july 2019 - coredata research australia...care market. 1 aged care pricing commissioner 2018 2...

AGED CARESTATE OF THE INDUSTRY

JULY 2019

COREDATA AGED CARE REPORT 2019

32

CONTENTS

INTRODUCTION6

10 EXECUTIVE SUMMARY

14 RESIDENTIAL CARERespite care playing greater role in Australia’s age care sector

Permanent residential care occupancy rates reach 10-year low

Residential care profits are subdued

Residential care services continue to receive the lion’s share of government funding

As approval numbers reach new heights, there is more ‘luxury’ residential care on offer

HOME CARESupply is not keeping pace with demand, leaving more people queued longer

Packages assigned are often not meeting recipients’ needs

Large numbers of Australians are languishing with no, or limited home care support

Quality of all care services a growing concern

Private for profit and local government providers have increased market share

HOME SUPPORTHome support dominates aged care market share

Entry level services to support wellbeing and independence

Well-funded systems are necessary to identify and care for ageing Australians

MARKET OUTLOOKExpenditure on healthcare set to rise

Revenue growth anticipated to remain consistent, despite troubles faced by industry

The Royal Commission into Aged Care Quality and Safety has highlighted concerns about industry

Key Challenges Facing Aged Care Sector

REFERENCES

14

15

15

16

17

2021

21

22

23

24

2828

28

30

3434

34

34

35

38


54

INTRODUCTION1


76

CoreData’s 2019 Aged Care Report is an annual investigation into Australia’s aged care landscape. The report provides a detailed view of the ways in which service providers are adapting in the wake of recent regulatory reforms, and highlights the market outlook for residential care, home care and home support.The aged care industry in Australia is undergoing a raft of changes driven by changing regulation, consumer preferences and the Royal Commission into Aged Care Quality and Safety.

Growth in demand, particularly for home care services, is outpacing supply and and impacting the ability of older Australians to access the level of service they require. At the same time, the sector is facing heightened expectations and a Royal Commission which will likely result in significant changes to service provision, at a time when many providers are struggling to survive.

This report aims to assist providers in understanding and responding to the market forces impacting the provision of aged care services in Australia.

In preparing the report, CoreData has relied on publicly available secondary data.

We acknowledge the contribution of third parties such as the Aged Care Financing Authority, Productivity Commission, The Department of Health, and Stewart Brown, among others cited in the report, from whom data has been incorporated and analysed to provide an overview of the key trends in the sector.

This paper offers an Australia-wide view of the aged care market. For state-based analysis, or bespoke aged care research needs, please contact CoreData.

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INTRODUCTION


98

EXECUTIVE SUMMARY2


1110

1

3

5

2

4

Respite Care is claiming an ever-growing stake in the aged care sector

Respite care enables older Australians to live in their own homes and still receive the care they need from their families, friends, and others. Far fewer people access respite care, as opposed to permanent residential care, but it is growing at a far greater rate (approximately four times faster).

Top and middle price-range residential care is showing strongest growth

Where residential care growth has stagnated at the lower end of the pricing options, the middle-range and more luxurious options have seen stronger growth. However, the lower range still constitutes the bulk of approvals.

Supply is struggling to meet the level of demand for home care

As demand continues to outweigh supply of government funded home care packages, the number of people in the queue, and their average wait time, is ballooning. At June 2018, 121,418 Australians were queued for home care services. This reflects an increase of more than 20% in just a 12-month period.

Permanent residential care occupancy rate is plummeting

As demand for respite care and other services grows, the occupancy rate of permanent residential care has experienced a sharp decline. This is despite the continued rise in operational permanent residential places.

Demand for home care services is rapidly increasing Older Australians are increasingly choosing to remain living at home longer. As more people turn their back on residential care, pressure on home care is rising.

6

87

Quality of care is suffering as a result of market imbalance

The mismatch between supply and demand, and rising costs of service provision, has seen aged care providers struggle to maintain quality standards, evidenced by an increase in the number of credible complaints.

