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Understanding unmet aged care need and care inequalities among older Australians

Published online by Cambridge University Press:  11 March 2021

Trish Hill*
Affiliation:
Social Policy Research Centre, University of New South Wales, Sydney, Australia

Abstract

In Australia, numerous reviews and inquiries have documented concerns about inadequate access to, and the quality of, aged care. Despite those concerns, research is yet to appraise fully how care needs are assessed, prioritised, and met or left unmet. This paper asks two interrelated questions: (1) How should we conceptualise and measure unmet care need and care inequalities among older people? (2) What are the policy parameters for assessing needs, prioritising access to support and monitoring quality in aged care in Australia? Key insights from academic literature are used to critically review Australian policy documents describing rights, assessments, prioritisation, quality standards and performance indicators for the aged care sector. Using the concepts of care inequalities and care poverty, the paper develops a framework for understanding and measuring needs and unmet needs in aged care, and for encompassing fundamental and valued aspects of life for older people, their carers and their care network. The paper argues that the concept of care poverty opens the space to discuss what level of unmet need and inequality in access to aged care in any society may be considered intolerable.

Type
Article
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

Aged Care Quality and Safety Commission (ACQSC) (2019 a) Aged Care Quality Standards. Canberra: Commonwealth of Australia. Available at https://www.agedcarequality.gov.au/providers/standards.Google Scholar
Aged Care Quality and Safety Commission (ACQSC) (2019 b) Charter of Rights. Canberra: Commonwealth of Australia. Available at https://www.agedcarequality.gov.au/consumers/consumer-rights.Google Scholar
Aged Care Quality and Safety Commission (ACQSC) (2019 c) Consumer Experience Reports in Residential Aged Care Services. Canberra: Commonwealth of Australia. Available at https://www.agedcarequality.gov.au/consumers/consumer-experience-reports-residential-aged-care-services.Google Scholar
Aged Care Quality and Safety Commission (ACQSC) (2019 d) Consumer Experience Reports in Home and Community Care. Canberra: Commonwealth of Australia. Available at https://www.agedcarequality.gov.au/consumers/consumer-experience-reports-home-and-community-care.Google Scholar
Australian Bureau of Statistics (ABS) (2019) Disability, Ageing and Carers, Australia: Summary of Findings, 2018 (Catalogue No. 4430.0D). Canberra: ABS. Available at https://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/4430.0Main%20Features62018?opendocument&tabname=Summary&prodno=4430.0&issue=2018&num=&view=.Google Scholar
Australian Human Rights Commission (2019) Your Rights at Retirement: A Guide to Making Decisions and Navigating Your Entitlements in Later Life. Sydney: Australian Human Rights Commission. Available at https://www.agedcarequality.gov.au/sites/default/files/media/guide_to_assessment_of_chsp_services.pdf.Google Scholar
Batchelor, F, Savvas, S, Dang, C, Goh, AMY, Levinger, P, Peck, A, Katz, I and Dow, B (2020 a) Inside the System: Aged Care Residents’ Perspectives. Parkville, Australia: National Ageing Research Institute. Available at https://agedcare.royalcommission.gov.au/sites/default/files/2020-10/research-paper-13.pdf.Google Scholar
Batchelor, F, Savvas, S, Peck, A, Dang, C, Wade, C, Goh, AMY and Dow, B (2020 b) Inside the System: Home and Respite Care Clients’ Perspectives. Parkville, Australia: National Ageing Research Institute. Available at https://agedcare.royalcommission.gov.au/sites/default/files/2020-10/research-paper-14.pdf.Google Scholar
