Young people in Australian residential aged care: evaluating trends from 2008 to 2018
Mark G. Brown A B C , Glenda M. Bishop A B , Di Winkler A B and Jacinta M. Douglas A BA Summer Foundation Ltd, P.O. Box 208, Blackburn, Vic. 3130, Australia. Email: glenda.bishop@summerfoundation.org.au; di.winkler@summerfoundation.org.au; j.douglas@latrobe.edu.au
B Living with Disability Research Centre, La Trobe University, Bundoora, Vic. 3086, Australia.
C Corresponding author. Email: mark.brown@summerfoundation.org.au
Australian Health Review 44(6) 831-837 https://doi.org/10.1071/AH19172
Submitted: 30 July 2019 Accepted: 15 October 2019 Published: 29 July 2020
Journal Compilation © AHHA 2020 Open Access CC BY-NC-ND
Abstract
Objective Over the past decade, various programs and reforms have targeted the issue of people aged <65 years living in ‘permanent’ residential aged care (PRAC). As context for ongoing policy discourse, the aim of this study was to evaluate trends in rates of young people entering and leaving PRAC from 2008 to 2018.
Methods Counts of people aged <65 years entering, remaining in and exiting PRAC were obtained from the National Aged Care Data Clearinghouse. Age standardisation was used to control for changes in the age and size of the Australian population. Annual age-standardised rates of admissions (subtracting transfers) and exits to the community were calculated. Linear regression models tested for a sustained increase or decrease in age-standardised rates nationally and within state and age subgroups.
Results Notwithstanding year-to-year variation, neither admissions (subtracting transfers) nor exits to the community showed statistically significant increasing or decreasing trends in the national age-standardised rates. Admission rates varied by age and state.
Conclusions Many more young people are admitted to PRAC each year than return to community living, with no sustained change between 2008 and 2018 at the national level. Age standardisation is crucial for evaluating systemic population-level change regarding younger people in PRAC.
What is known about the topic? As at June 2018, over 6000 people aged <65 years still live in PRAC in Australia. Previous research has demonstrated that this cohort experiences a much poorer quality of life on average than people of similar age and disability who reside in other community settings. Various strategies for improving outcomes have been trialled, many aiming to reduce the number of younger people living in aged care; the National Disability Insurance Scheme (NDIS) also has this among its aims.
What does this paper add? This paper reports trends in the number of young people entering and exiting aged care, after statistically controlling for changes due to population growth and aging. The paper highlights that national admission rates did not increase or decrease in a sustained manner, and that most of those admitted never return to community living before turning 65 years of age.
What are the implications for practitioners? Programs and policies aimed at reducing the number of young people in aged care must grapple with the scale of the issue and its apparent resistance to amelioration over the past 10 years. The results of this study provide a benchmark against which to judge the future impact of the NDIS.
References
[1] Cameron C, Pirozzo S, Tooth L. Long-term care of people below age 65 with severe acquired brain injury: appropriateness of aged care facilities. Aust N Z J Public Health 2001; 25 261–264.| Long-term care of people below age 65 with severe acquired brain injury: appropriateness of aged care facilities.Crossref | GoogleScholarGoogle Scholar | 11494997PubMed |
[2] Moylan M, Dey P, McAlpine E. A national research project examining the placement of younger people with a disability in nursing homes for the aged: a report to the Disability Services Sub Committee. Sydney: Ageing & Disability Department; 1995.
[3] Winkler D, Farnworth L, Sloan S. People under 60 living in aged care facilities in Victoria. Aust Health Rev 2006; 30 100–8.
| People under 60 living in aged care facilities in Victoria.Crossref | GoogleScholarGoogle Scholar | 16448382PubMed |
[4] Summer Foundation. Senate inquiry into the adequacy of existing residential care arrangements available for young people with severe physical, mental or intellectual disabilities in Australia. Melbourne: Summer Foundation Ltd; 2015.