CHSP funding needs to keep rising The upward trend of CHSP funding from the government needs to stay its course in order to accommodate the increasing ageing population.

Home support still dominates the aged care market share

With 65.1% of all aged care customers opting for home support, this area of the industry still dominates the market (in terms of customer numbers). The majority of users adopt the lower level packages offered in the CHSP.

EXECUTIVE SUMMARY

10Industry revenue is anticipated to continue steady growth Despite the challenges, the outlook for industry revenue is positive. This is a result of the heightened demand for services, and the expected positive outcome of the Royal Commission on consumer confidence and quality standards.9Residential providers are struggling to

remain profitable The number of residential aged care facilities operating in good financial health is deteriorating. One in every five facilities (21.2%) recorded a net operating cash loss in 2018, up from 16.1% in the previous financial year.

THE 10 KEY TAKEAWAYS


1312

RESIDENTIAL CARE3


1514

RESIDENTIAL CARE

The residential aged care sector is characterised by consolidation and growth. While operational places increased by 3.2%, and the number of services used by 1.7% in the year to June 2018, the number of providers contracted by 5.0% during the same period.1

Demand for residential aged care services continues to be driven by the nation’s rapidly ageing population. However, demand and usage varies across the sector, which is comprised of permanent and respite care.

Despite the increased number of people accessing residential care services, the sector’s share of the aged care market fell from 24.4% to 23.0% between June 2017 and June 2018, as growth was outpaced by other sectors.2

There are a number of key trends impacting the residential care market.

1 Aged Care Pricing Commissioner 20182 Productivity Commission 2019

Respite care playing greater role in Australia’s age care sectorRespite care helps enable those older Australians who want to live in their own homes for longer. Services also provide respite for family members who may be caring for and assisting elderly relatives. Far fewer people access respite care, as opposed to permanent residential care. However, growth in the number of people using respite care services has outpaced permanent care users, the former increasing by 4.7% over 2017-2018 compared to just a 1.0% increase in the latter. At June 2018, one in five people using residential care services were in respite care.

RESIDENTIAL AGED CARE SERVICES – GROWTH BY SERVICE TYPE 2017-2018

Permanent residential care occupancy rates reach 10-year lowThe number of operational aged care places has continued to expand at an annualised rate of 2.1% in the five years to June 2018. This has not kept pace, however, with 3.3% annualised growth rate of Australians aged over 65.3 Despite this disparity, the occupancy rate of residential aged care places has continued to decrease. In 2018 occupancy rates fell to just 90.3%, the lowest level in the past 10 years.4

A variety of factors are contributing to the decline in residential occupancy, with increasing preference for home care a key factor. Reviews of aged care quality reveal thousands of allegations and concerns across a broad range of issues, from the use of physical and chemical restraints, to cases of abuse and neglect and sub-par clinical care, including infection control, wound management and medication management.5 In light of this, it is possible that this trend toward respite and also to home care reflects a dissatisfaction with the quality of care received in residential care settings. Quality issues are not surprising given the proportion of providers operating at a loss in the sector.

RESIDENTIAL AGED CARE - OPERATIONAL PLACES AND OCCUPANCY RATES, 2009-2018

Residential care profits are subduedLow occupancy rates, combined with increasing staff costs, have contributed to falling profits in the residential aged care sector. Results from the 2018 financial year show a decline in the average residential care service earnings before interest, tax, depreciation, amortisation, and restructuring or rent costs (EBITDAR). In the year to September 2018 the EBITDAR fell $1,161 to $7,737 per bed per annum.6 Profits are expected to continue their decline as earnings fall and costs rise.

