The impact of ageing‐in‐place reforms on the provision of home care packages for older Australians, 2008–21: a repeated cross‐sectional study

Abstract

AbstractObjectivesTo assess changes following the 2013–21 Home Care Package (HCP) reforms in the rate of HCPs provided to Australians aged 65 years or older, the characteristics of people who have received HCPs, and the capacity of the program to meet demand for its services during 2018–21.Study designRepeated cross‐sectional population‐based study; analysis of Australian Institute of Health and Welfare GEN Aged Care and Australian Department of Health Home Care Packages program data.Setting, participantsHCPs provided to non‐Indigenous Australians aged 65 years or older, 2008–09 to 2020–21.Main outcome measuresChanges in age‐ and sex‐standardised HCP rates (number per 1000 older people) and changes in proportions of recipients for selected characteristics, 2013–14 to 2020–21, overall and by care level; correspondence of proportional HCP supply and demand, 2018–19 to 2020–21, by care level.ResultsA total of 490 276 HCPs were provided during 2008–21. The age‐ and sex‐standardised HCP rate rose from 9.23 per 1000 people aged 65 years or more in 2013–14 to 16.4 per 1000 older people in 2020–21. The increases in age‐ and sex‐standardised HCP rate between 2013–14 and 2020–21 were greatest for level 1 (from 0.19 to 5.05 per 1000 older people) and level 3 HCPs (from 0.35 to 3.62 per 1000 older people); the rate for level 2 HCPs declined from 6.75 to 5.82 per 1000 older people, and that for level 4 HCPs did not change. The proportion of culturally and linguistically diverse recipients rose from 10.8% to 16.2%; the overall proportion of recipients living outside major cities rose slightly, from 28.1% to 28.7%, but declined for higher care level HCPs (level 3: from 30.8% to 27.8%; level 4: from 29.6% to 25.2%). During 2018–19 to 2020–21, the proportions of lower level (1 and 2) HCPs generally exceeded demand, while the supply of higher level (3 and 4) HCPs generally fell short of demand.ConclusionsDespite the increased overall availability of HCPs, the supply of higher care level HCPs is still lower than the demand, probably contributing to suboptimal support for the ageing‐in‐place preferences of older Australians, especially in regional and remote areas.