People's care needs in aged care

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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Contents

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Related information can be found on other GEN topic pages:

• Admissions into aged care
• People using aged care

For a confidentialised unit record file (CURF) on this topic, view the GEN data: People’s care needs in aged care

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).

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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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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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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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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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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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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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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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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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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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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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.

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