Bergmark, A, Parker, M and Thorslund, M (2000) Priorities in care and services for elderly people: a path without guidelines? Journal of Medical Ethics 26, 312318.CrossRefGoogle ScholarPubMed
Bradshaw, J (1972) A taxonomy of social need. In McLachlan G, (ed) Problems and progress in medical care: essays on current research, 7th series. London, Oxford University Press, 71-82.Google Scholar
Braithwaite, J, Makkai, T and Braithwaite, V (2007) Regulating Aged Care: Ritualism and the New Pyramid. Cheltenham, UK: Edward Elgar.CrossRefGoogle Scholar
Brimblecombe, N, Pickard, L, King, D and Knapp, M (2017) Perceptions of unmet needs for community social care services in England. A comparison of working carers and the people they care for. Health and Social Care in the Community 25, 435446.Google ScholarPubMed
Carers, NSW (2020) 2020 National Carer Survey: Summary Report. Sydney: Carers NSW. Available at http://www.carersnsw.org.au/Assets/Files/2020NationalCarerSurveyReport_print[2].pdf.Google Scholar
Carnell, K and Patterson, R (2017) Review of National Aged Care Quality Regulation Processes. Canberra: Commonwealth of Australia. Available at https://agedcare.health.gov.au/quality/review-of-national-aged-care-quality-regulatory-processes-report.Google Scholar
Caughey, GE, Lang, CE, Bray, SC, Moldovan, M, Jorissen, RN, Wesselingh, S and Inacio, MC (2020) International and National Quality and Safety Indicators for Aged Care. Report for the Royal Commission into Aged Care Quality and Safety. Adelaide, Australia: South Australian Health and Medical Research Institute. Available at https://agedcare.royalcommission.gov.au/sites/default/files/2020-08/research_paper_8_-_international_and_national_quality_and_safety_indicators_for_aged_care.pdf.Google Scholar
Clarkson, P, Davies, S, Hughes, J, Xie, C, Stewart, K, Clifford, P and Challis, D (2018) Priorities for long-term care resource allocation in England: actual allocation versus the views of Directors of Service and older citizens. Journal of Long-term Care 2018, 1323.CrossRefGoogle Scholar
Dean, H (2010) Understanding Human Need. Bristol, UK: Policy Press.CrossRefGoogle Scholar
Department of Health (2018 a) 2017–18 Report on the Operation of the Aged Care Act 1997. Canberra: Commonwealth of Australia. Available at https://www.gen-agedcaredata.gov.au/Resources/Reports-and-publications/2018/November/2017%E2%80%9318-Report-on-the-Operation-of-the-Aged-Care-A.Google Scholar
Department of Health (2018 b) National Screening and Assessment Form Fact Sheet. Canberra: Commonwealth of Australia. Available at https://agedcare.health.gov.au/programs-services/my-aged-care/national-screening-and-assessment-form.Google Scholar
Department of Health (2018 c) My Aged Care Assessment Manual Version 1.1 June 2018. Canberra: Commonwealth of Australia. Available at https://www.health.gov.au/sites/default/files/documents/2020/01/my-aged-care-assessment-manual.pdf.Google Scholar
Department of Health (2018 d) Guidance on Priority for Home Care Services. Canberra: Commonwealth of Australia. Available at https://agedcare.health.gov.au/sites/default/files/documents/06_2018/guidance_on_priority_for_home_care_services_v1.pdf.Google Scholar
Department of Health (2019 a) Home Care Packages Program, Data Report 4th Quarter 2018–19. Canberra: Commonwealth of Australia. Available at https://www.gen-agedcaredata.gov.au/www_aihwgen/media/Home_care_report/HCPP-Data-Report-4th-qtr-2018-19.pdf.Google Scholar
Department of Health (2019 b) About the National Aged Care Mandatory Quality Indicator Program. Canberra: Commonwealth of Australia. Available at https://agedcare.health.gov.au/ensuring-quality/quality-indicators/about-the-national-aged-care-quality-indicator-programme.Google Scholar
Department of Health (2019 c) Current Quality Assessment Arrangements, Including Unannounced Re-accreditation Audits. Canberra: Commonwealth of Australia. Available at https://agedcare.health.gov.au/quality/current-quality-assessment-arrangements-including-unannounced-re-accreditation-audits#Quality%20against.Google Scholar
