

Nationally in 2022-23, permanent residents who entered care during the financial year and within one year of ACAT approval had an elapsed time of 63 days at the 50th percentile and 245 days at the 90th percentile (a largely consistent trend over the time series). Of all those admitted to residential care with known elapsed times in 2022-23, 67.4% were admitted within one year of ACAT approval.

In 2022-23, 42.9% of older people entered residential aged care within 3 months of their ACAT approval (figure 14.7d); the median elapsed time was 135 days, a decrease from 153 days in 2021-22 (table 14A.33). Nationally, the median elapsed time between ACAT approval and entry into aged care services increased by 200% (a threefold increase) between 2013-14 and 2022-23.

‘Addressing client needs’ is an indicator of governments’ objective to subsidise aged care services that are appropriate to meet the needs of clients – person‑centred, with an emphasis on integrated care, ageing in place and restorative approaches.

‘Addressing client needs’ will measure the extent to which:

• care recipients or their representatives had input into the planning of their care
• the supports identified in the care planning process to address an individual’s needs were provided (match of needs)
• individual interests, customs, beliefs and cultural and ethnic backgrounds were valued and fostered.

Data is not yet available for reporting on this indicator.

‘Compliance with service standards’ is an indicator of governments’ objective to subsidise high quality aged care services.

‘Compliance with service standards’ measures the extent to which approved aged care services are meeting expected standards. Measures are reported for residential care and home care and home support.

Residential care – re-accreditation

For residential aged care, the proportion of accredited facilities given three‑year re-accreditation is reported. Three years is the longest period for which re‑accreditation can be granted (in most cases), so if a service is re‑accredited for this period it implies a higher level of service quality than for those re‑accredited for a shorter period. Further information on the accreditation standards and process is available at http://www.agedcarequality.gov.au.

Data for this measure do not include new facilities (1.3% of all residential care facilities) that have not been re‑accredited as at 30 June 2023 (table 14A.40).

High or increasing proportions of services that are re‑accredited for three years are desirable.

During 2022‑23, 90.1% of the 1,598 services re‑accredited that year were given three-year accreditation status; up from 85.0% in 2021‑22 (table 14A.37). At 30 June 2023, 89.9% of all 2,606 re-accredited residential aged care services had been given three-year accreditation. This is the highest value since 30 June 2019, but is still significantly lower than a peak of 98.3 in 2016. (figure14.8 and table 14A.40).

Compliance with Aged Care Quality Standards

On 1 July 2019, the Aged Care Quality Standards took effect for organisations providing all types of Commonwealth‑subsidised aged care services.

• Standard 1 – Consumer dignity and choice
• Standard 2 – Ongoing assessment and planning with consumers
• Standard 3 – Personal care and clinical care
• Standard 4 – Services and supports for daily living
• Standard 5 – Organisation’s service environment
• Standard 6 – Feedback and complaints
• Standard 7 – Human resources
• Standard 8 – Organisational governance.

High or increasing proportions of services that met all expected outcomes are desirable.

For Australian Government subsidised aged care services, 60.7% of services received a re-accreditation audit during 2022-23 for residential aged care services, up from 26.6% in 2021-22, and 11.0% received a quality audit for home care and support (table 14A.41). The proportions of residential aged care and home care and home support service providers reviewed during 2022‑23 that achieved the standards are in table 14.2.

‘Quality of care’ is an indicator of governments’ objective to subsidise high quality aged care services. High quality aged care services provide services that meet residents’ personal, functional, clinical and psycho-social needs to a high standard.

‘Quality of care’ in residential aged care services is measured according to the expanded National Aged Care Mandatory Quality Indicator Program. Participation in the National Aged Care Mandatory Quality Indicator Program has been a requirement for all Australian Government subsidised residential aged care services since 1 July 2019.

Since 1 July 2021, approved providers of residential aged care are required to report on five quality indicators. The definitions and data collection methods for each quality indicator are outlined in the National Aged Care Mandatory Quality Indicator Program Manual 2.0 (Department of Health and Aged Care 2021b).

