What’s needed to make ‘ageing in place’ work for older Australians
Ageing in place is preferred by the majority of older Australians
10 December 2019
Recent interim findings from the Royal Commission into Aged Care Quality and Safety have led to the Australian Government increasing the number of home care packages by 10,000. The home care packages aim to help older Australians ‘age in place’—in December 2018, 93,331 people were receiving a home care package to help with their day-to-day living, while (in March 2019) another 75,739 people were waiting for a home care package.
What is ageing in place?
Ageing in place means that as people get older they can remain living in their home rather than entering residential aged care, even when the impacts of old age (e.g. the increasing risk of illness or disability) affect their mobility and mental ability.
Ageing in place requires a degree of independent living ability for the older person (with both adequate levels of mental and physical ability), but gives them control over their living space and how they live, as well as ongoing connection to the community that they are used to. It doesn’t necessarily mean they will continue living in the same dwelling throughout their retirement, rather that they won’t be living in a nursing home.
When ageing in place works, it brings a decent quality of life to individuals and families, and saves governments money in providing residential age care facilities. Indeed, the average annual cost of care for older Australians who receive assistance was $15,525 (adjusted to $2018) for those who received In-home formal and informal care and $66,512 (adjusted to $2018) for those in residential aged care.
Recent AHURI research reveals that between 78 and 81 per cent of older Australians aged over 55 (depending on age cohort) want to live in their own home as they age. An earlier Australia-wide survey of older Australians revealed a host of reasons why older Australians wanted to age in place including suitability of the dwelling, proximity to family and friends, shopping, transport and health services, and because of familiarity with the local community and neighbourhood.
What is required for ageing in place to work?
The dwelling needs to be able to accommodate the changing requirements of the occupants as they get older. If a person retires at 65 they might expect on average to live for another 19.7 years if they’re male and 22.3 years if they’re female. During that time their health and income levels may change significantly. While only 5 per cent of those aged 55–64 require assistance with core activities due to illness or disability, that percentage rises to nearly half (47%) of those aged 85 and over.
With around 80 per cent of the activities an older person undertakes typically taking place in the home, modifications required by older people with disabilities to live at home safely include ramps and handrails, and changes to facilitate daily living activities such as bathing, grooming and cooking.
The introduction of a Universal design code, where dwellings are designed and built to provide for a wide range of abilities without any need for further modification, may further improve the ability of larger numbers of older Australians to age in place into the future. Features of a Universal design include doorways wide enough for wheel chairs, reinforced walls for future grab rails and open plan bathrooms that allow good entry to shower recesses.
When assistance is provided primarily within the home (by family members or visiting professionals), the dwelling and its fittings may need to be modified so as to enable lifts, hoists and wheelchairs to operate effectively.
There are challenges for non-home owners who may wish to age in place however as landlords in the private rental market or social housing may be less inclined to modify the property. Research shows that while the vast majority of older people never enter residential care, the most vulnerable people—those in social housing flats—were the most likely to enter residential care, and those in owner-occupied housing were the least likely to enter residential care.
The dwelling needs to be affordable for the older person to continue to ‘age in place’. Affordability includes not just the initial purchase cost but also being able to afford all ongoing costs such as rates, insurances, maintenance and repairs, as well as any modifications required due to mobility or health issues of the residents. For older Australians on reduced or lower incomes (such as the age pension or income from self-owned investments) housing costs can be greater than anticipated, and usually rise over time.
The right location
The dwelling also needs to be in ‘right neighbourhood’ for the older household members so as to maintain ongoing connection with the community. This means the dwelling should be close to family, friends, services such as health centres and amenities such as public transport, which is particularly important for older people who have a reduced ability to drive a car.
A suitably skilled pool of care workers is also needed to help older residents in their homes as required. These workers may be funded by individuals or with government subsidies. However, when workers are employed in the home, the home becomes a legal workplace and must include minimum requirements for the occupational health and safety of all those providing services to and within the home.