Younger people in aged care is a problem: will the government keep its stated commitment?

Warehousing people with disability under 65 in nursing homes that are not resourced to meet their needs is a waste of human potential, argue Di Winkler and Peter Mulherin.

Australia has over 3,400 younger people living in aged care, due to a lack of timely funding for viable alternatives. Younger people living in aged care lose skills, social connection and hope. The federal government has committed to getting them out – but its targets will be difficult to achieve. 

In November 2019, Prime Minister Scott Morrison committed the government to the younger people in residential aged care (YPIRAC) targets. The three targets are as follows (barring exceptional circumstances): 

1. No people under 65 entering residential aged care by 2022.
2. No people under 45 living in residential aged care by 2022.
3. No people under 65 living in residential aged care by 2025.

Two of these targets are due by the end of 2022. 

Is the government on track?

No younger people entering RAC by 2022

Over 40 younger people continue to enter RAC each month in Australia – a 25 per cent decrease since 2020, but still 40 too many. The YPIRAC initiative has made it harder for young people to enter RAC: but it hasn’t necessarily resulted in better outcomes. A longitudinal evaluation is urgently needed to better understand the outcomes of people with disability who are at risk of RAC and no longer entering.

For example, Leila had a stroke in April 2021 and was unable to return to her former home in a wheelchair. A year later, Leila was still in hospital – waiting for NDIA housing and support funding. 

“I felt I was trapped,” she says. “It was like a prison”. 

Cut off from friends and family for weeks at a time, Leila found the pandemic particularly difficult. An interview with Leila and her sister can be heard in a podcast interview by Dr George Taleporos. 

Leila’s hospital stay cost Australian taxpayers twice the price of accommodating her in accessible housing with disability support. It also impacted her relationships, confidence, independence, and gains made in rehabilitation

Why are younger people still entering RAC?

Most young people enter aged care via hospital, falling through the gap between the hospital and disability sectors due to bureaucratic NDIS funding delays. Although some regional areas have less accessible housing, it’s not the main reason younger people end up in RAC. 

Housing Hub administrative data indicates that there are an estimated 3,000 vacancies in disability housing throughout Australia – 900 vacancies are in new housing called Specialist Disability Accommodation.

The primary reason younger people are still at risk of entering aged care lies in bureaucratic delays around NDIS funding. When people with a disability get stuck in hospital, the aged care system can provide funding for housing and support in three days. However, the NDIA currently takes an average of 60 days to approve scheme access and housing/support funding for hospital patients. 

The latest NDIS Quarterly Report reveals that 26 per cent of decisions for housing and support funding take over 90 days. Until the NDIA steps up and matches the efficiency of aged care with timely allocation of funding, younger people will always enter RAC.

No younger people living in RAC by 2025

Only 83 YPIRAC are aged under 45, which means target two may be met with additional focus and a strategic approach. However, there are still over 3,400 YPIRAC in total: so meeting target three by 2025 will be difficult.

The number of YPIRAC is falling, but mostly not for the right reasons. The drop is mainly explained by people dying in aged care – or because they turn 65 and “age out” of the cohort – and cease being counted. 

In the last year 791 YPIRAC exited aged care, but 71 per cent of these people died. Of those who left nursing homes alive, some went to hospital, some returned home – only 30 moved into NDIS-funded housing. 

Natural attrition is no way for the government to meet its targets. A more strategic and collaborative approach is required to achieve good outcomes for YPIRAC.

One person who has moved from aged care to a new disability housing with shared support is Helen. 

She says: “My life has changed since moving into my apartment. It’s just so wonderful to have people coming to my place. It’s wonderful to go out with them too, but just to sit down at my table and have a cup of tea or just talk, just talk in a normal environment. One of life’s simple pleasures.”

Her story of moving out of a nursing home can be seen here.

What is needed to achieve the YPIRAC targets?

To stop the flow of younger people into aged care the NDIA needs to match the efficiency of the aged care system, and decide to fund younger people at risk of RAC with housing and support within ten days. 

The Summer Foundation is partnering with the Victorian and South Australian governments to deliver a Housing Brokerage Service that supports discharge planners to document housing and support needs and identify housing options. Expanding this service to other states in addition to timely and accurate NDIA funding decisions would prevent most RAC admissions. 

As Helen says, “If you’re a person with disability living in a nursing or group home, it’s hard to imagine moving somewhere else – even if you don’t like where you are living and want to move”.

“With so many decisions and choices taken away, and with everything being done for me the same way each day, I lost my confidence and began to feel very passive,” she says. 

The NDIA needs to work with the sector to provide independent information and expert capacity-building for the younger people who remain in RAC. YPIRAC also need independent and skilled support, to document their housing needs and preferences.

This data would provide the Specialist Disability Accommodation market with the detailed information needed to build fit-for-purpose housing for YPIRAC. 

The current reality

Falling numbers of younger people in RAC overlook the grim reality: most don’t leave RAC for better housing. Australia won’t resolve this issue, unless the NDIA matches the efficiency of aged care, providing funding for people with disability in hospital and other young people at risk of entering RAC. 

The Down to 10 campaign is a coalition of over 130 health, housing and disability organisations calling on the next federal government to commit to funding housing and support for NDIS participants, when it’s needed. The bureaucratic delays in the NDIA require addressing: preventing new admissions of young people to RAC is a key reason why.