If you're investigating aged care options for yourself or a loved one you might find, like many before you, that you're overwhelmed by the sheer volume of information covering everything from care options to sector failures.
Our guide will help you cut through the noise, covering:
Australia's changing population: why we need aged care
The Australian population is changing rapidly. According to the Australian Bureau of Statistics, by 2056, one quarter of all Australians will be 65 or older.
The change is due to longer life expectancy and an ongoing trend in low fertility rates. And while we're enjoying longer lives and better health, many say that Australia's aged-care sector is far from fit. Others say it's a work in progress. Either way, here's how it works currently.
Main types of care
- Home care – you stay at home but receive government-subsidised assistance with things like home maintenance, personal care, meal services and nursing care.
- Residential aged care – you move to an aged care home (or nursing home) either temporarily or permanently and receive a variety of support services, including help with day-to-day tasks such as cleaning, cooking and laundry, personal care and nursing or medical care.
- Respite care – a short-term option that supports both you and your carer and can take place either at home or in a respite cottage or aged care facility temporarily. Respite care can be provided by family, friends or neighbours and can take many forms.
The type of care you receive depends on the outcome of a free assessment managed by the Aged Care Assessment Team (known as ACAT, or ACAS in Victoria). The ACAT team will visit you at home to evaluate your care needs and options. See myagedcare.gov.au or phone 1800 200 422.
Who provides care?
Australia's aged-care services are delivered by a mix of not-for-profit organisations (comprising religious, charitable and community-based providers), and for-profit and government sectors.
Currently, for both residential and in-home care, not-for-profit organisations provide the largest percentage of services followed by private business, then government. In recent years, however, private business has consistently been offering more new residential aged care places – meaning the private sector looks set to account for an increasing share of the market.
Government statistics show that residential aged care is the most popular aged care option, followed by care at home (during the 2013-14 financial year 270,559 people received residential care at some point, compared to 83,481 people who received home care).
Caveat emptor – buyer beware
Aged care is currently undergoing major changes following the federal government's decision to open the sector up to the market. With increasing growth by private business, aged-care services are now being promoted with all the persuasion and slick marketing of big business.
There's no official government channel that rates or reports on aged-care services and factors such as a home's staffing levels and skills. This can put users at a disadvantage.
Consumers should use caution when selecting residential aged care services, especially when looking at care-related issues around staffing ratios and skills.
Staffing is the largest ongoing expenditure faced by aged-care providers and, when reduced, care quality suffers. As providers become increasingly competitive, cutting staff costs to maximise profits is a real concern.
Fees and charges
Fees for aged-care services are means-tested. The amount you pay and the amount of government subsidy depends on your personal situation including your domestic arrangement (do you live alone or with a spouse?), your assets and your annual income.
If the government assessment concludes you are able, you will have to pay a portion of your aged-care service costs. Your home is currently excluded from the aged care means test, but if you rent it out, the rental income is not excluded. But again, be cautious – some critics note that you may well have to sell your home to afford your chosen aged-care facility.
- The My Aged Care website helps you estimate fees for home care and residential care. In addition, you should consider getting professional financial and legal advice.
- agedcareonline.com.au provides a good overview of residential aged care costs.
Staff ratios and skills
One of the most urgent concerns shared by clients, staff and advocates is care-related issues around staffing including staff ratios and skills.
Many Australians might be shocked to know that there are no federal laws governing staff ratios or skills in aged care. This can lead to some worrying outcomes where low – or no – staff are in attendance. A 2012 report from the Australian Aged Care Quality Agency found one aged care home had no staff at all on duty overnight.
Many advocates want to see this changed and are calling for legislated ratios or, at the least, ways for consumers to be made more aware.
"Government should at least provide information publicly about how homes are staffed, then family members can make informed decisions about aged care placement for their loved ones," says Lynda Saltarelli, advocate and founder of advocacy group Aged Care Crisis.
Monitoring and accreditation
The Department of Health has a multi-faceted role, which includes funding and regulating aged-care providers, offering policy advice to government and applying sanctions to aged-care homes which are not compliant with standards.
The Australian Aged Care Quality Agency is responsible for accrediting residential aged care homes and conducting reviews of home care. It publishes the results of any planned and prepared-for visits, which are mostly "site audits". The published reports provide no information about what may occur between these cyclical 3-5 yearly accreditation visits.
The Aged Care Complaints Commissioner resolves complaints about Australian government-funded aged care. There is no cost to lodge a complaint. Visit agedcarecomplaints.gov.au or call 1800 550 552.
- If you're moving to a residential home, the Department of Social Services has produced a guide – Five steps to entry into an aged care home.
- For some independent resources including a checklist for choosing a nursing home and discussion on areas like staffing, advocacy and resident's rights visit Aged Care Crisis.
In their own words
"Aged Care Crisis's current strategy is to create an informed customer with sufficient market power. We are advocating for the creation of a network of local community groups with the knowledge and power to do this.
All of the regulatory and support services that protect consumers of aged care would be channeled through these groups which would be supported and mentored by government.
Critically, this would give the community the knowledge and the power to change this to a system driven by care rather than profit."
– Lynda Saltarelli, advocate, Aged Care Crisis team
"I visit clients for assessment in aged care homes in an area considered to be lower-socio-economic.
I've seen groups of dementia patients left together for hours in a room with no staff to supervise and no activities or entertainment. The issue of staff ratios is urgent."
– *Dana, government-employed medical specialist (*Not her real name)
"I worry about the complexity of the information delivered to in-home care clients. Unless there is another family member to help, it's difficult to comprehend. Also, without family near generally, loneliness is a big issue. Companionship is a fundamental part of good care."
– Lucretia, in-home aged care worker in the private sector
"Navigating the system is incredibly difficult. There's so much to do from the geriatrician assessment to the ACAT assessment and all the forms from Centrelink for a carer's allowance.
Then there's registration at the Commonwealth carers' respite centre for short-term emergency. Finding a specialist financial advisor seems very expensive at around $1500.
I've given up trying to get help from just one person. I feel like I can't do it and I don't know what to do."
– Anthony Nicholas, adult son seeking aged care for an elderly parent