Academic journal article Australian Health Review

The Dynamics of Residential Aged Care in Australia: 8-Year Trends in Admission, Separations and Dependency

Academic journal article Australian Health Review

The Dynamics of Residential Aged Care in Australia: 8-Year Trends in Admission, Separations and Dependency

Article excerpt

Abstract

The aims of this paper are to analyse changes in dependency of residents in residential aged care homes consequent upon the passing of the Commonwealth Aged Care Act in late 1997, and to establish the extent of resultant changes in the dynamics of residential aged care. The paper outlines the major changes brought by the Aged Care Act, and evidence for the effects of these changes is examined to test the hypothesis that changes in dependency generated changes in turnover and length of stay. The findings show that the proportion of admissions classified at higher categories of the Resident Classification Scale has increased over time, and that the trend to higher classification is even more pronounced by the time residents separate. As funding of residential aged care is based on resident dependency, change in dependency and in the dynamics of the aged care system have potentially significant consequences for Commonwealth funding of providers to ensure care can be provided commensurate with resident needs. The conclusions take up a number of implications of the findings for future policy in relation to planning and funding of residential aged care as a new resident funding system based on the Aged Care Funding Instrument (ACFI) is phased in from mid 2007.

Aust Health Rev 2007: 31(4): 611-622

What Is known about the topic?

As legislation covering residential care determines who is admitted and the care provided to residents, changes in legislation will lead to changes in the characteristics of residents of aged care homes.

What does this paper add?

This paper provides a comprehensive review of admissions and separations by Resident Classification Scale (RCS) category from 1999 to 2006, illustrating higher proportions of residents classified at the higher categories. The analysis further suggests that the upward shift is due primarily to increasing proportions of admissions at the two highest care categories and that ageing-in-place from low to high care has played a secondary role.

What are the implications for practitioners?

The authors suggest that recent trends mean residential aged care is increasingly concerned with higher dependency residents, and continuation of these trends will see diminishing demand for low care, with potentially significant consequences for funding and planning.

THE COMMONWEALTH Aged Care Act, passed in October 1997, introduced diree major changes that sought to integrate the previously separate nursing homes and hostels into a single residential aged care system. Each of these changes had consequences for the classification of resident dependency and flows of residents through the system, and the general view has been diat dependency of residents in aged care homes in Australia has been increasing over time. Given diat more dependent residents can be expected to have shorter stays, die aims of this paper are to examine die evidence for increasing dependency of diose admitted to, resident in and separating from residential care, and to investigate the changing dynamics generated by changes in resident movement into and out of residential care at different levels of dependency.

The first major change introduced by the Aged Care Act 1997 (Cwlth) was the replacement of the two separate instruments for assessing resident dependency, the Resident Classification Instrument used in nursing homes and Personal Care Assessment Instrument used in hostels, with a single Resident Classification Scale (RCS). Details of the RCS are set out in the Residential Care Manual.1 The RCS was designed to fund residents consistently on the basis of dependency and related care needs and so provide a standard measure of dependency across the full spectrum of residential care. Residents are classified into one of eight categories on the basis of their score on the 20-item RCS. In line with classification of the least dependent residents as RCS8 and the most dependent residents as RCS1, RCS8 is the lowest category and RCS1 the highest in terms of dependency and associated funding. …

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