Australia’s aged care system offers a variety of services to support people as their care needs change.
Last updated: 28 July 2022.
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For a downloadable summary of the information in this topic, view the People's care needs in aged care fact sheet.
The aged care system offers a continuum of care under three main types of service (for more information on any of these services see the Report on the Operation of the Aged Care Act):
- Home support (Commonwealth Home Support Programme), which provides entry-level services focused on supporting individuals to undertake tasks of daily living to enable them to be more independent at home and in the community.
- Home care (Home Care Packages Program), which is a more structured, more comprehensive package of home-based support, provided over four levels.
- Residential aged care, which provides support and accommodation for people who have been assessed as needing higher levels of care than can be provided in the home, and the option for 24-hour nursing care. Residential care is provided on either a permanent, or a temporary (respite) basis.
There are also several types of flexible care available that extend across the spectrum from home support to residential aged care:
- Transition care, which provides short-term care to restore independent living after a hospital stay
- Short-term restorative care, which expands on transition care to include anyone whose capacity to live independently is at risk
- Multi-purpose services, which offer aged care alongside health services in regional and remote areas
- Innovative Care Programme which includes a range of programs to support flexible ways of providing care to target population groups
- National Aboriginal and Torres Strait Islander Flexible Aged Care Program, which provides culturally-appropriate aged care at home and in the community.
For more information on aged care services in Australia see the Report on the Operation of the Aged Care Act, or visit the Department of Health website.
Care needs in the community
Some aged care services provide care to people while they live in the community. In general, individuals receiving these services have lower-level care needs than those living in permanent residential care.
Home support provides mostly entry-level care services to people requiring extra assistance at home. For more information about home support, visit the home support dashboard.
In 2020–21:
- Of the top ten most commonly used home support services, domestic assistance was the most-used service (41% of recipients), followed by Allied Health and Therapy Services (29% of recipients). Least used were personal care (9.3% of recipients) and specialised support services including incontinence, dementia, vision and hearing advisory services and client advocacy (7.2% of recipients).
The horizontal bar graph shows the proportion of home support recipients using the ten most commonly used services. In 2020–21 domestic assistance and allied health and therapy services were the most commonly used services (41% and 29% of recipients used these services respectively).
Home care provides varying levels of care to individuals based on their assessed care needs. Home care packages are available at 4 levels, from Level 1 (suitable for basic care needs) through to Level 4 (suitable for high-level care needs).
At 30 June 2021:
- The majority of home care was delivered in Level 2 packages (40%), followed by Level 3 (26%), Level 4 (24%), and Level 1 (10%).
- The distribution of home care packages was similar across Australian states and territories, although Level 4 packages were most common in Western Australia (42% of packages) and least common in New South Wales (19% of packages).
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The stacked bar graph shows the proportion of people using home care packages by care level across states and territories. Across Australia most home care services were delivered in level 2 packages (40%), followed by Level 3 (26%), Level 4 (24%) and Level 1 (10% ).
The My Aged Care platform is a website and contact centre that serves as the starting point for accessing Government-subsidised aged care services in Australia. Following an initial screening through My Aged Care, people may be directed to a home support or comprehensive assessment.
Home support assessments are conducted by Regional Assessment Services (RAS) for people seeking low-level support for independent living. Comprehensive assessments are conducted by Aged Care Assessment Team (ACAT) assessors for people seeking support for care needs greater than the Commonwealth Home Support Programme can provide for. The ACAT can assess for entry to Home Care Packages, short-term care options, and residential aged care.
For more information regarding aged care assessments, visit the My Aged Care assessments page.
Care needs in permanent residential care
Permanent residential care provides up to 24-hour care for people who need ongoing assistance with everyday tasks and health care, and who can no longer live independently in the community.
At 30 June 2021:
- Just over 183,000 people living in permanent residential care had a current Aged Care Funding Instrument (ACFI) assessment.
- Almost everyone living in permanent residential care was assessed as having some care needs for activities of daily living (99.7%) and complex health care (99.6%), and 96.9% of people had some care needs for cognition and behaviour.
