Community-based aged care
Home based aged care services are a vital resource for supporting older Australians to remain living in their own home for as long as possible. Many older people express a desire to continue to live in a familiar setting in the community, with the Royal Commission into Aged Care Quality and Safety reporting that 80% of older Australians want to remain living in their current home and 62% want to receive community-based aged care services (Royal Commission 2020).
There are two types of community-based aged care services available:
- Commonwealth Home Support Programme (CHSP) – provides entry level care for people who require a low level of support to remain living independently
- Home Care Packages (HCP) program – provides community-based care to people with greater or more complex care needs.
Health conditions (such as dementia) are recorded in aged care assessments undertaken for people seeking access to aged care services, but they are not recorded directly for people using these services. However, there is some information on home care provided to people with dementia who receive the Dementia and Cognition Supplement. This supplement is available to people with moderate or severe cognitive impairment to acknowledge the additional costs of caring for this group. However, there are a number of factors to consider when using this information to describe the use of community-based aged care services by people with dementia (see Box 10.2).
As at 30 June 2022, over 17,200 people were receiving the Dementia and Cognition Supplement as part of their Home Care Package (10,900 women and 6,400 men). Around 80% of both men and women who were receiving the Dementia and Cognition Supplement were receiving high levels of care (Home Care Package Level 3 designed for those with intermediate care needs and Home Care Package Level 4 for those with high care needs) (Table S10.25).
Box 10.2: Home Care Dementia and Cognition Supplement
The Home Care Dementia and Cognition Supplement was introduced in 2013 to provide additional funding for people with moderate or severe cognitive impairment to acknowledge the additional costs associated with caring for this group. To receive the Dementia and Cognition Supplement, a person must meet specified criteria as part of a psychogeriatric assessment performed by a medical professional trained in the particular cognitive assessment tool.
It is acknowledged that this will not identify all people with dementia receiving Home Care services, for a number of reasons:
- A dementia diagnosis alone does not mean that a Home Care recipient is eligible for receipt of the supplement. People with lower levels of cognitive impairment do not attract the supplement and thus, people with less severe dementia may not be eligible for the supplement.
- Home Care recipients who are eligible for the Veterans’ Supplement are not also paid the Dementia and Cognition Supplement.
- People with cognitive impairment associated with conditions other than dementia may also be found eligible for the supplement.
Therefore, the number of people using Home Care Packages who receive the Dementia and Cognition Supplement may not accurately describe the provision and need for community-based aged care services for people with dementia.
Respite care is especially important for people caring for someone with dementia, where the demands of the caring role may involve providing substantial amounts of physical, psychological, cognitive and social support, while behaviour changes may add to the complexity of caring.
The Australian Government subsidises community-based and residential respite with the aim of providing a person and their carer with a break from their usual care arrangements, or during emergencies. However, due to a lack of national data, this page does not present any national statistics on the use of respite services by people with dementia.
Aged care assessments data records whether the person being assessed has received any respite services (informal, community or residential respite) in the past 12 months, but this information is not currently available for analysis in the first supply of the NSAF data. Although respite stays are usually short, many people also access respite care provided in residential aged care facilities. People who use residential respite care are not appraised using the Aged Care Funding Instrument (ACFI; see Box 10.3 in Residential aged care), so their dementia status cannot be determined using the currently available data, unless they go on to use permanent residential care and have an ACFI assessment.
For information on expenditure on respite care for people with dementia in 2018–19, see Expenditure on aged care services. Due to the lack of data on the use of respite care by people with dementia, expenditure was estimated using the proportion of approvals for respite care for people not currently living in residential care and were associated with a dementia diagnosis from the NSAF data.
Almost 1 in 4 (23%) primary carers of people with dementia in 2018 reported they needed more respite care. This was higher than what was reported by primary carers of people without dementia (13%). Refer to Carers unmet needs for more information.
(Royal Commission (Royal Commission into Aged Care Quality and Safety) (2020) Research Paper 4: What Australians Think of Ageing and Aged Care, Royal Commission, Australian Government, accessed 26 June 2023.