The indicator is defined by five measures:

• Pressure injuries
• Physical restraint
• Unplanned weight loss
• Falls and major injury
• Medication management.

Further details on the definitions of these measures are available in the Key terms section.

From 1 April 2023, the QI Program was expanded to include six new indicators (Activities of daily living, Incontinence care, Hospitalisations, Workforce, Consumer experience, and Quality of life). Reporting on these indicators commenced Q1 2023-24. This data is expected to be included in the 2025 report.

All else being equal, a low or decreasing occurrence of pressure injuries, use of physical restraint, unplanned weight loss, falls, and polypharmacy can suggest higher-quality services. However, high or increasing occurrences might reflect more effective reporting and monitoring arrangements.

Pressure injuries – care recipients were observed for pressure injury once each quarter during 2022-23. In quarter 4 (Q4; April to June 2023), 5.8% of care recipients had one or more pressure injuries, down from the same quarter in 2022 (6.3%), prevalence was higher for lower grade pressure injuries. Data were similar across all quarters (between 5.8% and 6.5% of care recipients with one or more pressure injuries in Q3-Q4 and Q1, respectively) (table 14A.42).

Physical restraint – the use of physical restraint was assessed by reviewing three days of existing care records each quarter during 2022-23. In quarter 4 (Q4; April to June 2023), 17.8% of care recipients experienced physical restraint, and 14.3% were restrained exclusively through the use of a secure area, down from the same quarter in 2022 (21.6% and 17.1%). Data showed some variation across quarters: for care recipients who experienced physical restraint (between 17.8% and 21.1% in Q4 and Q1, respectively) and for care recipients who experienced physical restraint through the use of a secure area (between 14.3% and 16.9% in Q4 and Q1, respectively) (table 14A.43).

Unplanned weight loss – assessment of care recipients’ weight loss occurred monthly, however both unplanned weight loss indicators were measured on a quarterly basis during 2022-23. In quarter 4 (Q4; April to June 2023), 7.7% of care recipients experienced significant unplanned weight loss (meaning unplanned weight loss of 5.0% or more when comparing their current and previous quarter finishing weights), and 7.9% of care recipients experienced consecutive unplanned weight loss (meaning consecutive unplanned weight loss every month over three consecutive months of the quarter) down from the same quarter in 2022 (9.4% for both measures). Data showed some variation across quarters: for care recipients who experienced significant unplanned weight loss (between 7.7% and 9.3% in Q4 and Q2, respectively) and for care recipients who experienced consecutive unplanned weight loss (between 7.9% and 11.0% in Q4 and Q1, respectively) (table 14A.44).

Falls and major injury – falls and falls resulting in major injury were assessed by reviewing care records over the entire quarter for each quarter during 2022-23. In quarter 4 (Q4; April to June 2023), 32.1% of care recipients experienced a fall, with 1.9% resulting in major injury (for example, bone fractures, joint dislocations, and head injuries), down from the same quarter in 2022 (32.2% and 2.2%). Data were similar across all quarters: for care recipients who experienced a fall (between 31.2% and 32.3% in Q3 and Q1, respectively) and for care recipients who experienced a fall resulting in major injury (between 1.9% and 2.1% in Q3-Q4 and Q1, respectively) (table 14A.45).

Medication management – care recipients' medication charts and/or records were assessed through a single review each quarter during 2022-23. In quarter 4 (Q4; April to June 2023), 35.5% of care recipients were prescribed nine or more medications, down on the same quarter in 2022 (37.5%). In Q4, 9.5% of all care recipients received antipsychotic medications for a diagnosed condition of psychosis, although 18.0% of all care recipients received antipsychotic medications, down from the same quarter in 2022 (10.7% and 19.7%). Data were similar across all quarters: for care recipients who were prescribed nine or more medications (between 35.5% and 36.7% in Q4 and Q1, respectively) and for care recipients who received antipsychotics (between 18.0% and 18.6% in Q4 and Q1, respectively) (table 14A.46).

