Australia’s aged care system offers a variety of services to support people as their care needs change.
Last updated: 28 June 2023.
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Related information can be found on other GEN topic pages:
For a confidentialised unit record file (CURF) on this topic, view the GEN data: People’s care needs in aged care
The aged care system offers a continuum of care under three main types of service:
- 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 4 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:
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 and Aged Care 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 2021–22:
- Of the top ten most commonly used home support services, domestic assistance was the most-used service (40% of recipients), followed by Allied Health and Therapy Services (29% of recipients). Least used were personal care (8.7% of recipients) and specialised support services including incontinence, dementia, vision and hearing advisory services and client advocacy (6.9% of recipients).
The bar graph shows the proportion of home support recipients using the ten most commonly used services. In 2021–22 domestic assistance and allied health and therapy services were the most commonly used services (40% 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 2022:
- The majority of home care was delivered in Level 2 packages (41%), followed by Level 3 (31%), Level 4 (22%), and Level 1 (5.4%).
- The distribution of home care packages was similar across Australian states and territories, except in Western Australia where Level 4 packages were the most common (39%).
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The stacked column graph shows the proportion of people using home care packages by care level across states and territories at 30 June 2022. Across Australia most home care services were delivered in level 2 packages (41%), followed by Level 3 (31%), Level 4 (22%) and Level 1 (5.4%).
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 2022:
- Almost 177,000 people living in permanent residential care had a current Aged Care Funding Instrument (ACFI) assessment. This represents 97.9% of all people using permanent residential care at 30 June.
- Almost everyone living in permanent residential care was assessed as having some care needs for activities of daily living (99.8%) and complex health care (99.6%), while 97.4% 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 (68% of people for activities of daily living, 68% of people for cognition and behaviour, and 58% of people for complex health care).
- Among people who had their first ACFI assessment in 2021–22, high care need ratings when first entering permanent residential care were most common for activities of daily living (58% of people) followed by cognition and behaviour (55% of people), and complex health care (43% 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 Aged Care Funding Instrument (ACFI) User Guide on the Department of Health and Aged Care website.
On 1 October 2022, the Australian National Aged Care Classification (AN-ACC) residential care funding model replaced the ACFI. The AN-ACC Assessment Tool focuses on the characteristics of residents that drive care costs in residential care. AN-ACC data are not currently reported on this page.
For more information about AN-ACC, see the AN-ACC Reference Manual and AN-ACC Assessment Tool on the Department of Health and Aged Care website.
The stacked column 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 need ratings across each care domain, at 30 June 2022. Most people in permanent residential care had high care need ratings in at least one care domain (68% of people for activities of daily living, 68% of people for cognition and behaviour, and 58% 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 2022:
- The proportion of people with high care need ratings for activities of daily living increased with age from age 65, from 59% 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 (78% of people) and less common among older people (63% 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 (64% of people 0–49) and the oldest (69% of people aged 100 and over) age groups.
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The stacked column graph shows the proportion of care need ratings for people living in permanent residential care by care domain and age group at 30 June 2022. 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 55–59.
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, as they generally enter and use care at older age groups.
At 30 June 2022:
- Approximately twice as many women had an ACFI assessment on record as men (around 118,000 women compared with 59,000 men).
- Compared with men, women were more likely to have high care need ratings for activities of daily living (70% compared with 65%) and complex health care (60% compared with 56%). 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 (69% and 68%, respectively).
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The stacked column graph shows the proportion of care ratings for people in permanent residential care by care domain and sex, at 30 June 2022. Women were more likely to have high care need ratings for activities of daily living (70% compared with 65% for men) and complex health care (60% compared with 56% for men), while the proportion of high care need ratings for cognition and behaviour were similar for women and men (69% and 68%, 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 2022:
- There were higher proportions of women with high care needs for activities of daily living than men for all age groups except 0–49. For example, 57% of men aged 60–64 had high care need ratings in activities of daily living compared with 70% 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 column 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 30 June 2022. There were higher proportions of women with high care need ratings for activities of daily living than men for all age groups except for people aged under 50.
