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Changes in the Profile of Australians in 77 Residential Aged Care Facilities

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Changes in the Profile of Australians in 77 Residential Aged Care Facilities HEALTH SERVICE RESEARCH CSIRO PUBLISHING Australian Health Review, 2017, 41, 613–620 http://dx.doi.org/10.1071/AH16125 Changes in the profile of Australians in 77 residential aged care facilities across New South Wales and the Australian Capital Territory Robert Borotkanics1,2,5 DrPH, MS, MPH, Research Fellow Cassandra Rowe3 Andrew Georgiou1 BA LaTrobe, DipArts Sydney, MSc Southampton, PhD Sydney, FCHSM, FACHI, FSc (Research) RCPA, Professor Heather Douglas4 BPsych (Hons), PhD, Lecturer Meredith Makeham1 BMed(Hons) MPH(Hons) PhD FRACGP, Associate Professor Johanna Westbrook1 BAppSc (Cumb) Distinction, GradDipAppEpid, MHA (UNSW), PhD (Sydney), Professor 1Macquarie University, Faculty of Medicine, Australian Institute for Health Innovation, Centre for Health Systems and Safety Research, Level 6, 75 Talavera Road, NSW 2109, Australia. Email: [email protected]; [email protected]; [email protected] 2Present address: John Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA. 3Independent Healthcare Consultant, Sydney, NSW 2000, Australia. Email: [email protected] 4Murdoch University Singapore Campus, #06-04 Kings Centre, 390 Havelock Road, Singapore 169662. Email: [email protected] 5Corresponding author. Email: [email protected] Abstract Objective. Government expenditure on and the number of aged care facilities in Australia have increased consistently since 1995. As a result, a range of aged care policy changes have been implemented. Data on demographics and utilisation are important in determining the effects of policy on residential aged care services. Yet, there are surprisingly few statistical summaries in the peer-reviewed literature on the profile of Australian aged care residents or trends in service utilisation. Therefore, the aim of the present study was to characterise the demographic profile and utilisation of a large cohort of residential aged care residents, including trends over a 3-year period. Methods. We collected 3 years of data (2011–14) from 77 residential aged care facilities and assessed trends and differences across five demographic and three service utilisation variables. Results. The median age at admission over the 3-year period remained constant at 86 years. There were statistically significant decreases in separations to home (z = 2.62, P = 0.009) and a 1.35% increase in low care admissions. Widowed females made up the majority (44.75%) of permanent residents, were the oldest and had the longest lengths of stay. One-third of permanent residents had resided in aged care for 3 years or longer. Approximately 30% of residents were not born in Australia. Aboriginal residents made up less than 1% of the studied population, were younger and had shorter stays than non-Aboriginal residents. Conclusion. The analyses revealed a clear demographic profile and consistent pattern of utilisation of aged care facilities. There have been several changes in aged care policy over the decades. The analyses outlined herein illustrate how community, health services and public health data can be used to inform policy, monitor progress and assess whether intended policy has had the desired effects on aged care services. What is known about the topic? Characterisation of permanent residents and their utilisation of residential aged care facilities is poorly described in the peer-reviewed literature. Further, publicly available government reports are incomplete or characterised using incomplete methods. What does this paper add? The analyses in the present study revealed a clear demographic profile and consistent pattern of utilisation of aged care facilities. The most significant finding of the study is that one-third of permanent residents Journal compilation Ó AHHA 2017 Open Access CC BY-NC-ND www.publish.csiro.au/journals/ahr 614 Australian Health Review R. Borotkanics et al. had resided in an aged care facility for 3 years. These findings add to the overall picture of residential aged care utilisation in Australia. What are the implications for practitioners? The analyses outlined herein illustrate how community, health services and public health data can be utilised to inform policy, monitor progress and assess whether or not intended policy has had the desired effects on aged care services. Additional keywords: elderly, residential aged care facilities, aged care, aged, nursing homes. Received 20 June 2016, accepted 7 September 2016, published online 28 November 2016 Introduction professionals that review the residential aged care needs of an The proportion of Australia’s aged population is growing.1 This individual if these needs are to be paid for by the Australian demographic