National Aged Care Mandatory Quality Indicator Program data used to report on this indicator are based on quarterly assessment data recorded by service as distinct from care recipients. Therefore, it is not possible to determine the number of quarters in which the same care recipients were assessed.

‘Client and carer satisfaction’ is an indicator of governments' objective to subsidise high quality aged care services.

‘Client and carer satisfaction’ is defined by four measures:

• the proportion of people aged 65 years or over living in households, who are satisfied with the range of organised and formal service options available
• the proportion of people aged 65 years or over living in households, who are satisfied with the quality of assistance received from organised and formal services in the last six months
• the proportion of primary carers living in households (caring for people aged 65 years or over), who are satisfied with the range of formal service options available to help them in their caring role
• the proportion of primary carers living in households (caring for people aged 65 years or over), who are satisfied with the quality of assistance received from formal services in the last six months to help them in their caring role.

A high or increasing proportion of clients and carers who are satisfied is desirable as it suggests that the service received was of a higher quality.

Data for the Northern Territory should be interpreted with caution as the Survey of Disability, Ageing and Carers excludes very remote areas which comprises more than 20% of the estimated resident population in the Northern Territory living in private dwellings.

Nationally in 2018, 71.2% of people aged 65 years and over who reported a need for, or received formal services in the previous six months were satisfied with the range of services available – a decrease from 2015, but similar to 2012 (figure 14.10a).

Of people aged 65 years or over who received formal services in the previous six months, 84.4% were satisfied with the quality of assistance they received (table 14A.48) – a decrease from 2015 and 2012 (89.2% and 88.6% respectively).

For primary carers of people aged 65 years or over, the proportion who were satisfied with the range of organised services available to help them in their caring role was 36.1% in 2018 – a decrease of around 10 percentage points from 2015 and 2012 (figure 14.10b).

Around 7 in 10 primary carers (71.3%) were satisfied with the quality of services provided to help them in their caring role – down from 84.7% in 2012 (table 14A.50).

‘Complaints received’ is an indicator of governments’ objective to subsidise high quality aged care services.

‘Complaints received’ is defined as the number of in‑scope complaints received by the Aged Care Quality and Safety Commission that relate to Australian Government funded providers of residential care, home care, CHSP or flexible aged care services. The complaints rate (complaints per 10,000 occupied bed days) is for complaints about residential aged care services only.

All else being equal, a low or decreasing rate of complaints can suggest higher quality services. However, a high or increasing rate of complaints may not necessarily mean lower quality services. It may reflect more effective complaints reporting and monitoring arrangements.

Further information on the operation of the Aged Care Quality and Safety Commission is available at http://www.agedcarequality.gov.au.

During 2022‑23, the Aged Care Quality and Safety Commission received 9,198 in‑scope complaints. Of these, 5,077 concerned permanent and respite residential aged care services, equivalent to 0.73 complaints per 10,000 occupied bed days, a decrease from 0.93 in 2021-22 (figure 14.11).

‘Serious incident notifications’ is an indicator of governments’ objective to subsidise high quality aged care services.

‘Serious incident notifications’ is defined as the number of Serious Incident Response Scheme notifications received by the Aged Care Quality and Safety Commission, by primary incident type, per 10,000 occupied bed days in residential care.

The Serious Incident Response Scheme (the Scheme) was introduced on 1 April 2021. The purpose of the Scheme is to help prevent and reduce incidents of abuse and neglect in residential aged care services subsidised by the Australian Government. The Scheme was extended to aged care services delivered in home or community settings on 1 December 2022.