[5] Parliament of Australia. Chapter 4 – young people in residential aged care. In: Humphery E, McDonald C, Short P, Peake L, Zappe I, editors. Quality and equity in aged care. Vol. 4. Canberra: Parliament of Australia; 2005. pp. 79–130. Available at: https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Completed_inquiries/2004-07/aged_care04/report/c04 [verified 14 June 2019].
[6] Barry S, Knox L, Douglas JM. ‘Time’s up’: the experience of entering residential aged care for young people with acquired neurological disorders and their families. Brain Impair 2019; 20 37–48.
| ‘Time’s up’: the experience of entering residential aged care for young people with acquired neurological disorders and their families.Crossref | GoogleScholarGoogle Scholar |
[7] Winkler D, Sloan S, Callaway L. Younger people in residential aged care: support needs, preferences and future directions. Melbourne: Summer Foundation Ltd; 2007.
[8] Department of Human Services. Creating new opportunities: responding to the needs of younger people in Victoria’s residential aged care services. Melbourne: Department of Human Services; 2005.
[9] Sloan S, Callaway L, Winkler D, McKinley K, Ziino C, Anson K. Changes in care and support needs following community-based intervention for individuals with acquired brain injury. Brain Impair 2009; 10 295–306.
| Changes in care and support needs following community-based intervention for individuals with acquired brain injury.Crossref | GoogleScholarGoogle Scholar |
[10] Strettles B, Bush M, Simpson G, Gillet L. Accommodation in NSW for adults with high care needs after traumatic brain injury. Sydney: Motor Accident Authority; 2005.
[11] Winkler D, Callaway L, Sloan S, Holgate N. Everyday choice making: outcomes of young people with acquired brain injury after moving from residential aged care to community-based supported accommodation. Brain Impair 2015; 16 221–35.
| Everyday choice making: outcomes of young people with acquired brain injury after moving from residential aged care to community-based supported accommodation.Crossref | GoogleScholarGoogle Scholar |
[12] Winkler D, Farnworth L, Sloan S, Brown T. Moving from aged care facilities to community-based accommodation: outcomes and environmental factors. Brain Inj 2011; 25 153–68.
| Moving from aged care facilities to community-based accommodation: outcomes and environmental factors.Crossref | GoogleScholarGoogle Scholar | 21219088PubMed |
[13] Winkler D, Farnworth L, Sloan S, Brown T, Callaway L. Comparison of people with ABI living in two accommodation settings: shared supported accommodation and residential aged care. Brain Impair 2010; 11 313–25.
| Comparison of people with ABI living in two accommodation settings: shared supported accommodation and residential aged care.Crossref | GoogleScholarGoogle Scholar |
[14] Honey K. Ministerial implementation committee on head injury data research project report. Melbourne: Health Department Victoria, Community Services Victoria, Transport Accident Commission; 1995.
[15] Jones G, Lawn R. The Young People in Nursing Homes Project evaluation: the history of the YPINH project from 1995 to 1997 [Report No. 1]. Perth: Disability Services Commission of Western Australia; 1999.
[16] Jones G, Lawn R. The Young People in Nursing Homes Project evaluation: evaluation of the individual planning process [Report No. 3]. Perth: Disability Services Commission of Western Australia; 1999.
[17] Australian Government Department of Social Services. Younger people in residential aged care. Action plan. 2019. Available at: https://www.dss.gov.au/disability-and-carers/programmes-services/for-people-with-disability/younger-people-with-disability-in-residential-aged-care-initiative [verified 14 June 2019].
[18] Australian Government Department of Families Housing Community Services and Indigenous Affairs. Mid-term review, Younger People in Residential Aged Care (YPIRAC) Program. 2009. Available at: https://www.dss.gov.au/sites/default/files/documents/05_2012/ypirac_mter_report.pdf [verified 14 June 2019].
[19] Australian Institute of Health and Welfare (AIHW). AIHW national aged care data Clearinghouse. 2014. Available at: https://meteor.aihw.gov.au/content/index.phtml/itemId/586498 [verified 14 June 2019].