- Most people in permanent residential care had high care need ratings in at least one care domain (66% of people for activities of daily living, 66% of people for cognition and behaviour, and 56% of people for complex health care).
- High care need ratings when first entering permanent residential care were most common for activities of daily living (59% of people), followed by cognition and behaviour (52% of people) and complex health care (46% of people).
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The Aged Care Funding Instrument (ACFI) is a tool for assessing the care needs of people entering and living in permanent residential aged care. The tool is used to allocate government funding to residential aged care service providers based on the needs of the people in their care, regardless of the actual care planning or care provided by the service to the assessed individual.
The ACFI contains 12 questions and two diagnostic sections used to assess how much assistance a person needs in a range of areas. The ACFI is not a comprehensive assessment; it is focused on factors that affect the cost of care. Needs are classified under the 3 funding domains
- activities of daily living (ADL), including questions relating to nutrition, mobility, personal hygiene, toileting and continence,
- cognition and behaviour (BEH), including questions relating to cognitive skills, wandering, verbal behaviour, physical behaviour and depression, and
- complex health care (CHC), including questions relating to the need for assistance with administering medications, and need for management of complex health care procedures,
with four ratings for each domain
The rating on each of the ACFI domains is based on the scores on the 12 underlying questions. The ratings across the ACFI domains determine the amount of funding the residential aged care provider receives per day per person in their care. If a person is assessed as having nil or minimum care needs in a particular domain the provider receives no funding for that domain for that person. Reappraisals can be undertaken as a person’s needs change.
To find out more about the ACFI and subsidy amounts, see the Department of Health website.
The stacked bar graph shows the proportion of current and first assessment ratings for people living in permanent residential care who have high, medium, low or nil care needs across each care domain. Most people in permanent residential care had high care need ratings in at least one care domain (66% of people for activities of daily living, 66% of people for cognition and behaviour, and 56% of people for complex health care).
Residential care needs by age
Although the majority of people using aged care services are aged 65 and over, people aged under 65 can also access these services. In permanent residential care, people in different age groups have different patterns of care needs. Younger people in residential care are generally there because they have high care needs. For those aged 65 and over, there is a trend of increasing care needs with increasing age for activities of daily living and complex health care.
At 30 June 2021:
- The proportion of people with high care need ratings for activities of daily living increased with age from age 65, from 57% of people aged 65–69 to 81% of people aged 100 and over.
- High care need ratings for cognition and behaviour were more common among people aged 55–64 (75% of people) and less common among older people (61% of people aged 95–99 and 62% of people aged 100 and over).
- High care need ratings for complex health care were highest among both the youngest (60% of people 0–49) and the oldest (68% of people aged 100 and over) age groups.
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The stacked bar graph shows the proportion of care need ratings for people living in permanent residential care by care domain and age group. For both the activities of daily living and complex health care domains, the proportion of people who had a high care need rating increased as age increased after age 65–69. In contrast, high care need ratings for cognition and behaviour decreased as age increased after age 60–64.
Residential care needs by sex
Men and women have different life experiences that lead to them having different care needs when living in permanent residential care. Compared with men, women have a greater proportion of high care need ratings in most domains.
At 30 June 2021:
- Almost twice as many women had an ACFI assessment on record as men (around 122,000 compared with 62,000).
- Compared with men, women were more likely to have high care need ratings for activities of daily living (68% compared with 61%) and complex health care (57% compared with 53%). This is in part because high care need ratings increase with age, and there are higher proportions of residents in older age groups for women than for men.
- Women and men had a similar proportion of high care need ratings for cognition and behaviour (66% and 65%, respectively).
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The stacked bar graph shows the proportion of care ratings for people in permanent residential care by care domain and sex. Women were more likely to have high care need ratings for activities of daily living (68%) and complex health care (57%), while the proportion of high care need ratings for cognition and behaviour were similar for women and men (66% and 65%, respectively).
Residential care needs by age and sex
From age 65, care needs generally increase with age. As the age profiles of men and women in permanent residential care differ, so do their care needs.