The Scheme requires aged care providers to:

• Manage and take reasonable action to prevent incidents with a focus on the safety, health, wellbeing and quality of life of older people in residential aged care.
• Have an effective incident management system to respond to, assess, and enable continuous improvement to their management and prevention of incidents.
• Notify the Aged Care Quality and Safety Commission of all reportable incidents. Reportable incidents include any of the below that have occurred, are alleged to have occurred, or are suspected of having occurred to a consumer:
  • unreasonable use of force
  • unlawful sexual contact or inappropriate sexual conduct
  • neglect
  • psychological or emotional abuse
  • unexpected death
  • stealing or financial coercion by a staff member
  • inappropriate use of restrictive practices
  • unexplained absence from care

In a mature system where providers are routinely complying with reporting obligations, low or decreasing rates of Serious incident notifications are desirable. However, high or increasing rates might reflect more effective incident reporting mechanisms and organisational cultural change.

The number of Serious incident notifications does not necessarily correlate to the number of instances of harm to an older person in aged care. Reports might include multiple notifications of the same matter, allegations of incidents, and situations where incidents occurred but injury was avoided. Incident rates should be monitored over time to identify trends.

Notifications in this report concern residential aged care providers. Reporting will expand to the home care sector in future.

Nationally, during 2022-23, the Aged Care Quality and Safety Commission received 50,583 Serious Incident Response Scheme notifications from residential aged care service providers, which equates to 7.3 notifications per 10,000 occupied bed days (an increase from 5.5 notifications per 10,000 occupied bed days in 2021-22, which was the first full year of the scheme)(figure 14.12). Notifications most commonly concerned the unreasonable use of force (table 14A.52).

‘Workforce sustainability’ is an indicator of governments’ objective to provide sustainable aged care services.

Aged care workforce sustainability relates to the capacity of the aged care workforce to meet current and projected future service demand. These measures are not a substitute for a full workforce analysis that allows for training, migration, changing patterns of work and expected future demand. They can, however, indicate that further attention should be given to workforce planning for aged care services.

This indicator is currently under development for reporting in the future.

‘Residential aged care unit costs’ is an indicator of governments’ objective to subsidise aged care services in an efficient manner.

‘Residential aged care unit costs’ is defined by two measures:

• Average annual program cost, per occupied bed day – real annualised government expenditure on residential aged care services.
• Average annual Australian Government residential aged care subsidy (all levels of care), per claim day – real annualised subsidy entitlements plus Conditional Adjustment Payment (CAP).

For measure 1, annualised costs are derived using total government aged care program expenditure on residential aged care services (Australian Government Department of Health and Aged Care, Department of Veterans' Affairs, and state and territory government supplements), divided by the number of occupied bed days, multiplied by 365 to present an average cost figure for an aged care resident in care for a year.

For measure 2, annualised costs are derived using total Australian Government aged care subsidy claims, divided by the number of claim days, multiplied by 365 to present an average subsidy amount that aged care providers could have claimed for an aged care resident in care for a year.

While high or increasing cost per residential aged care unit might reflect deteriorating efficiency, it might also reflect changes in aspects of the service (such as greater time spent with clients) or differences in the characteristics of clients (such as their geographic location or higher levels of acuity). Similarly, while low or declining cost per residential aged care unit might reflect improving efficiency, it might also reflect declining quality.

Not all expenditure is included in these measures. Expenditure by local governments and non-government sources is not captured.

Nationally, in 2022-23, the average annualised cost per occupied bed day was $85,891, up from $71,420 in 2014-15 (table 14A.53 and figure 14.13).

Nationally, in 2022-23, the average annualised Australian Government subsidy per claim day was $77,697, up from $60,663 in 2013-14 (table 14A.54 and figure 14.13).

‘Home care unit costs’ is an indicator of governments’ objective to subsidise aged care services in an efficient manner.

‘Home care unit costs’ is defined by four measures:

• Average annual program cost of home care – real Australian government expenditure on the home care package program per recipient
• Average annualised home care package payment – real payments on home care packages to recipients.
• Expenditure per hour of service for CHSP – real Australian Government expenditure on services, divided by the number of hours of service provided
• Average annual program cost of CHSP – real Australian Government expenditure on CHSP per client.