3 ABS 31014 Productivity Commission 20195 Royal Commission into Aged Care 20196 Stewart Brown 2018

Source: Productivity Commission 2019

Residential Care Home Care

Home Support Transition Care

23.0%

250,000

200,000

150,000

100,000

5000

0Permanent Respite

2017 2018

+1.0%

+4.7%

85%

86%

87%

88%

89%

90%

91%

92%

93%

94%

95%

150,000

160,000

170,000

180,000

190,000

200,000

210,000Occupancy rate (RHS)

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Num

ber o

f peo

ple


1716

AGED CARE SERVICES - CHANGES IN GOVERNMENT EXPENDITURE 2013-2018

7 Stewart Brown 20188 IBIS 20189 Stewart Brown 201810 Productivity Commission 2019

There are a number of drivers of increased cost in the sector. These include increasing care hours per day, up by 0.15 hours per person per day in 2018, and increased service delivery costs. The typical patient now requires over 3.06 hours of care per day, while service delivery costs have exceeded revenue growth by $7.85 per bed per day. These cost increases, likely due to demand pressures and numerous supply constraints, are having a large impact on the industry, and the scope in which it operates.7

The external drivers of subdued profitability in the industry are those that apply upward pressure on demand for these services, where supply is unable to meet demand. Two of the key drivers of demand, according to an IBISworld report, are the ageing population, and the increase in average weekly working hours. The link between the age of the population and demand for aged care is intuitive, but rising weekly working hours impacts the industry further, as IBISworld’s Arna Richardson explains:

“The number of hours worked can influence a family member’s ability to take care of ageing parents. A rise in the average weekly hours worked often leaves fewer hours to provide care services for elderly relatives, thereby directly boosting demand for aged-care residential services.”8

The number of residential aged care facilities operating in good financial health declined over the 2017/2018 financial year, the result of low earnings and high costs. Some 21.2%, or one in every five facilities recorded a net operating cash loss in 2018, up from 16.1% in the previous financial year. Residential aged care facilities operating in regional and remote areas felt the pinch more so than their urban counterparts. Outside the metropolitan area, 63.5% of facilities recorded a net cash loss in the 2018 financial year, almost double that of the previous financial year.9 The service delivery costs faced by regional and remote providers are higher than their metropolitan counterparts, and the retention of high quality staff is an ongoing and costly challenge.

Residential care services continue to receive the lion’s share of government fundingResidential care services accounted for 23.0% of total aged care service usage over the 2017/ 2018 financial year, a decline from more than 24% the previous year. Over the same period, there was a slight increase in total government expenditure on these services as shown in the figure below. As of the last financial year, almost 71% of government aged care expenditure, or just under $13 billion funds was for residential care.10


As approval numbers reach new heights, there is more ‘luxury’ residential care on offer As demonstrated in the figure below, lower- and middle-range aged care options still hold the bulk of the approvals share. However, it is worth noting that, while all approvals have increased from 2014-2018, the lower end of the price range has stagnated in the past couple of years, while the upper end (particularly $1,000,000 - $1,250,000) has increased rapidly. This could be seen as a sign of rising demand for higher-end or luxury residential care, greater consumer expectations around quality of care, and providers increasing prices to account for the rising cost of care provision.

APPROVALS ARE INCREASING AT A GREATER YEARLY RATE IN THE UPPER AND MIDDLE PRICES

$551,000 to under $700,000 $700,000 to under $1 million

$1 million to $1.5 million $1.5 million and above

1,797

2,401 2,511

2,053

4,3224,588

343 329538

84 186 680

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

3 year average to June 2016 2016-17 2017-18

5.5%

13.6%

1.7%

-4.2%

4.7%

Source: Aged Care Pricing Commissioner 2018

-10% -5% 0 5% 10% 15%

Total Expenditure on Aged Care Services

Workforce Quality and Ageing and Service Improvement

Residential Care and Flexible Care Services

Home Care and Support Services

Assessment and Information Services

2016-17

Num

ber o

f app

rova

ls


19184 HOME CARE


2120

Among older Australians the growing preference to remain living at home longer, is placing increased pressure on home care.