At 30 June 2021:
- At older ages, there were higher proportions of women with high care needs for activities of daily living than men. For example, 73% of men aged 100 and over had high care need ratings in activities of daily living compared with 82% of similarly aged women.
- The proportion of people with high care needs for cognition and behaviour tended to decrease with increasing age, while the proportion with high care needs for complex health care tended to increase, for both women and men aged 65 and over.
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The stacked bar graph shows the proportion of care need ratings (high, medium, low and nil) for people in permanent residential care by care domain, age group and sex. At older ages there were higher proportions of women with high care need ratings for activities of daily living compared to men.
Residential care needs over time (first assessment)
The proportion of people assessed as having high care needs when they first enter permanent residential care has increased. Expand the Care need ratings in permanent residential care section for more on the limitations of ACFI. See also COVID-19 and people's care needs.
Trends over the decade from 2011–12 to 2020–21 indicate that:
- High care ratings when first entering permanent residential care have become more common for activities of daily living (from 36% to 59% of people) and cognition and behaviour (from 35% to 52% of people). Ratings for complex health care have fluctuated.
- Low and nil care need ratings became less common in all three domains, with the largest decrease in nil care ratings for complex health care (from 12% to less than 1% of people), and the largest decrease in low care ratings for activities of daily living (from 32% to 9.3%).
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The line graph shows the proportion of care need ratings at first assessment for people in permanent residential care by care domain over time (2011–12 to 2020–21). The proportion of high care need ratings has increased for activities of daily living and cognition and behaviour over the years. However the proportion of care ratings for complex health care has fluctuated, likely due, in part, to policy changes relating to ratings for complex health care.
Residential care needs by dementia status
People with dementia tend to have higher care needs than people without dementia. These differences are also reflected in care need ratings as assessed by the ACFI.
To learn more about how dementia affects people in Australia, see the AIHW Dementia webpage.
At 30 June 2021:
- The majority of people with dementia (81%) and almost half (48%) of people without dementia were assessed as having high care needs for cognition and behaviour.
- The proportion of high care need ratings for activities of daily living was also greater among people with dementia (69% compared with 62%).
- High care need ratings for complex health care were more common for people without dementia (58%) than with dementia (54%).
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The stacked bar graph shows the proportion of care need ratings for people in permanent residential care by dementia status and care domain. The majority of people with dementia were assessed as having high care needs for cognition and behaviour (81%), compared with almost half (48%) of people without dementia.
Residential care needs of Aboriginal and Torres Strait Islander people
Aboriginal and Torres Strait Islander people face multiple health and social disadvantages. As a consequence, they are more likely to develop serious medical conditions earlier in life and have a lower life expectancy than their non-Indigenous counterparts. You can learn more about Indigenous Australians in aged care by viewing the Aboriginal and Torres Strait Islander people dashboard, or learn about the health and welfare of Indigenous Australians on the AIHW website.
Delivering culturally appropriate aged care can improve access to, and the quality of, aged care for Indigenous Australians. The National Aboriginal and Torres Strait Islander Flexible Aged Care Program provides culturally appropriate care for Indigenous Australians in certain locations, mostly in rural and remote areas, that are close to their communities.
In recognition of poorer health among Aboriginal and Torres Strait Islander communities, aged care services are offered to Aboriginal and Torres Strait Islander people from age 50. In practice, Indigenous Australians may face barriers to accessing and using aged care services for complex, inter-related reasons, including remoteness, language barriers, and the effects of racism and continued socioeconomic disadvantage.
At 30 June 2021:
- There were less Aboriginal and Torres Strait Islander people assessed with high care needs for activities of daily living (59% compared with 66% of non-Indigenous people) and complex health care (46% compared with 56% of non-Indigenous people).
- The proportion of high care need ratings in cognition and behaviour was similar for both Indigenous and non-Indigenous people (65% and 66%).
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The stacked bar graph shows the proportion of care need ratings for people in permanent residential care by Indigenous status and care domain. Compared with non-Indigenous people, Indigenous people had a lower proportion of high care need ratings for activities of daily living and complex health care, while the proportion of high care need ratings for cognition and behaviour was similar across Indigenous and non-Indigenous people.
