Snapshot of the RAC sector
A recently released Australian Institute of Health and Welfare (AIHW) report, Residential Aged Care and Home Care 2013-14, provides some interesting insights into the provision of residential aged care services and the changes taking place across the sector as a whole.
For the many hardworking, underpaid and undervalued nurses and carers employed in this sector, much of the information contained in the report is not new but simply reflects the day to day reality of trying to provide high quality care in very difficult circumstances.
No nurse or carer will be surprised to hear that 83% of residents in permanent care are classified as needing ‘high care’. This compares with 76% in 2008 and 64.4% in 2003. The report also shows the majority of residents have a diagnosis of dementia. As of 30 June 2014 this was reported to be 52% of all residents and for people entering permanent care for the first time, 42% were diagnosed with dementia.
The trends highlighted in this latest report are a reflection of Australia’s ageing population and reflects the evidence that the people who are entering aged care facilities are the ones who have multiple chronic conditions whose care needs are too complex to be managed at home.
The number of people aged 85 years and over is expected to increase rapidly in the future, with the ABS projecting that the 420,300 people in this age group (as at June 2012) will more than double within 20 years and double again by 2045.
The total number of admissions into residential care has steadily increased over the years with the latest figures indicating 137,948 admissions (permanent and respite) in 2013-14 compared to 103,183 in the year 2006-07.
Who provides residential aged care services?
Nationally, there are 1,016 providers who operate 2,688 residential aged care facilities providing a total of 189,283 operational places in residential care. While the number of operational places are increasing overall, the ratio of places per 1,000 persons aged 70 years and over has actually decreased from 86 per 1,000 as at June 2013 to 82.6 per 1,000 persons aged 70 plus at June 2014. Going back a few more years to June 2008, the ratio was higher again providing 87.7 places per 1,000 persons aged 70 plus.
The AIHW data also shows that aged care facilities are getting bigger with the average number of places per facility now at 70.4. This compares with 60 places, in 2006.
The ownership of residential aged care facilities is also changing. The figures show that in recent years, the number of operational places owned by ‘not-for-profit’ providers (that is, religious, community based and charitable providers), has increased at a slower rate than the number of places owned by ‘private for profit’ providers. As of June 2014, private for-profit providers owned 37.4% of operational places compared with 32% in June 2006.
Looking at the ‘not-for-profit’ providers separately: 26% of places were in facilities operated by religious organisations; 13.6% in community based organisations and 17.4% in charitable organisations. Overall, there is a decline in the share of places operated by the ‘not-for-profit’ providers from 60.3% in 2006 to 57.7% in 2014.
There is also a reduction in places operated by state, territory and local governments which combined operate just 5.2% of places, down from 7.7% in 2006.
Residential aged care workforce
Staffing levels and skill mix in residential aged care is a long standing and unresolved issue that cannot be ignored. The ANMF has campaigned for many years for the development of an aged care workforce strategy. These issues continue to compromise the amount of quality care that can be provided to residents, putting direct care staff under ongoing pressure.
While workforce data does not tell us any more than what we already know from ANMF members working in this sector, it does attach numbers to the problem. This data is not part of the AIHW report, but is collected as part of a periodic census and survey conducted by the federal government in conjunction with the National Institute of Labour Studies. The first data collection took place in 2003. A further two reports have been provided for 2007 and 2012.
The table below indicates the changes in the number and composition of the direct care workforce since 2003 and that this is not compatible with a 25% increase in residential places and the level and complexity of care that 83% of residents now require.
Link to AIHW report Residential Aged Care and Home Care 2013-14: www.aihw.gov.au/aged-care/residential-and-homecare-2013-14/
Full time equivalent (FTE) direct care employees in the residential aged care workforce
|Personal Care Attendant||42,943||50,542||64,669|
|Allied Health Professional
Allied Health Assistant
|Total Number of Employees (FTE)||76,006||78,849||94,823|
Source: King D, Mavromaras K, Wei Z, et al. The Aged Care Workforce 2012, Canberra: Australian Government Department of Health and Ageing 2012 Table 3.3
*In 2003 and 2007 these categories were combined under ‘Allied Health’
Federal Industrial Research Officer