Is Australia over‐reliant on residential aged care to support our older population?

To the Editor: In a recent MJA article, Dyer and colleagues1 stated, “Australia provides institutional long term care for almost 20% of the population aged ≥ 80 years, and 6% of those aged ≥ 65 years. This places Australia as the nation with the highest proportion of older people living in institutional care compared with 11 other nations”.

However, the Australian numbers quoted are not comparable to the other 31 countries in the Organisation for Economic Co‐operation and Development (OECD) database.2 The “almost 20% of the population aged ≥ 80” refers to all persons in residential aged care at some time over the course of a year, whereas other countries mainly report point‐in‐time data. Only two countries (Australia and Greece) submitted data relating to residents over an entire one‐year period.

In 2018, the Australian point‐in‐time rate for people aged ≥ 80 years was 13.9%.3 Point‐in‐time or census data are the appropriate numerator for calculating age‐specific usage rates for residential care, the standard method used in Australia for national purposes and the most common metric internationally.

For people aged ≥ 65 years, the point‐in‐time rate was 4.5%4 rather than the 6.0% reported by Dyer et al. This is the difference between the 174 875 residents aged ≥ 65 years living in residential aged care at 30 June 2018 and the 234 617 who had lived in residential aged care during the 2017–18 financial year. For residents aged ≥ 80 years, the comparable figures were 137 537 (point‐in‐time) and 186 952 (the financial year).3

The Box presents statistics from the OECD countries used by Dyer and colleagues but incorporating point‐in‐time data for Australia.3,4,5 For persons aged ≥ 65 years, Switzerland has the highest rate at 5.6%. Seven countries then pack closely in between Australia (4.5%) and Denmark (3.9%). Given OECD data have inevitable limitations for comparative purposes, based on differences in national systems and reporting, these seven countries have similar levels of use.

For people aged ≥ 80 years, rates are highest in Switzerland (16%), New Zealand (14%) and Australia (13.9%). Four additional countries sit close behind: the Netherlands, Sweden, Denmark and Canada, all in the 12.3–12.7% range.

Nationally, the accurate 2018 usage rates for Australia are 4.5% for people aged ≥ 65 years and 13.9% for those aged ≥ 80 years. Internationally, Australia is a relatively high provider of residential aged care, but there are a number of countries with similar or higher levels of provision. Although there is insufficient evidence to claim that Australia is over‐reliant on residential care, the authors’ argument for increased investment in community‐based care is nonetheless an important one.