Diwan, S and Moriarty, D (1995) A conceptual framework for identifying unmet health care needs of community dwelling elderly. Journal of Applied Gerontology 14, 4763.CrossRefGoogle Scholar
Donabedian, A (1988) The quality of care: how can it be assessed? JAMA: The Journal of the American Medical Association 260, 17431748.CrossRefGoogle ScholarPubMed
Eagar, K, McNamee, J, Gordon, R, Snoek, M, Duncan, C, Samsa, P, Loggie, C. et al. (2019) The Australian National Aged Care Classification (AN-ACC). The Resource Utilisation and Classification Study: Report 1. Wollongong, Australia: Australian Health Services Research Institute, University of Wollongong. Available at https://www.health.gov.au/resources/publications/resource-utilisation-and-classification-study-rucs-reports.Google Scholar
Fraser, N (1987) Women, welfare and the politics of need interpretation.Hypatia, 2, 103121.CrossRefGoogle Scholar
Fraser, N (1989) Talking about needs: interpretive contests as political conflicts in welfare-state societies. Ethics 99, 291313.CrossRefGoogle Scholar
Freedman, VA and Spillman, B (2014) The residential continuum from home to nursing home: size, characteristics and unmet needs of older adults. Journals of Gerontology: Psychological Sciences and Social Sciences 69B, supplement 1, S42S50.CrossRefGoogle Scholar
Grove, A (2019) Improving aged care. In Parliamentary Library (2019) Briefing Book: Key Issues for the 46th Parliament. Canberra: Commonwealth of Australia, pp. 166169. Available online at https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/BriefingBook46p.Google Scholar
Groves, A, Thomson, D, McKellar, D and Procter, N (2017) The Oakden Report. Adelaide, Australia: SA Health, Department for Health and Ageing. Available at https://apo.org.au/sites/default/files/resource-files/2017-04/apo-nid76130.pdf.Google Scholar
Harrison, F, Low, L-F, Barnett, A, Gresham, M and Brodaty, H (2014) What do clients expect of community care and what are their needs? The Community care for the Elderly: Needs and Service Use Study (CENSUS). Australasian Journal on Ageing 33, 206213.CrossRefGoogle Scholar
He, S, Craig, BA, Xu, H, Covinsky, KE, Stallard, E, Thomas, J III, Hass, Z and Sands, LP (2015) Unmet need for ADL assistance is associated with mortality among older adults with mild disability. Journals of Gerontology: Biological Sciences and Medical Sciences 70A, 11281132.CrossRefGoogle Scholar
Hill, T (2005) Understanding Australian Women's Poverty and Income Inequality: Towards an income of one's own. PhD Thesis, UNSW Sydney.Google Scholar
Ignatieff, M (1985) The Needs of Strangers. New York: Viking.Google Scholar
Ipsos, MORI (2017) Unmet Needs for Care: Final Report July 2017. London: Ipsos MORI. Available at https://www.ipsos.com/sites/default/files/2017-07/unmet-need-for-care-full-report.pdf.Google Scholar
Kröger, T (2010) Lone mothers and the puzzles of daily life: do care regimes really matter? International Journal of Social Welfare 19, 390401.CrossRefGoogle Scholar
Kröger, T, Mathew Puthenparambil, J and Van Aerschot, L (2018) Care poverty: unmet care needs among older people in Finland. Paper presented at the ESPAnet 2018 Conference, Vilnius, August/September.Google Scholar
Kröger, T, Mathew Puthenparambil, J and Van Aerschot, L (2019) Care poverty: unmet care needs in a Nordic welfare state. International Journal of Care and Caring 3, 485500.CrossRefGoogle Scholar
LaPlante, M, Kaye, S, Kang, T and Harrington, C (2004) Unmet need for personal assistance services: estimating the shortfall in hours of help and adverse consequences. Journal of Gerontology: Psychological Sciences and Social Sciences 59B, S98S108.CrossRefGoogle Scholar
Liddiard, M (2007) Social need and patterns of inequality. In Baldock, J, Manning, N and Vickerstaff, S (eds), Social Policy, 3rd Edn. Oxford: Oxford University Press, pp. 120143.Google Scholar