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 over time. Expand the Care need ratings in permanent residential care section for more on the limitations of the ACFI. See also COVID-19 and people's care needs.
Trends over time for the 10 years from 2012–13 to 2021–22 indicate that:
- High care ratings when first entering permanent residential care have become more common for activities of daily living (from 36% to 58% of people) and cognition and behaviour (from 35% to 55% of people). Ratings for complex health care have fluctuated, reflecting changes to the rating method for complex health care that were introduced in January 2017.
- 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 11% to less than 1% of people), and the largest decrease in low care ratings for activities of daily living (from 32% to 8.9%).
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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 (2012–13 to 2021–22). 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 of people in permanent residential care, as assessed by the ACFI. To learn more about how dementia affects people in Australia, see the AIHW Dementia webpage.
At 30 June 2022:
- The majority of people with dementia (83%) and over half (51%) 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 (71% compared with 65%).
- High care need ratings for complex health care were more common for people without dementia (60%) than with dementia (56%).
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The stacked column graph shows the proportion of care need ratings for people in permanent residential care by dementia status and care domain, at 30 June 2022. The majority of people with dementia were assessed as having high care needs for cognition and behaviour (83%), compared with just over half (51%) 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 socio-economic disadvantage.
At 30 June 2022:
- There were less Aboriginal and Torres Strait Islander people assessed with high care needs for activities of daily living (62% compared with 69% of non-Indigenous people) and complex health care (49% compared with 58% of non-Indigenous people).
- The proportion of high care need ratings in cognition and behaviour was similar for both Indigenous and non-Indigenous people (69% and 68%, respectively).
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The stacked column graph shows the proportion of care need ratings for people in permanent residential care by Indigenous status and care domain, at 30 June 2022. 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 heterogeneous, 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 2022:
- 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 75% of people born in non-English speaking countries, compared with 66% of people born in Australia and 69% 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, 77% of people who preferred to speak languages other than English were assessed as having high care needs in cognition and behaviour, compared with 67% of people who preferred to speak English.
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The two stacked column graphs show the proportion of care need ratings for people in permanent residential care by care domain, country of birth and preferred language, at 30 June 2022. 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 2022:
- Northern Territory, Tasmania and Victoria had the highest proportion of high care need ratings for activities of daily living (71% of people in each jurisdiction) and Australian Capital Territory had the lowest proportion (64%).
- Northern Territory had the highest proportion of high care need ratings for cognition and behaviour (77% of people), while South Australia and Tasmania had the lowest proportion (57% of people in each jurisdiction).
- South Australia had the highest proportion of high care need ratings for complex health care (65% of people) and Western Australia had the lowest proportion (50%).
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The stacked column graph shows the proportion of care need ratings for people in permanent residential care by care domain and state and territory, at 30 June 2022. The Northern Territory,Tasmania and Victoria had the highest proportion of high care need ratings for activities of daily living (71% of people, respectively), and the Northern territory had the highest proportion for cognition and behaviour (77%). The proportion of high care need ratings for complex health care was highest in South Australia (65%).
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 and social support services. Across all types of aged care, the lockdowns and social restrictions during the COVID-19 pandemic may have affected access to formal and informal support. Some older people in the community were encouraged to seek health services remotely through telehealth, for example.
Most of Australia’s residential aged care homes experienced a COVID-19 outbreak during 2021–22 (2,570 facilities experienced one or more outbreaks in 2021–22). Aged care homes locked down and restricted visitors during active outbreaks. This reduction in activity and social interaction had impacts on the wellbeing and functional abilities of residents, particularly those living with dementia.
For further information on aged care services and the COVID-19 pandemic, see the Report on the Operation of the Aged Care Act and the COVID-19 outbreaks in Australian residential aged care facilities weekly report.