[20] Australian Institute of Health and Welfare. GEN data dictionary 2018.06.01. 2018. Available at: https://www.gen-agedcaredata.gov.au/www_aihwgen/media/GEN-Data/GEN-Data-Dictionary-2018-06-01.pdf [verified 14 June 2019].
[21] Australian Bureau of Statistics. Australian demographic statistics September quarter 2018. Catalogue no. 3101.0. 2018. Available at: http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/F513573F5A89B780CA2583C30023B062/$File/31010_sep 2018.pdf [verified 14 June 2019].
[22] Australian Institute of Health and Welfare. Age-standardised rate. 2005. Available at: https://meteor.aihw.gov.au/content/index.phtml/itemId/327276 [verified 14 June 2019].
[23] Australian Institute of Health and Welfare (AIHW). Principles on the use of direct age-standardisation in administrative data collections: for measuring the gap between Indigenous and non-Indigenous Australians (AIHW). Catalogue no. CSI 12. 2011. Available at: https://www.aihw.gov.au/reports/indigenous-australians/principles-on-the-use-of-direct-age-standardisatio/contents/table-of-contents [verified 13 March 2020].
[24] Ahmad OB, Boschi-Pinto C, Lopez AD, Murray CJL, Lozano R, Inoue M. Age standardization of rates: a new WHO standard. GPE Discussion Paper Series: no. 31. Geneva: World Health Organization; 2001. Available at: https://www.who.int/healthinfo/paper31.pdf [verified 14 June 2019].
[25] Australian Bureau of Statistics. 3101.0 – Australian demographic statistics, Mar 2013. 2013. Available at: https://www.abs.gov.au/ausstats/abs@.nsf/Previousproducts/3101.0Main%20Features3Mar%202013?open [verified 13 March 2020].
[26] Berry AC. The accuracy of the Gaussian approximation to the sum of independent variates. Trans Am Math Soc 1941; 49 122–36.
| The accuracy of the Gaussian approximation to the sum of independent variates.Crossref | GoogleScholarGoogle Scholar |
[27] Holland PW, Welsch RE. Robust regression using iteratively reweighted least-squares. Commun Stat Theory Methods 1977; 6 813–27.
| Robust regression using iteratively reweighted least-squares.Crossref | GoogleScholarGoogle Scholar |
[28] Winkler DF, Farnworth LJ, Sloan SM, Brown T. Young people in aged care: progress of the current national program. Aust Health Rev 2011; 35 320–6.
| Young people in aged care: progress of the current national program.Crossref | GoogleScholarGoogle Scholar | 21871194PubMed |
[29] The Senate Standing Committee on Community Affairs. Funding and operation of the commonwealth state/territory disability agreement. 2007. Available at: http://wwda.org.au/wp-content/uploads/2013/12/cstdafr06.pdf [verified 14 June 2019].
[30] Buckmaster L, Clark S. The National Disability Insurance Scheme (NDIS). Aust J Rural Health 2013; 21 54
| The National Disability Insurance Scheme (NDIS).Crossref | GoogleScholarGoogle Scholar |
[31] Callaway L, Brown M, Fensham-Cobb P, Worsnop T, Farrell D. Considerations for National Disability Insurance Scheme design: the health and disability interface for people with complex needs living in shared supported accommodation. Melbourne: Monash University, Yooralla, Summer Foundation & Multiple Sclerosis Ltd; 2015.
[32] SGS Economics and Planning, Summer Foundation. Specialist disability accommodation: market insights. 2018. Available at: https://www.summerfoundation.org.au/wp-content/uploads/2018/03/SDA-Market-Insights-report-web.pdf [verified 7 January 2020].
[33] National Disability Insurance Agency. COAG Disability Reform Council quarterly report. 31 March 2019. 2019. Available at: https://www.ndis.gov.au/media/1358/download [verified 13 March 2020].
