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People's care needs in aged care

As people age, their need for care changes. Each person’s needs are different and in Australia services are tailored so that each person receives the assistance they need. Care is generally provided through residential and community-based approaches—lower levels of care are delivered in a person’s home, and higher levels of care are provided in residential facilities.

People in permanent residential care require assistance with most activities. Their needs are assessed through the Aged Care Funding Instrument (ACFI), an assessment tool which looks at three different areas of care—activities of daily living, cognition and behaviour, and complex health care. This topic focuses on information from the ACFI assessments.

A snapshot of the people who were in permanent residential aged care on 30 June 2016 shows:

  • Almost all had a current ACFI assessment on their record—this was 175,262 people or 99.6% of all people in permanent residential aged care. Most people (92%) had a high care need rating in at least one of the three ACFI assessment areas.
  • More than half (57%) of the residents were diagnosed with a mental health or behavioural condition.

  • Depression was the most commonly diagnosed mental health condition (46%).

  • Dementia had been diagnosed in just over half of the residents.

  • Women, people born in non-English speaking countries and people who prefer speaking a language other than English were more likely to have a ‘high’ rating across all three assessment areas.

  • The largest proportion of care needs rated as ‘high’ (63%) was in the cognition and behaviour  assessment area. This can be seen in the graph below.

What is the Aged Care Funding Instrument (ACFI)?

The ACFI is a tool used to assess and provide basic information on the care needs of a person in permanent residential aged care. The ratings—high, medium, low or nil—are used to allocate government funds to these facilities.  

The ACFI contains 12 questions used to assess how much help a person needs in nutrition, mobility, personal hygiene, toileting, continence, cognitive skills, wandering, verbal and physical behaviour, medication, depression and complex health care. These questions all relate to the three ACFI assessment areas (also called care domains). Responses to ACFI questions are rated on a scale of A to D and are used to determine the level of care a person needs. Mental health or behavioural diagnoses, along with other medical diagnoses, can be recorded but the ACFI is not designed to be a comprehensive assessment tool.

The ACFI is administered by the Department of Health and performed by a trained employee of the residential aged care provider. Funding on each of the ACFI domains is provided based on an individual’s rating. The sum of needs across the ACFI domains determines the amount of funding the residential provider receives per day per person in their care. ACFI reappraisal is undertaken as a person’s needs change. To find out more about the ACFI and subsidy amounts, please go to the Department of Health website.

In the next section you can explore more about how care needs have changed over time, the care need ratings for people with dementia, and care needs based on demographic factors such as age, sex, Indigenous status, language and country of birth.