Planning Ratios and Population Growth: Will There be a Shortfall in Residential Aged Care by 2021?

Actual and projected gaps in the provision of residential aged care in New South Wales, Australia

ObjectiveThe need for residential care services will grow significantly over the coming years as the general population in Australia continues to age. The aim of this study was to assess the adequacy of residential care services across New South Wales (NSW), Australia, in relation to the current and predicted future aging population.MethodThis study was a secondary data analysis. Existing datasets were compiled for analysis by creation of a temporal geodatabase, with predicted population data from 2019 to 2029 linked to corresponding geographic zones.ResultsDemand for operational places was over capacity in 2019, at 101.5%. From 2019 to 2029, this will grow to 120.2% of 2019 capacity by 2024 and to 135.6% by 2029. An additional 25 800 operational places will be required by 2029 to meet targets. During the previous decade of 2008-18, operational places grew by only 11 502 places.ConclusionsNSW was not providing an adequate level of residential aged care and, under current allocations, this problem will worsen substantially over time, with flow-on impacts for the health sector. With aged care reform a current federal government focus, the results of this study may guide decisions that better support the provision of residential aged care.What is known about this topic?The recently completed Australian Royal Commission into aged care noted widespread system failure and highlighted the gaps in medical services that older Australians were experiencing.What does this paper add?This paper reports that demand for residential aged care places in NSW was already over capacity in 2019 and that the availability of places varies considerably across the state. Further, an additional 25 800 operational places are required by 2029 to meet government targets. If the growth rate from the past decade is maintained, this will result in a shortfall of 14 298 aged care places in NSW alone.What are the implications?Without significant increases in the current rate of growth for aged care places, the mainstream medical and health sectors will face significant additional pressures arising from unmet need in both older patients and their informal carers.

Planning the supply of aged care services: It's time to talk denominators

OBJECTIVES

This paper explores how changes in demography, service use and the aged care system have implications for the appropriateness of the denominator in the aged care provision ratio.

METHODS

Official statistics were analysed to create five alternative scenarios for residential care planning in a 2000-2027 time series.

RESULTS

The four age-based denominators and a revised denominator incorporating age- and sex-specific disability rates generated diverse levels of absolute supply. The 75+ denominator produced 1400 fewer beds than the 70+ denominator by 2018, but over 14 000 additional beds by 2027.

CONCLUSION

The 70+ based ratio developed almost forty years ago has served its purpose reasonably well. However, changes in the nature of the aged care system, different patterns of use by age and sex, and demographic changes suggest that long-term aged care planning requires careful review in choosing a more robust version of the provision ratio for the future.

Identifying seminal papers in the Australasian Journal on Ageing 1982-2011: a Delphi consensus approach

AIMS

The aim of this study was to identify seminal Australasian Journal on Ageing papers published over 30 years through a Delphi consensus process.

METHOD

The main data collection was a three-round Delphi consensus study with 38 past and current members of the Australasian Journal on Ageing Editorial Board, Editorial Team and Management Committee.

RESULTS

Three papers were agreed as top-ranking. One of the top-ranking articles was also highly cited. One article was published in the 1990 s, two in 2001.

CONCLUSIONS

While it is difficult to judge how well the top-ranking papers represent seminal papers arising over 30 years, these papers do represent three different research strengths in Australasia, they do span three different disciplines, and they do reflect some of the diversity that characterises ageing research in Australasia over 30 years.

Developing an adaptive policy for long-term care capacity planning

This paper describes a refined methodology for determining long-term care (LTC) capacity levels over a multi-year planning horizon based on a previous study. The problem is to find a capacity level in each year during the planning horizon to meet a wait time service level criterion. Instead of a static policy for capacity planning, we proposal an adaptive policy, where the capacity level required in this year depends on the achieved service level in the last year as the state of the LTC system. We aggregate service levels into a few groups for tractability. Our methodology integrates a discrete event simulation for describing the LTC system and an optimization algorithm to find required capacity levels. We illustrate this methodology through a case study. The results show that the refined methodology overcomes the problems observed in the previous study. It also improves resource utilization greatly. To execute this adaptive policy in practice requires availability of surge or temporary capacity.

Perspectives of carers on the move from a hospital to a transitional care unit

The authors describe carers' experiences of the traditional process of moving a relative into residential care from an acute hospital admission and how a transitional care unit affected this experience. Telephone interviews (total 31) confirmed that looking for permanent care was a stressful, time-consuming, and confusing process for all carers. The transitional care unit did not make a great difference to the stress of finding a residential care vacancy, but the overall experience of transitional care was positive, with carers feeling that it gave them time to consider residential care options. Carers felt that a hospital was not the best environment to assess ongoing care needs. The implementation of transitional care did not reduce the stress felt by carers when looking for a residential care facility, but it was an acceptable alternative to waiting for residential care in hospital.

Relocation stress syndrome: the case of palliative care patients

Transfer of patients from palliative care services to nursing homes is necessary at present when a patient is relatively stable, but does not have adequate support systems at home. With the ageing of the population and the increasing incidence of cancer, the need for inpatient palliative care beds is growing with corresponding pressure for patients to be transferred to nursing homes. Transfer to a nursing home in the general population has been described extensively in the gerontology literature where a critical early phase of relocation has been identified by a high incidence of morbidity and mortality. The vulnerability of terminally ill patients means that they are at increased risk of suffering from stress associated with a transfer. The prognosis of a patient may be shorter than the time required for adjustment to the patient's new home. The issues surrounding transfer of palliative care patients to nursing homes and possible strategies designed to reduce distress associated with transfers are explored.