Home Care, Hostels And Nursing Homes

The Value of Independence in an Aging Population

Maintaining an independent lifestyle is valued by Australia’s rapidly aging populateion. People prefer to remain living in their own homes with some assistance. This may be provided informally by family or formally through private or government services. The Australian Bureau of Statistics reported that in 1998, 80% of the 65 years + population lived at home alone or with a partner as compared to 10% with relatives/non-relatives and 5.9% in nursing homes/hostels. Of those aged 80+, three-quarters of all males and half all females lived at home alone or with a partner. At the same time 13% males and 23% females lived in nursing homes/hostels while 5% males and just under a fifth of all females lived with relatives (Australian Bureau of Statistics 1999).

While the provision of aged care has long been a broader Church initiative, the lifestyle choice of remaining at home requires some reflection both in terms of its wider implications for the ways in which churches can minister.

The Bureau suggests that living at home is a trend both reflected in, and a product of, the Commonwealth Government’s 1980’s aged care reforms and the subsequent transferral of funding into a system of home-based care and hostels as opposed to nursing homes. The Commonwealth recognised the preference for home care with varied levels of formal assistance and emphasised the role of informal assistance, by family or friends, in aged care.

An additional impetus for reform has been Australia’s aging population. In 1998, the number of persons aged 65 or over was 2.3 million and Australian Bureau of Statistics projections indicate this will reach 5.1 million by 2031. Currently, those aged 80 or over, or those most likely to require assistance, make up 3% of the population and this is expected to climb to 6% of the population in 2031 (Australian Bureau of Statistics 1999). Hence, home based care and reliance on informal care are two means by which the Commonwealth hopes to address this dilemma. More recently, a liberal “user pays” orientation has also been applied to this policy, as compared with older welfare state models.

Given that the Church is aging at an even more rapid rate than the overall population, aged care is a particular concern. One fifth of Australia’s population was aged 60 or over in the 1996 Census while just over one third of all Church attenders were aged 65 or over. The Anglicans and the Uniting Church had the oldest populations with two in every five attenders aged 65 or over. These proportions are likely to be higher now in the year 2000.

The Increased Role of Informal Care

While data suggest persons 65-79 years can generally maintain an independent lifestyle with some assistance, the need for this increases among those aged 80 or over due to the increased likelihood of illness, disability and infirmity. In 1998, half of all males and 46% of females aged between 65 and 79 experienced a disability of some kind and for around 42% this entailed core activity restrictions. For those aged 80 or over, core activity restrictions impacted 70% of this population, an increase of 28%. The everyday implications of disability are reflected through the data on the level of assistance required. Overall, 42% required informal or formal assistance with everyday activities such as property maintenance, transport and housework (Australian Bureau of Statistics 1999, p.158).

The providers of this informal care are likely to be partners, the middle aged children, grandchildren or friends of Australia’s aging population and this means that a large portion of the population have the responsibility of aged care. It is a responsibility which falls unevenly on the population, with women taking much of the burden. Hence, as well as addressing the needs of its elderly constituent, churches must consider the sometimes stress-filled role of attenders and affiliates in caring for their spouses, parents or grandparents.

The research indicated that while people are under 80, reliance on informal assistance alone was often sufficient. However, the need for formal assistance increased from 56% for the 65-79 age group to 67% for those aged 80 or over. Generally the elderly relied on a combination of both informal and formal care (1999).

The Privatisation of Formal Care

The Bureau’s data indicated that in 1998, the Commonwealth provided one quarter of all formal assistance to people between 65 and 79 years of age. Access to assistance was dependent on their knowledge of the existence of the services, their availability and cost, and the financial circumstances of the recipient, whether they could afford to pay for private services.

The ‘user pays’ philosophy could potentially increase the church role in aged care through expansion in the for profit sector. At the same time, some elderly people will lack the means to pay for care thus increasing both the need for and demands on the charitable sector which has traditionally been dominated by church-affiliated organisations. ‘User pays’ will also mean that more people will rely on informal care via friends or relatives and the provision or reception of such services is likely to impact a large proportion of congregations and wider communities.

Commonwealth Reform of Formal Care

The Home and Community Care Program is the Commonwealth program for the elderly living at home and assisted just over one quarter of those aged over 65 in 1998. Services include washing, dressing, health and respite care, home centre-based meals, home help and maintenance, centre day care and transport. As a reflection of the shift toward home-based help, bureau research indicated that a 157% funding increase occurred in the late 1980’s with the Home and Community Care Program’s share of total funds increasing from 15% to 22%. An estimated 240,000 people used at least one of the mentioned Home and Community Care Program services in any given month and with the 65 and over age group projected to reach 1.2 million in 2031, 692,500 will participate in the Home and Community Care Program that year.

While policy makers anticipate a rise in informal care to compensate, changes in social conditions will decrease the availability of informal support. Such changes will be due to increased female workforce participation, levels of volunteer labour in the welfare system and increases in divorce rates and single income households (Australian Bureau of Statistics 1999).

An additional form of care, the Community Aged Care package, was initiated in 1992 to provide more intensive home-based assistance. The Bureau reports that this package assisted just under 9,000 aged persons in 1998 at $9,923 per person or around $600 more than the subsidy for hostel care per person. Hostel care increased its share from 5% to13% of total expenditure between the 1985-1986 and 1995-1996 periods. At the same time, expenditure on nursing homes was reduced from 80% to 63% as a proportion of the total (1999).
As part of the changed approach to aged care, funding is now based on the assessment of residents. The intention is that this enables them to remain in their hostel accommodation and not be forced into a nursing home. Research indicates that since 1993 the proportion of people aged 65 or over in nursing homes decreased by 0.3% with a 0.2% increase for hostels. Moreover, by 2011, nursing home beds will be further reduced, from 47 to 40 per 1,000 aged 70 or over.

At the same time hostel beds will be increased from 41 to 50 per 1,000 and care packages from 6 to 10 (1999). The intention is that the various funding levels for hostel care and packages should decrease overall expenditure to cope with Australia’s aging population.

Recent aged care reform and the ‘preference’ for maintaining an independent lifestyle has numerous implications both for the churches and wider communities. With growing emphasis on a ‘user pays’policy, remaining at home may be based more on finances than needs and the growing emphasis on informal care places a greater responsibility on parts of the community and particularly on women. Australian Bureau of Statistics research findings and government reform presents numerous dilemmas and challenges to the aging Australian Church and the nation as a whole.

Sharon Bond
Research Assistant, CRA

References:

Australian Bureau of Statistics, 1999, ‘Home care, hostels and nursing homes: Housing assistance,’ Australian Social Trends 1999, Canberra.

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