While high or increasing cost per home care unit might reflect deteriorating efficiency, it might also reflect changes in aspects of the service (such as greater time spent with clients) or differences in the characteristics of clients (such as their geographic location). Similarly, while low or declining cost per home care unit might reflect improving efficiency, it may also reflect declining quality.

Not all expenditure is included in these measures. Expenditure by local governments and non-government sources is not captured.

Nationally in 2022-23, the cost per recipient of a home care package programme was $17,892 (table 14A.55).

Nationally in 2022-23, the cost per recipient of the Commonwealth Home Support Programme (CHSP) was $3,631, up from $3,115 in 2017-18 (table 14A.56).

Nationally, in 2022-23, the average annualised payment per home care package was $22,400. The average annualised payment amount increased with package level ($6,800 for a level one home care package, compared to $40,300 for a level four home care package) (figure 14.14b).

Table 14A.57 includes additional contextual information on aged care package entitlement (i.e. allocated funds) and unspent funds.

Nationally, in 2022-23, Australian Government expenditure on CHSP services per hour was higher for nursing and allied health than for domestic assistance and personal care (figure 14.14c and 14.14d). Expenditure per hour of service for personal care was $120.55 in 2022-23, up from $104.23 in 2021-22. Expenditure per hour of service for allied health decreased to $124.77 in 2022-23 from $141.79 in 2021-22. The national real expenditure per hour of service for personal care is significantly closer to that of allied health than has been the case over the five years of the recorded time series. In some jurisdictions, expenditure per hour of service for personal care exceeded that of allied health.

‘Restorative care unit costs’ is an indicator of governments’ objective to subsidise aged care services in an efficient manner.

‘Restorative care unit costs’ is defined by two measures:

• Transition care, real cost per recipient day
• Short-term restorative care, real cost per recipient day.

The Transition Care Programme is funded by the Australian Government and the state and territory governments, while the Short Term Restorative Care Programme is funded by the Australian Government.

While high or increasing cost per restorative care unit might reflect deteriorating efficiency, it might also reflect changes in aspects of the service (such as greater time spent with clients) or differences in the characteristics of clients (such as their geographic location or entry conditions). Similarly, while low or declining cost per restorative care unit might reflect improving efficiency, it might also reflect declining quality.

Not all expenditure is included in these measures. Expenditure by local governments and non-government sources on services is not captured.

Nationally, in 2022-23, the cost per day of the Transition Care Programme was $397.10, up from $326.33 in 2017-18 (table 14A.59).

Nationally, in 2022-23, the cost per day of the Short Term Restorative Care Programme was $213.00, up from $195.66 in 2021-22 (table 14A.59).

‘Aged care assessment unit costs’ is an indicator of governments’ objective to subsidise aged care services in an efficient manner.

‘Aged care assessment unit costs’ is defined by two measures:

• Australian Government expenditure per ACAT assessment – Australian Government expenditure on the Aged Care Assessment Team (ACAT) Program, divided by the number of completed assessments
• Australian Government expenditure per RAS assessment – Australian Government expenditure on the Regional Assessment Services (RAS) program, divided by the number of completed assessments.

While high or increasing cost per assessment unit might reflect deteriorating efficiency, it might also reflect changes in aspects of the service (such as greater time spent with clients) or differences in the characteristics of clients (such as their geographic location). Similarly, while low or declining cost per assessment unit might reflect improving efficiency, it might also reflect declining quality.

Not all expenditure is included in these measures. Expenditure by local governments and non‑government sources on services (for example, client fees for CHSP) and state and territory governments’ contributions to the cost of ACAT assessments are not captured.

Nationally, in 2022-23, the average Australian Government expenditure per ACAT assessment was $656.61 up from $638.24 in 2013-14, and down from $849.35 in 2016-17 (table 14A.60).

Nationally, in 2022-23, the average Australian Government expenditure per RAS assessment was $398.40, down from $473.98 in 2017-18 (table 14A.61).