shift is consistent with international trends, which Government. After review and consultation, ACATs report the indicate that the world’s population aged 60 years is growing services that are approved to be received. This means that faster than any other age group.2 This population aging can be residents are now more likely to be able to age in place. For ’ viewed as a public health success. Australians are living longer, example, if a resident s care needs increase, that individual is not but decreases in infectious disease and improved life expectancy required to change facilities unless the circumstances are have resulted in an increase in people living with chronic diseases. extraordinary. In fact, Australians are often living with multiple chronic dis- Aged care services that occur outside of residential aged care eases.2,3 Many chronic diseases impair activities of daily living facilities, but could alter residential care provision, have also been fi and functional status. Residential aged care facilities, also known recon gured. A cross-section of the aged population receives as nursing homes or care homes, provide services for Australians home care services, which are referred to as home care packages requiring ongoing assistance with activities of daily living.4 (HCPs). From July 2013, HCP program services were redesigned to encourage aging at home and empower individuals to choose The proportion of the Australian population requiring resi- 15 dential aged care services is increasing with the aging of the services they need. The HCP program provides support for Australia’s largest demographic cohort, the baby boomers.5,6 services ranging from basic activities of daily living to nursing The baby boomers are people who were born between 1946 and care, care coordination and case management. 1965. Further, Australia is experiencing decreases in birth rates Data on residential aged care demographics and utilisation are and migration from overseas.7 The 2015 population growth rate important to allow assessment of the effects of new and emerging was 1.4%, with a 2014 net reproduction rate of 0.869.8 The aged care policies on residential aged care services. Yet, there are proportion of the Australian population aged 65 years com- surprisingly few statistical summaries in the peer-reviewed lit- prises almost 15% of the total population.9 Combined, these erature on the trends in service utilisation. For example, one study evaluated changes in admissions and discharges, but is based on issues are putting increased pressures on aged care services. The 16 Australian Government subsidises aged care, and government data from 1999 to 2006. The Australian Institute of Health and expenditure for aged care is increasing.10 For example, the Welfare (AIHW) provides more current data, published in dif- crude cost for residential aged care increased from A$8.9 ferent reports and Internet-based data summaries. The AIHW data billion in the 2013 fiscal year to A$10 billion in the 2015 are distilled largely from the System for the Payment of Aged fi 9,11 Residential Care and are limited due to time lags in aggregating scal year. The number of aged care facilities has increased 12 consistently since 1995.12 data and under-reporting due to death. Annual summaries and In an attempt to address these trends, the Australian Govern- trends are provided based on active residents on the last day of the fi fl ment has introduced a series of policy reforms. Major initiatives scal year (30 June, annual) and do not necessarily re ect started in 2012 and are progressively being implemented.13 To seasonal variations. date, bureaucracies and funding schemes have been reconfigured, Therefore, the aim of the present study was to characterise the fi including the establishment of the Australian Aged Care Quality demographic pro le of a large cohort of 77 residential aged care Agency and the Aged Care Pricing Commission. A new means facilities providing services to 9398 residents and assess trends testing scheme was introduced for payment in 2014. The federal in demographics and aged care facility utilisation over a 3-year government also abandoned the ‘high’ and ‘low’ care designa- period. tions. Historically, residents were classified as requiring high or Methods low care. Residents requiring high care are those who require regular support from a full-time healthcare professional, whereas Setting and data residents requiring low care are those who require assistance with Uniting Care Australia (Uniting) maintains aged care resident activities of daily living.14 Residents are now classified by the data and further monitors the progress of residents in electronic government only as being eligible for residential aged care records. Data from all 77 residential aged care facilities operated services. Although permanent residents
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