Home is where the care is: rethinking ageing in Australia

OPINION: For Professor Maria Inacio, aged care research is more than a profession - it’s personal. With her own loved ones navigating dementia and home care, she’s helping lead a national shift toward home-based care that prioritises dignity, independence, and better outcomes for older Australians.

I have been conducting research in the area of ageing and aged care since 2017, but my interest in this space goes beyond just professional curiosity - for me it’s also personal. My father had dementia for many years and passed away in a nursing home, and other close relatives have experienced major health events that led them to need support to continue to live at home independently. I’ve seen first-hand the struggles people face as they age and strive to stay in their homes.

How Australia’s approach to ageing has shifted 

As a trained epidemiologist, it was in 2017 when I became the Director of the Registry of Senior Australians (ROSA) at the Flinders University Caring Futures Institute. My research efforts were directed toward monitoring and evaluating the quality of care provided to older individuals receiving long-term care in Australia, whether in residential settings or through home-based support.

At that time, the predominant focus of research within the team, and more broadly across Australia, was on residential aged care. At the time the long term home support program, known as Home Care Packages, were still in their infancy and the short term services program was changing from the Home and Community Care Program to the Commonwealth Home Support Program. Although there was considerable discourse around the potential for home care to eventually supplant residential care, progress remained slow.

Prior to 2017 there had already been the introduction of consumer directed care, underpinned by new legislation that was supported by a number of consumer advocacy bodies and underpinned by research that found older people want to stay at home as long as possible and want to choose their own paths. However internationally at that time, most OECD countries had already started the shift of more long-term care options at home, but Australia was lagging.

It was in 2018 when things really started to shift thanks to the announcement of The Royal Commission into Aged Care Quality and Safety. The purpose of the Royal Commission was to inquire into the quality of aged care services, address systemic issues, and provide recommendations for improvement. The findings were startling, and it was clear, amongst many other recommendations that were handed down, that Australia needed to do more to keep people in their homes.

How we can improve home care support

We’re now at a place in Australia where that shift has happened and we are a country that care mostly for our elders in their own homes rather than in residential care facilities. 

However, it’s vital that we continue to conduct research in this space so that we can continue to allow individuals to age well.

Increasingly, research teams at Flinders University - including my own - have been dedicating more time and attention to understanding what it truly takes to support older individuals to live independently at home. It is clear that home care packages alone are insufficient to meet the complex needs of this population. 

The team have examined the experiences of people receiving aged care services both in South Australia and nationally. At a population level, we have determined that there are varying experiences between those individuals receiving home care packages and those in residential care. While part of this is due to differences in the individuals, part is also because of the health experiences they have and how they are managed in the different settings. Another aspect however is because people at home are at higher risk of certain adverse events without having adequate support. For example, we have determined that there are more hospitalisations for delirium and dementia related issues for those at home – more than two times higher, from four to 10 per cent. Weight loss and malnutrition is also more than two times higher for those at home from 2.5 to 5.5 per cent, and medication related adverse events affect those at home at a rate of 4.6 per cent versus 2.4 per cent.

These are all issues that we know residential care facilities likely address better on site, but when you have older people still living at home, there clearly needs to be more support to address these concerns. With a hospital system under strain, the answer cannot be to continually send these people there.

The strongest evidence of models of care that help people live at home longer are those that have both clinical and aged care components. We need care models that bring together different types of healthcare professionals and services from various sectors to work as a team. Supporting older people to live at home is not just the job of one sector and alone the aged care sector can’t do it. We need both health, aged, and social welfare to come together to best attend to older people’s needs.