The home care sector is the most rapidly growing in the aged care market. Between June 2017 and June 2018, the number of people using home care services jumped to just under 92,000, an increase of 28.6% . These packages serve the needs of individuals requiring varying levels of support. Growth has varied across the sector, with level 1 and 3 packages the key drivers, despite their lower overall usage.

The desire to remain in their own homes has driven an increas in the market share of home care services, from 8.3% to 9.9% in the year to June 2018. During the same period, the number of home care providers increased by 18.2%, to 869.

Supply issues continue to plague the sector, with some concerns around service quality due to limited supply and heightened demand.

HOME CARE

Supply is not keeping pace with demand, leaving more people queued longerThe national prioritisation queue houses all those who have been approved by the Aged Care Assessment Team (ACAT) for a home care package, but who are still waiting for one to become available. As demand continues to outstrip supply of government funded home care packages, the number of people in the queue, and their average wait time, is ballooning. At June 2018, 121,418 Australians were queued for home care services. This reflects an increase of more than 20% in just a 12-month period.

For those queued there is an average wait time between package approval and availability of 121 days. Concerningly, 35.6% of those queued during the year to June 2018 were waiting more than nine months for service approval.13

13 Australian Institute of Health and Welfare 201814 Productivity Commission 2019

Packages assigned are often not meeting recipients’ needsThe majority of home care packages assigned are for basic care (Level 1) and low-level care (Level 2). These accounted for a combined 61.4% of package assignments in the year to June 2018. However, as of June 2018, the national prioritisation queue was predominantly those approved and waiting for intermediate (Level 3) and high-level care (Level 4) packages. Only 21.5% of people queued are waiting for basic or low-level packages. Rather, a significant proportion of those with higher level needs are accepting an interim option of lower level support while still waiting for the appropriate level care.



HOME AGED CARE SERVICES – USAGE GROWTH BY SERVICE PACKAGE LEVEL 2017-2018

+326.0%

+9.0%

+86.8%

+40.5%

0

10,000

20,000

30,000

40,000

50,000

60,000

Level 1 Level 2 Level 3 Level 4

2017 2018

11 Australian Institute of Health and Welfare. People using aged care. 201812 Department of Health 2018

ELAPSED TIME BETWEEN ACAT APPROVAL AND ENTRY INTO AGED CARE SERVICES, 2009-2018


9.9%

0

20

40

60

80

100

120

140

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2009

% > 9 months (LHS)

2012 2013 2015 2017 2019



2322

COMPARISON OF HOME CARE PACKAGE USE AND APPROVALS BY LEVEL NATIONAL PRIORITISATION QUEUE, ASSIGNED VS NOT ASSIGNED A LOWER LEVEL PACKAGE, JUNE 2018


Large numbers of Australians are languishing with no, or limited home care supportThe majority of those queued are receiving some form of home care support (53.3%). However, 46.7% are receiving no home care services at all. Of these, around half elect to access CHSP while they wait, with the other half waiting remain without service.15 Those waiting for Level 3 packages are most likely to do so without any home care services to support them (38.6%).

The Federal Budget 2018-19 included the allocation of 14,000 additional higher-level home care places.16 This represents just 24.5% of the number of people approved and waiting for access to Level 4 packages. Unsurprisingly, the Aged Care Financing Authority (2018) has stated that some of the most desperate and in need Australians are going without any support that could be “considered adequate.”17

HOME CARE

15 Department of Health 201816 Aged Care Financing Authority 201817 Aged Care Financing Authority 2018

Quality of all care services a growing concernAs demand increases and supply becomes more broadly distributed, it is understandable that the quality of aged-care services would begin to decrease. A good indicator of quality (or lack thereof) is the number of credible complaints that the Aged Care Complaints Scheme receives from customers.

As can be clearly seen in the figure below, the number of complaints is increasing at a rate much faster than the number of users – a clear sign of the declining quality of the services being provided to residents.

