Report sheds light on care system


The Productivity Commission finds some states and territories perform better than others in terms of quality of care.

Key Points


  • NSW aged care services are worst performing in terms of quality
  • Total government expenditure on aged care services in 2019-20 was $21.5 billion
  • Federal Government has until 31 May to respond to royal commission final report

With government mulling the 148 recommendations of the final royal commission report, further evidence of the failings of the system highlight the need for reform.

A recent Productivity Commission report into government services has highlighted how some states and territories are performing worse than others.

The report shows the results of 497 reviews of residential aged care services against the Aged Care Quality Standards in 2019-20.

There were more than 217,000 operational places at June 2020 with the number of quality reviews undertaken corresponding to number of places in each state.

It found NSW aged care services performed the worst of all states and territories across each of the eight quality standards.

For home care support, the report found that Western Australia and Tasmania performed best across the standards.

The report provides a rich insight into the performance of our aged care system, at a time when it is the subject of intense community and royal commission scrutiny.

Total cost and places


Cost and places key points


During 2019-20:

  • 88,640 older clients received Level 1-2 Home Care Packages,
  • 86,123 older clients received Level 3 and 4 Home Care Packages,
  • 829,193 older clients accessing the Commonwealth Home Support Program
  • 238,778 older clients who received permanent care, and
  • 65,709 who received respite care.

Total government expenditure on aged care services in 2019-20 was $21.5 billion. This comprised $13.6 billion on residential care services, $6.7 billion on home care and support services and $1.2 billion on other services, such as flexible care and assessments.

As at June 2020, there were 217,145 operational places (excluding flexible places) in residential care services, and 142,436 recipients of Home Care Packages Level 1–4.

Residential aged care services accounted for the largest proportion of expenditure in 2019-20 ($13.6 billion, or 63.4%). Home care and home support services accounted for much of the remainder ($6.7 billion).

The Australian Government provided 98.5% of the government funding for aged care services in 2019-20. State and Territory governments provided the remainder.

Current types of care and support


Types of care and support key points


  • The Commonwealth Home Support Programme (CHSP) - helps older people to access entry level support services
  • The Home Care Packages Program - helps people live independently in their own homes. There are four levels of care
  • Veteran Home Care (VHC) services - provide assistance for people with low care needs
  • Carers - they can also access respite care through home care and home support programs
  • Residential care - assists those not able to live in the community and in their own home

There are a range of supports provided through the aged care system:

  • The Commonwealth Home Support Programme (CHSP) helps older people to access entry level support services to remain living independently and safely at home and in their community. Services available under the CHSP include domestic assistance, personal care, social support, allied health and respite services.
  • The Home Care Packages Program helps people with complex care needs to live independently in their own homes. There are four levels of care ranging from low level care needs (Home Care Package Level 1) to high care needs (Home Care Package Level 4). Services provided under these packages are tailored to the individual and might include personal care (such as showering), support services (such as cleaning) and/or clinical care (such as nursing and allied health support). 
  • As at 30 June 2020, 142,436 people were recipients of Home Care Packages, of which 41.3% received a Home Care Package Level 2. In 2019-20, median elapsed times for a Home Care Package ranged from 6 months for a Level 1 package to 28 months for a Level 4 package, lower than for 2018 19.
  • Department of Veterans’ Affairs (DVA) community care for eligible veterans — Veteran Home Care (VHC) services provide domestic assistance, home and garden maintenance, and respite for people with low care needs; DVA community nursing services provide acute/post-acute support and maintenance as well as palliative care for people with high care needs or disability. In 2019-20, 37,735 older veterans were approved for VHC services and 13,842 older people received community nursing services, representing 29.5 and 10.8% of older eligible veterans respectively.
  • Carers can also access respite care through home care and home support programs. In 2019-20, there were 65,709 in residential respite care. The majority of these (49,514) were people aged 80 and over.
  • Residential care assists those not able to live in the community and in their own home. In 2019-20, 42.2% of older people entered residential aged care within three months of their ACAT approval; the median elapsed time was 148 days, a decrease from 152 days in 2018-19 but higher than 121 days in 2017-18.

Will this all change?


One of the key recommendations of the royal commission final report was to integrate each of these different services into a single system with a single assessment process replacing the dual assessments currently undertaken.

This is an important change and one that has been mooted for some time. However, there is conjecture about the efficacy of the model suggested. It will be important that the final system that is adopted does not throw out the successful elements of the existing system and includes funding models that are suitable to the type of service being delivered.

National Seniors is not convinced the current individualised funding model applied to the Home Care Packages program is appropriate to the needs of older Australians or is the most efficient way to fund quality care.

Federal Government has until 31 May to respond to royal commission final report and we will be keeping a close eye on their response to the recommendation for a new integrated aged care system to ensure it is suited to the needs of older Australians.