Lister, R (2010) Understanding Theories and Concepts in Social Policy. Bristol, UK: Policy Press.CrossRefGoogle Scholar
Low, L, Fletcher, J, Gresham, M and Brodaty, H (2015) Community care for the Elderly: Needs and Service Use Study (CENSUS): who receives home care packages and what are the outcomes? Australasian Journal on Ageing 34, E1E8.CrossRefGoogle ScholarPubMed
Meagher, G, Cortis, N, Charlesworth, S and Taylor, W (2019) Meeting the Social and Emotional Support Needs of Older People Using Aged Care Services. Sydney: Macquarie University, UNSW Sydney and RMIT University. Available at http://doi.org/10.26190/5da7d6ab7099a.Google Scholar
Productivity Commission (2011) Caring for Older Australians, Volume 1. Report No. 53, Final Inquiry Report. Canberra. Available at https://www.pc.gov.au/inquiries/completed/aged-care/report/aged-care-volume1.pdf.Google Scholar
Royal Commission into Aged Care Quality and Safety (RCACQS) (2019 a) A History of Aged Care Reviews (Background Paper No. 8). Adelaide, Australia: Commonwealth of Australia. Available at https://agedcare.royalcommission.gov.au/publications/Documents/background-paper-8.pdf.Google Scholar
Royal Commission into Aged Care Quality and Safety (RCACQS) (2019 b) Interim Report: Neglect, Volume 1. Adelaide, Australia: Commonwealth of Australia. Available at https://agedcare.royalcommission.gov.au/publications/Documents/interim-report/interim-report-volume-1.pdf.Google Scholar
Royal Commission into Aged Care Quality and Safety (RCACQS) (2019 c) Navigating the Maze: An Overview of Australia's Current Aged Care System (Background Paper No. 1). Adelaide, Australia: Commonwealth of Australia. Available at https://agedcare.royalcommission.gov.au/publications/Documents/background-paper-1.pdf.Google Scholar
Royal Commission into Aged Care Quality and Safety (RCACQS) (2020) Royal Commission into Aged Care Quality and Safety. Counsel Assisting's Final Submissions 22 October 2020. Available at https://agedcare.royalcommission.gov.au/sites/default/files/2020-10/RCD.9999.0541.0001_1.pdf.Google Scholar
Sen, A (1993) Capability and well-being. In Nussbaum, MC and Sen, A (eds), The Quality of Life. Oxford: Oxford University Press, pp. 3053.CrossRefGoogle Scholar
Steering Committee for the Review of Government Service Provision (SCRGSP) (2019) Report on Government Services 2019. Part f, Chapter 14, Aged Care Services Report and Attachment Tables. Available at https://www.pc.gov.au/research/ongoing/report-on-government-services/2019/community-services/aged-care-services/rogs-2019-partf-chapter14.pdf.Google Scholar
Tune, D (2017) Legislated Review of Aged Care. Canberra: Commonwealth of Australia as represented by the Department of Health. Available at https://agedcare.health.gov.au/sites/default/files/documents/08_2017/legislated_review_of_aged_care_2017.pdf.Google Scholar
Veit-Wilson, J (1994) Dignity Not Poverty: A Minimum Income Standard for the UK. London: Institute for Public Policy Research.Google Scholar
Veit-Wilson, J (1998) Setting Adequacy Standards: How Governments Define Minimum Incomes. Bristol, UK: Policy Press.Google Scholar
Visvanathan, R, Amare, AT, Wesselingh, S, Hearn, R, McKechnie, S, Mussared, J and Inacio, MC (2019) Prolonged wait time prior to entry to home care packages increases the risk of mortality and transition to permanent residential aged care services: findings from the Registry of Older South Australians (ROSA). Journal of Nutrition, Health & Aging 23, 271280.CrossRefGoogle Scholar
Vlachantoni, A (2019) Unmet need for social care among older people. Ageing & Society 39, 657684.CrossRefGoogle Scholar
Vlachantoni, A, Shaw, R, Willis, R, Evandrou, M, Falkingham, J and Luff, R (2011) Measuring unmet need for social care amongst older people. Population Trends 145, 6076.CrossRefGoogle Scholar