The new dynamics of residential aged care in Australia: Continuity and change

Abstract

Objective: This paper tests the hypothesis that increases in recorded dependency levels of permanent residential aged care clients are associated with reduced length of stay and higher turnover. A secondary objective is to compare the Aged Care Funding Instrument with its predecessor, the Resident Classification Scale, on a common schema. Methods: Administrative data for all Commonwealth-subsidised residential aged care services in Australia from 2008-09 to 2018-19 were obtained from the National Aged Care Data Clearinghouse. More than 750 000 episodes of permanent residential aged care were analysed. The categories from the two rating systems were mapped to a six-level schema, primarily based on the dollar value of the categories at the time of transition. Results: There was a strong trend towards higher dependency ratings across admissions, residents, and separations. However, contrary to expectation, measures of system activity showed a slowing of the system: length of stay increased and turnover decreased. Conclusions: The mapping of dependency rating schemes to a common rating enables the analysis of long-term trends in residential care dynamics. There is no evidence that the marked increases in reported dependency ratings led to accelerated system activity, consistent with an earlier study. This analysis forms a solid base for ongoing analysis of care appraisals in the context of a possible new rating scheme. It highlights the interplay between policy changes and provider behaviour, and the need for robust data to monitor care appraisals and system dynamics. What is known about the topic?: Residential aged care subsidies are determined by care needs in relation to assessed dependency levels, using the Aged Care Funding Instrument since 2008, and before that, the Resident Classification Scale. Between 2008-09 and 2018-19, there was considerable growth in residents classified at more dependent levels, and this would be expected to result in greater turnover in the system. What does this paper add?: This paper maps the rating schemes to a simplified, common rating that enables the analysis of long-term trends in residential care dynamics. It shows that the system is slowing, contrary to the trends expected if residents were more frail as the reported ratings imply. The paper examines possible explanations of these trends, and addresses policy implications. What are the implications for practitioners?: In the context of a potential new client-dependency classification, this study shows the importance of robust measures of the dynamics of the system - and the underlying data - vis-à-vis the means by which client dependency is assessed.