Residential care needs of people from culturally and linguistically diverse backgrounds
Many older Australians, including those living in residential aged care, were born overseas, speak a variety of languages, may not speak English fluently or have defining religious or cultural practices. These groups of people can be referred to as culturally and linguistically diverse (CALD), although these Australians are by nature heterogenous, and situations and needs vary greatly. CALD Australians can face barriers in engaging with aged care and the support they require.
Cultural and linguistic factors can influence how people access and engage with aged care services, as well as how their care needs are assessed while using aged care. Expand the Care need ratings in permanent residential care section for more on the limitations of ACFI assessments. Due to data availability, this section focuses on country of birth and preferred language as measures of cultural and linguistic diversity.
At 30 June 2021:
- Compared with people born in Australia or other English-speaking countries, people born in non-English-speaking countries were assessed as having slightly higher care needs in each domain. For example, in cognition and behaviour, high care needs were recorded for 73% of people born in non-English speaking countries, compared with 64% of people born in Australia and 67% of people born in other English-speaking countries.
- Similarly, care need ratings were slightly higher among people who preferred to speak languages other than English compared with people who preferred to speak English—For example, 76% and 65% of people were assessed as having high care needs in cognition and behaviour, respectively.
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Two stacked bar graphs show the proportion of care need ratings for people in permanent residential care by care domain, country of birth and preferred language. People born in non-English-speaking countries were assessed as having slightly higher care needs in each domain compared to people born in Australia or other English-speaking countries. Care needs were also slightly higher among people who preferred to speak languages other than English compared with people who preferred to speak English.
Residential care needs in states and territories
The care need ratings of people living in permanent residential care vary across Australia, although variability in how ACFI assessments are used may also contribute to these differences.
At 30 June 2021:
- The Northern Territory had the highest proportion of high care need ratings for activities of daily living (72% of people), Victoria had the highest proportions for cognition and behaviour (75% of people), and South Australia had the highest proportion of high care need ratings for complex health care (63% of people).
- Medium and low care need ratings were most common for activities of daily living in the Australian Capital Territory (39% of people), for cognition and behaviour in South Australia and Tasmania (both 41% of people), and for complex health care in Western Australia (49% of people).
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The stacked bar graph shows the proportion of care need ratings for people in permanent residential care by care domain and state and territory. The Northern Territory had the highest proportion of high care need ratings for activities of daily living (72%), and Victoria had the highest proportion for cognition and behaviour (75%). The proportion of high care need ratings for complex health care was highest in South Australia (63%).
Explore people’s care needs
Use the interactive table below to explore the care needs of people using permanent residential care by age group, sex, Indigenous status, preferred language, country of birth and geography (state and territory).
If you are interested in accessing a confidentialised data set that includes selected information about care needs in permanent residential aged care in Australia by state and territory please see the relevant Confidentialised Unit Record File available on GEN.
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The table shows the care needs of people in permanent residential aged care by care domain, care rating, age group, sex, Indigenous status, preferred language, country of birth and geography (state and territory).
COVID-19 and people’s care needs
Australia has faced significant challenges during the COVID-19 pandemic. COVID-19 illness can be more serious for people who have pre-existing health conditions, including older Australians.
COVID-19 affected health care services in many ways. Residential aged care services locked down and restricted visitors throughout much of the 2020–21 period. This reduction in activity and social interaction had impacts on the wellbeing and functional abilities of residents, particularly those living with dementia.
The data presented here are to 30 June 2021, spanning the year and few months since the onset of the COVID-19 pandemic and associated restrictions in Australia. The extent of pandemic-related impacts will be clearer in future data releases.
For further information related to aged care and COVID-19, including access to advice and support resources, see the Australian Government’s My Aged Care website. To access additional information about types of care and the care needs they cater for, see My Aged Care’s types of care page. For more information on COVID-19-related changes to aged care assessments, see the My Aged Care assessment page.