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Interfaces between the aged care and health systems

As Australians age and their needs change, they will use several different aged care programs. Although aged care services provide a key role in providing support and assistance to older people, people who use aged care also routinely use health care services, similar to the rest of the population. They may see GPs or specialists, have medications dispensed to them, visit an emergency department, or be admitted to hospital. Understanding the patterns of service use between the aged care and health systems is important for improving services and outcomes across both systems.

Last updated: 15 November 2019

16 GP attendances per person among stable home support users and 25 GP attendances per person among stable permanent residential care users

74% of stable home support users had at least one specialist visit in 2016–17

More than 98% of stable aged care users had at least 1 prescription in 2016–17

How do we explore the interfaces between the aged care and health systems?

To help understand these interactions, the Australian Institute of Health and Welfare (AIHW) has developed a linked data set joining data from the National Aged Care Data Clearinghouse (NACDC) with key health service data sets.

To develop this data set, the AIHW brought together routinely collected administrative data, covering 5 years from 2012 to 2017, from 6 sources: 

  • NACDC—for aged care program data 

  • Medicare Benefits Schedule (MBS)—for patterns of GP and specialist use

  • Pharmaceutical Benefits Scheme (PBS)—for patterns of prescriptions dispensed

  • National Non-Admitted Patient Emergency Department Care—for emergency department (ED) presentations

  • National Hospital Morbidity Database—for hospital separations 

  • National Death Index—for date of death. 

Which health services were included

Primary care attendances: visits or consultations with a general practitioner (GP attendances) or specialist (specialist attendances) where a rebate under the MBS was claimed. 

Prescriptions dispensed: medications eligible for a subsidy under the PBS, prescribed by a doctor or other health care provider and provided by a community pharmacist. Medications that are provided in a hospital, purchased over the counter, or otherwise not eligible for a subsidy are not included.

ED presentations: visits to an emergency department where the patient is registered or triaged for care.

Hospital separations: the completion of a stay at hospital. Same day stays begin and end on the same day, and overnight stays involve at least one night in hospital.

Further information on the data set and how the analysis groups were chosen is available in the AIHW report Interfaces between the aged care and health systems in Australia.

What can the data tell us?

The linked data can be used to examine how particular groups of people using aged care differ in their characteristics and patterns of health service use in 2016–17. This information focuses on ‘stable aged care users’ (that is individuals who used the same aged care type for the year) of the 3 biggest aged care programs—permanent residential aged care, home support and home care—across the year in 2016–17, as well as a sample group of non-aged care users for comparison. The data set includes people who were aged 50 and over at 1 July 2016, and who were still alive on 30 June 2017.

The stable aged care user groups represent only a portion of all people using aged care services. There are many people using aged care who are not included who used other types of aged care, moved between types of aged care during the year, did not use these types of aged care for the full year, or were no longer alive by 30 June 2017.

A table shows the three groups of stable aged care users in 2016–17 included in the linked dataset. The ‘Residential care’ groups includes 122,100 people who lived in permanent residential aged care for the full year. The ‘Home care’ group includes 20,800 people who lived in the community and had a home care package for the full year. The ‘Home support’ group includes 155,200 people who lived in the community and used home support services in 2 or more quarters of the year.

  • People using community-based aged care were younger than those who were living in permanent residential care—of those using home support and home care, 25% and 37% were aged 85 and over, compared with 57% among people in permanent care.

  • The median age was 79 among those using home support and 82 among those using home care, rising to 86 among those using permanent residential care. Among the sample of older people living in the community and not using aged care in 2016–17, the median age was 80.

  • Overall, about 7 in 10 people in each of the 3 groups were female. The proportion of females rose with age, reflecting that women, on average, live longer than men. 

  • Around two-thirds of people in each group lived in Major cities, ranging from 60% of those using home support to 66% of those living in permanent care.  

The data do not provide a complete picture of the health care that people in these groups received—some people may receive health services as part of their aged care and those services are not included here—but they do allow us to explore usage patterns for certain types of mainstream health services.  

A table shows, for each of the four groups, key measures of primary care use. The measures include the proportion of people with at least 1 GP attendance, and the average number of GP attendances per person, the proportion of people with at least 1 specialist attendance, and the average number of specialist attendances per person. Almost everyone in each group attended a GP at least once in 2016–17, ranging from 90% of people who never used aged care to 98% of people using home support services.
  • Generally, in 2016–17, people living in permanent residential aged care had more GP attendances per person than the other 3 groups, but fewer specialist attendances, diagnostic imaging services and operations.
  • While people in permanent residential aged care were less likely to see a GP than people using home support or home care, those who saw a GP had more visits. People living in permanent residential aged care averaged almost 1 GP attendance per fortnight (25), while people using home support had on average 17 GP attendances, and people using home care 16.
  • Around one-third (32%) of people living in permanent residential aged care had at least 1 specialist attendance—much lower than aged care users in the community (74% of people using home support, 65% of those using home care and 58% of those who did not use aged care.

People using aged care were more likely to have prescriptions dispensed to them than people who did not use aged care

  • In 2016–17, around 98–99% of people using aged care services had at least one prescription, compared with 93% of people who did not use aged care.
  • Most people had prescriptions for multiple medicines—the median number of distinct medicines dispensed per person in 2016–17 was 10 for people for each of the community-based aged care groups, 11 for people living in permanent residential aged care, and 6 for people who had not used aged care.
  • Medicines for the cardiovascular system were the type most dispensed for people using community-based aged care and those with no use of aged care. For people living in permanent residential aged care, the most commonly dispensed medicines were those that act on the nervous system.
A bar graph shows the proportion of people in the four groups with at least 1 prescription dispensed by type of medication, age and sex. For each type of drug, the proportion was generally larger among people living in residential care, but this differed between aged groups.

Reasons for visiting an emergency department varied between different groups of aged care users

Data on ED presentations were available for people in the 4 groups of interest who used hospitals in 2 jurisdictions only (Queensland and Victoria). 

  • About one-third of people who used aged care services had at least 1 ED presentation in 2016–17 (between 32–38%) compared with 14% of people who had not used aged care. 
  • Most people who had an ED presentation in 2016–17 had only 1 presentation—52–54% among people using community-based aged care, 58% among people living in permanent residential aged care, and 70% among people who had never used aged care.
  • Just over one-quarter (28%) of ED presentations for people living in permanent residential aged care were due to injuries.

People using community-based aged care services were more likely to have had a hospital separation than non-aged care users and people living in permanent residential aged care

Data on hospital separations were available for people in the 4 groups of interest who used hospitals in 2 jurisdictions only (Queensland and Victoria). 

  • More than half of people using home support (58%) and home care (51%) had at least 1 hospital separation in 2016–17, compared with 37% of people living in permanent residential aged care and 32% among those not using any aged care.
  • In 2016–17, the most common reason for same-day separations from hospital for all 4 groups was Dialysis and other health services—ranging from 37% among people who never used aged care to 70% among those using home care. 
  • Overnight hospital stays commonly related to more serious acute or chronic issues. The most common reason for overnight separations varied between the 4 groups: Injury and poisoning for people living in permanent residential aged care, Respiratory diseases for people using home care, and Circulatory diseases for people using home support and people who had not used aged care. 
A side-by-side bar graph shows the 5 most common reasons for hospital separations for the 4 groups, and the proportion of hospitalisations in each group due to that reason, by duration of stay (overnight or same-day). The most common reason for overnight hospitalisations of people living in permanent residential aged care was ‘Injury and poisoning’. The most common reason for same day hospitalisations for all 4 groups was ‘Dialysis and other health services’.