If the imbalance between supply and demand isn’t corrected soon, it is likely that this will continue.

RESIDENTIAL AGE CARE COMPLAINTS, 2012-2018

17.7

19.9

23.119.3

22.7 22.421.6

22.1

26.4

10

12

14

16

18

20

22

24

26

28

2012 2013 2014 2015 2016 2017 2018

0.4%

21.2%

31.3%

47.1%

Queue by approved package level

Level 1

Level 2

Level 3

Level 4

5.3%

56.1%13.8%

24.8%

Package use by levelLevel 1 Level 2 Level 3 Level 4

0

10,000

20,000

30,000

0,000

50,000

60,000

70,000

Source: Department of Health 2018


Num

ber o

f com

plai

nts

Assigned lower level interim package Not assigned any package

Permanent & Respite Permanent


2524

Private for profit and local government providers have increased market shareHome care is provided by for-profit, religious, community-based and charitable organisations, as well as local government. While charitable and religious providers currently provide the majority of packages (57.7% combined), their market share is stagnating. Private, for profit providers, however, are showing strong growth, holding 16.9% market share at June 2018, up from just 10.0% just three years ago.18 The bulk of this growth occurred in the year to June 2018.

HOME CARE

MARKET SHARE GROWTH BY PROVIDER TYPE

GROWTH IN HOME CARE PACKAGE RECIPIENTS BY OWNERSHIP STATUS OF PROVIDER, 2018


Home care services account for 10.1% of aged care expenditure, compared to 75.5% for residential care.¹⁹ By providing more cost-effective care in-home, the home care sector has the potential to reduce the burden on residential aged care, and hospitals, in terms of both service demand and government expenditure.

18 Aged Care Financing Authority 201819 Aged Care Financing Authority 2018

2.6% 4.3%

16.9%

18.5%

27.9%

29.8%

10.8% 7.1% 12.1% 9.5%0.4% 1.1%1.6%

-10.6% -9.9% -10.8%-23.5% -27.8%

87.0%

12.5%

34.2%

20.2%

42.7%

11.5%

-40%

-20%

0%

20%

40%

60%

80%

100%

Private for Religiousbased

Charitable Stategovernment

Localgovernment

2016 2017 2018

Community

Community-baseReligious

Local Government State Governmentd

Charitable


27265 HOME SUPPORT


2928



ALMOST TWO IN THREE AGED CARE CLIENTS RECEIVE HOME SUPPORT

Private for profit and local government providers have increased market shareBy client number, home support is the largest aged care sector.20 After peaking in 2015, then declining the following year,21 growth in the sector was moderate over 2017/2018 at 7.5%, with almost 858,000 Australians receiving services. It appears that one driver of increasing home support service uptake is the comparatively high cost to recipients of Level 1 and 2 home care packages.22

Across Australia, home support services are provided under the Government’s Commonwealth Home Support Program (CHSP). However, in WA, services were still delivered under the old Home and Community Care (HACC) program until the state transitioned to CHSP on 1 July 2018.

HOME SUPPORT

CHSP SERVICE USE, JUNE 2018 (%)


Australians aged 65 and over are making use of the services on offer. On average, Australian seniors are consuming 8.6 services per person per year. Australians from Queensland are the greatest consumers of home support services with the average senior Queenslander making use of 10.9 services per year on average.24Entry level services to support

wellbeing and independenceA broad variety of home support care services are offered under the CHSP. While most people access social support and domestic assistance services, a range of clinical care, home maintenance and general living supports are also available. Services provided are typically small in volume and low level, to assist individuals in maintaining their independence and quality of life while delaying their need for higher level, more costly supports and residential care. Over 68% of Commonwealth Health Support Services are related to non-medical services. For this reason, and the lack of accommodation expense, home support expenditure represents just 11.6% of the government aged care budget.