‘Social participation in the community’ is an indicator of governments’ objective to encourage the wellbeing and independence of older people.

‘Social participation in the community’ is indicative of the wellbeing and independence of older people as defined by three measures, the estimated proportions of older people (aged 65 years and over) who:

• participated in social or community activities away from home in the last three months
• had face‑to‑face contact with family or friends not living in the same household in the last week
• did not leave home or did not leave home as often as they would like.

These measures are reported by disability status (profound or severe disability, other disability, all disability, without disability) and for all older people. Disability status is used as a proxy to identify older people who might need more assistance to support their social participation.

High or increasing proportions of social participation in the community are desirable.

Data for the Northern Territory should be interpreted with caution as the Survey of Disability, Ageing and Carers excludes very remote areas which comprises more than 20% of the estimated resident population in the Northern Territory living in private dwellings.

Nationally in 2018:

• 94.4% of older people reported having participated in social or community activities away from home in the last three months; similar to 2015 (figure 14.17)
• 77.1% of older people reported having face‑to‑face contact with family or friends who were not living in the same household in the last week; similar to 2015 (table 14A.63)
• 13.8% of older people reported they did not leave home or did not leave home as often as they would like; similar to 2015 (table 14A.64).

Data is available by disability status in tables 14A.62–64.

‘Enabling people with care needs to live in the community’ is an indicator of governments’ objective to promote the wellbeing and independence of older people, by enabling them to stay in their own homes.

Enabling people with care needs to live in the community’ is defined as the proportion of older people with care needs who are living in the community.

An increasing proportion of older people with care needs who want to and are living in the community is desirable. This indicator should be considered alongside the outcome indicator on social participation.

Data is not yet available for reporting against this indicator.

‘Maintenance of individual function’ is an indicator of governments’ objective for aged care services to promote the wellbeing and independence of older people.

‘Maintenance of individual function’ is defined as improvement in the level of physical function for Transition Care Programme (TCP) and Short-Term Restorative Care Programme (STRCP) clients from entry to exit, measured as the difference between the average Modified Barthel Index (MBI) score on TCP entry and exit.

An increase in the score from entry to exit is desirable.

The MBI measures functioning ranging from zero (fully dependent) to 100 (fully independent). Data is reported for recipients who completed an episode only. See the context section for more information on TCP and STRCP.

This indicator needs to be interpreted with caution. The TCP and STRCP operate with some differences across jurisdictions, including differences in health and aged care service systems, local operating procedures and client groups. Variations in the average MBI scores on entry and exit from the program may reflect differences in client groups for the program across jurisdictions.

The TCP is a small program only available directly upon discharge from the hospital (in 2022‑23 there were 14,340 admissions to the TCP) (table 14A.65). The average duration is around 10 weeks, with a maximum duration of 12 weeks (may be extended by a further six weeks in some circumstances).

The STRCP provides services to older people for up to 8 weeks (56 days) to help them delay or avoid long-term care (in 2022‑23, there were 8,087 admissions to the STRCP) (table 14A.66). A client can access 2 episodes of STRC within a 12-month period. The support can occur in the person’s home, an aged care (nursing) home or a combination of both.

Nationally in 2022‑23, the average MBI score for TCP clients increased from entry (71) to exit (82), similar to previous years (table 14A.65). Nationally in 2022‑23, the average MBI score for STRCP clients increased from entry (82) to exit (85), similar to the previous year. Entry and exit scores vary across jurisdictions (table 14A.66).

‘Wellbeing and independence in residential care’ is an indicator of governments’ objective to promote the wellbeing and independence of older people, by assisting them in residential care.

‘Wellbeing and independence in residential care’ is defined as the proportion of older people assessed as having a high quality of life in residential aged care. Quality of life is the degree to which an individual resident’s wellbeing meets their personal expectations and those of their carers.

A high or increasing proportion of older people in residential aged care with a high quality of life is desirable.

Data is not yet available for reporting on this indicator.