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Pathways in aged care

The Pathways in Aged Care (PIAC) link map brings together a number of data sets—and records for more than 5 million people. It allows us to analyse how people used aged care services between July 1997 and June 2014.

5 million people have records that are available for analysis through PIAC.
2.7 million deaths can be linked to other data sets through PIAC.
11.5 million aged care service events are available for analysis with PIAC.
3.6 million users of aged care services have records that can be linked between data sets with PIAC.
2.3 million aged care assessments can be linked to other data sets through PIAC.

What is PIAC?

PIAC is a link map that allows us to connect data from different sources, using privacy preserving linkage methods. Information can be brought together for each person who used one of the following aged care programs between 1 July 1997 to 30 June 2014:
  • Aged Care Assessment Program (ACAP)
  • Permanent and respite residential aged care
  • Aged care packages (Home Care Packages and its pre-2013 counterparts)
  • Home and Community Care
  • Transition Care Program

The link map also includes National Death Index data for people who died between July 1997 and September 2015. The extended timeframe ensures that the link map can be used to identify as many deaths of people who used aged care before June 2014 as possible. The data sources, and the linkage processes that connected them, are described in Pathways in Aged Care 2014: technical guide.

What can PIAC tell us?

PIAC can be used to examine a particular cohort and study their patterns of use in some detail. For example, by linking assessment information with people’s subsequent use of aged care, the link map can show how people move between assessment for and entry into permanent residential aged care.
  • 61,300 people entered permanent residential aged care for the first time in 2013–14. Of these, around 90% had previously used other aged care services—in all, they had used aged care in more than 1,000 combinations (or ‘pathways’).
  • People commonly entered the aged care system through community-based aged care—for 76% of people, home support (termed Home and Community Care or HACC at the time) was the first aged care service they ever used.
  • On the other hand, only one-third (36%) of people had last used home support before entering permanent residential aged care: the last service used was most commonly respite residential care (39% of people).
1. A pie chart shows the proportion of people who first entered permanent residential aged care in 2013–14 by the programs that they had used previously. The graph shows either the first program that this cohort used, or the last program before permanent residential care. Home support was the program most commonly used first (76% of people used this program first). Respite residential care was the most commonly used just before permanent residential care (39%), followed by home support (36%).
Of those people who first entered permanent residential aged care in 2013–14, valid geographical information for both the people entering care and the facility they entered was recorded for 60,550 people.
There are many reasons why people might move after their assessment into aged care. While PIAC can help us understand some parts of this process, it cannot tell us why people moved. People may have moved because of:
  • access to or availability of aged care services
  • personal choice
  • changes to their situation
  • time factors or location of previous aged care service.
In 2013–14, one-quarter (25%) of people were in the same immediate area at assessment as the facility where they eventually entered permanent care (move 0 kilometres). Among those who moved into permanent residential care, the average distance was 54 kilometres, but this varied depending on people’s characteristics:
  • Younger people (aged under 65) were relatively less likely to move 0 kilometres for permanent residential care (19%), while people aged 85–94 and 95 or over were more likely (both 26%).
  • There was little difference in the distance moved between men and women.
2. A stacked bar chart shows the proportion of people who first entered permanent residential aged care in 2013–14 by their age group or by their sex. People aged under 65 were less likely to move 0km outside of their immediate area (19%) than people aged 95+ (26%). There was little difference between men and women.
PIAC can be used to explore use of aged care by Aboriginal and Torres Strait Islander people. However, it does not include people using the National Aboriginal and Torres Strait Islander Flexible Aged Care Program, and is not representative of all Indigenous people who use aged care. Indigenous people make up less than 1% of people using mainstream residential aged care, and were less likely to move for the care than non-Indigenous people. On the other hand, Indigenous people who did need to move were 4 times as likely to move over 100 kilometres to enter permanent care than non-Indigenous people (21% compared with 5.5%). This is impacted by a small number of Indigenous people moving large distances from remote areas to access residential care.
PIAC data can also be integrated into your own data set or sets, to create an expanded linked database for your research project. Strict requirements apply for collecting and releasing linked data. The AIHW is an accredited Integrating Authority and is able to undertake this work. You can visit the AIHW Researcher resources web page for information on the process for accessing linkage services and/or data.
All linkage projects require both a technical assessment from the AIHW Data Linkage Unit and an ethics approval from the AIHW Ethics Committee. It is important to leave plenty of time for the technical assessment and to be aware of the submission dates for the AIHW Ethics Committee. For more information on a technical assessment, you can contact the Data Linkage Unit ([email protected]). For AIHW Ethics Committee meeting and submission timeframes please see the AIHW Ethics Committee webpage.

Explore more about findings from PIAC, including pathways to permanent residential aged care and program use, in the next section.