While delivery of Level 2 supports dominates the sector, almost one in three are in receipt of intermediate or high level home care.23

HOME CARE CONSUMERS, BY PACKAGE LEVEL

20 Productivity Commission 2019 21 Aged Care Financing Authority 201822 Aged Care Financing Authority 201823 Aged Care Financing Authority 2018 24 Productivity Commission 2019

Home support services are the first engagement many people will have with the aged care industry. Ease of access and quality provides a foundation for physical, psychological and financial wellbeing that promotes independence and less reliance on high level, resource intensive support.

1.6%

66.2%9.5%

22.7%

Level 1 Level 2 Level 3 Level 4

0.0% 5.0% 10.0% 15.0% 20.0% 25.0%

0.2%0.3%

1.8%

3.1%

3.4%

5.3%

5.8%

6.2%

7.9%

8.6%

10.0%

23.1%

24.3%

Other Food Services

Assistance with care and housing

Specialised Support Services

Home Maintenance

Centre Based Day Care

Allied Health Care

Personal Care

Social Support - individual

Nursing Care

Social Support (group)

65.1%



3130

AUSTRALIAN GOVERNMENT CHSP GRANTS, 2016-2017

HOME SUPPORT

Source: Aged Care Financing Authority 2018

As the CHSP system matures and expands, prices are likely to stabilise as economies of scale combat inflationary pressures. The hourly cost of all services fell in the year to June 2018. The greatest reduction in cost came from nursing services, which fell by 45.3%.26

HOURLY COST OF CHSP SERVICES, 2017-2018


25 Aged Care Financing Authority 201826 Productivity Commission 2019

Well-funded systems are necessary to identify and care for ageing AustraliansThe government continues to raise and allocate funds towards the CHSP. Between the 2015-16 and 2016-17 financial years Commonwealth funding for the CHSP rose from $2.2 to $2.4 billion, an increase of 9.1%. Over the 2012-2017 period funding for the CHSP grew at an annualised rate of 8.4%.25 The Commonwealth government should continue to fund home support programs in order to increase the contact with ageing Australians and foster a system of attentive and preventative care.

$51.7

$70.6

$118.8

$142.3

$49.4

$62.2

$102.3

$77.9

$0

$20

$40

$60

$80

$100

$120

$140

$160 2017 2018

Domestic Assistance Personal Care Allied Health Nursing

693

138195

1867

22 20 2

15783

118

80

200

400

600

800

< $0.5m $0.5m - $1m $1m - $10m $10m+

Government

Num

ber o

f gra

nts

Cost

per

hou

r


33326 MARKET OUTLOOK


3534

ACTUAL AND FORECAST RESIDENTIAL AGED CARE SERVICES REVENUE, 2009-2023

Expenditure on healthcare set to riseAs Australia’s population ages, the public expenditure on healthcare services will rise as the use of aged care services increases. The greatest proportion of a person’s lifetime healthcare expenditure comes in the last years of their life. Population ageing will continue to support growth in the aged care sector, although the nature of aged care services and delivery is likely to continue to evolve.

Revenue growth anticipated to remain consistent, despite troubles faced by industryAs is clear in the revenue projections provided by IBISworld, industry revenue is expected to continue growing in the next decade and beyond. The demand for aged care services is at its peak, and will continue to grow over time. Revenue is also expected to rise on the back of the outcomes of the Royal Commission, as regulation improves the quality of the industry as a whole.

MARKET OUTLOOK COREDATA AGED CARE REPORT 2018

The Royal Commission into Aged Care Quality and Safety has highlighted concerns about the industryHowever, there are clouds on the horizon with uncertainty hanging over the industry due to the Royal Commission into Aged Care Quality and Safety that was underway at the time of writing. The Royal Commission was established on 8th October 2018 by the Governor-General, with hearings commencing on the 6th May 2019. The Commissioners will provide an interim report by 31st October 2019, and a final report by 30th April 2020.

Key challenges facing aged care sector

Restrictive practices in residential aged care in Australia“The use of restrictive practices in residential aged care in Australia is contentious. There is significant public interest in the issue of restraint and ways to reduce or avoid it. Numerous media reports and inquiries have highlighted accounts of the misuse or overuse of physical restraint and psychotropic medication. This includes personal accounts from members of the public about residents being physically restrained frequently, or for long periods of time, or restrained without consent”

Dementia in Australia: nature, prevalence and care

“Over half (52%) of people living in residential aged care in 2016 have a diagnosis of dementia.

People living with dementia will have different experiences of care, from the time of diagnosis

and living at home, to care in residential aged care, and palliative and end-of-life support. Improving

dementia care drives research into prevention, assessment and diagnosis, intervention and

treatment, living with dementia, and models of care”

Medium- and long-term pressures on the system: the changing demographics and dynamics“Normal ageing slows functionality, but age-related physical, emotional and social changes can be anticipated and managed by understanding the ageing process, adopting a healthy approach to ageing throughout life and adapting to specific changes. Care available from within the community can support adaptation. However, chronic conditions can diminish functionality. Supportive environments and integrated care systems can help ensure that older people whose capacity has diminished live with dignity and grow personally”

Navigating the maze: an overview of Australia’s current aged care system“More older Australians will mean a greater

demand for aged care and greater pressure on government budgets. In addition to the sheer

increase in the demand for aged care, we can also expect changes in the needs of people requiring

care, with changing patterns of disease, more diverse preferences for and expectations of care,

changing wealth levels and developments in technology”

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

2009 2011 2013 2015 2017 2019 2021 2023

($ m

illio

ns)

Actual Projected

Source: IBIS 2018

Source: The Royal Commission into Aged Care Quality and Safety


37367 REFERENCES


3938

Aged Care Financing Authority: Factors Influencing the Financial Performance of Residential Aged Care Providers, 2018, Canberra: The Australian Federal Government

Aged Care Financing Authority, 2018, Sixth Report of the Funding and Financing of the Aged Care Sector, Canberra: Australian Federal Government

Aged Care Pricing Commissioner: Annual Report 2017-18, Australia, Sydney

Australian Bureau of Statistics, September 2018, 6523 – Household Income and Wealth, Australia, Sydney

Australian Bureau of Statistics, September 2018, 4125 – Gender Indicators, Australia, Sydney

Australian Bureau of Statistics, December 2018, 3101 – Population estimates, Australia, Sydney

Australian Bureau of Statistics, May 2019, 8155 – Australian Industry, Australia, Sydney

Australian Bureau of Statistics, May 2019, 6291.0.55.001 – Labour Force: Detailed, Australia, Sydney

Brown. L, Hansnata. E, Anh La. H, February 2017, Economic Cost of Dementia in Australia: 2016-2056, Alzheimer’s Australia, NATSEM & the University of Canberra, Sydney

Department of Health, December 2018, Home care Packages Program Data Report 2nd Quarter 2018-2019, Canberra

Department of Health, Report on the Operation of the Aged Care Act 1997, 2016, Canberra

Department of Home Affairs, May 2018, Historical migration statistics, Canberra

Leading Age Services Australia, November 2017, Second Home Care provider Survey Report: Reflecting on the First Year of Increasing Choice in Home Care, Melbourne

Productivity Commission 2011, Caring for Older Australians, Inquiry report, Productivity Commission, Canberra

Productivity Commission, Report on Government Services 2018: Volume F: Aged Care Services. Section 14, Canberra

Productivity Commission, Report on Government Services 2019: Aged care services data attachment: Section 14, Canberra

Richardson, A., April 2018. IBISWorld Industry Report Q8601: Aged care Residential Services in Australia, Melbourne: IBISWorld

Stewart Brown, Aged Care Financial Performance Survey: Residential Care Report, March 2019, New South Wales

REFERENCES

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