The Australian government has committed to getting all young people out of aged care facilities by 2025, but progress has been slow.
Just over three years ago, then-Prime Minister Scott Morrison said the federal government would finally solve the issue of young people with disability having to live in nursing homes. The government developed a strategy and committed to getting all young people out of aged care facilities by 2025.
This week, NDIS (National Disability Insurance Scheme) Minister Bill Shorten said this remained “absolutely the target”. The 2023–24 budget commitsA$7.3 million to “further reduce the number of people under the age of 65 living in residential aged care”.
Since 2020, the federal government has spent more than $50 million on initiatives that have done little to improve the lives of young people living in aged care or those at risk of entry.
Given the lack of progress to date, the three new initiatives to be funded by this commitment are unlikely to achieve the 2025 target of no younger Australians living in facilities meant for much older people.
Why are young people in aged care facilities?
Younger people are typically admitted to aged care facilities after a late-onset disability such as a brain injury, or deteriorating with a neurodegenerative condition such as multiple sclerosis.
Two-thirds of younger people enter residential aged care from hospital. They may not be able to return to their previous home because it isn’t wheelchair accessible or they need a high level of paid support.
While Australians under 65 who acquire a severe disability are eligible for the NDIS and funding for housing and support, NDIS processes are slow. Young people can get lost in the gap between the health and disability systems and fall into aged care.
Our recent analysis looked at the pathways into and out of aged care in 2021-22. It shows fewer young people are entering residential aged care each year.
In June 2022, 2,934 younger people were in residential aged care, down from 3,899 in June 2021. During the year, there were 553 new admissions.
Some 1,518 people left. But this was mostly due to people either turning 65 and “ageing out” or dying.
Pathways of the young people in residential aged care cohort 2021-22. Just 3% of people went to SDA, or supported disability accommodation. Summer Foundation
There are an estimated 3,000 vacancies in disability housing across Australia, 1,000 of which are newly built specialist disability accommodation.
Yet last financial year, only 39 young people left residential aged care to go into NDIS-funded specialist disability accommodation. More than 500 NDIS participants aged under 65 remain in residential aged care with a goal to move.
So while the number of young people in residential aged care is diminishing, they’re not necessarily finding alternative accommodation.
What hasn’t done the job so far?
Since 2020, the federal government has implemented a range of ideas with limited success.
A $29.5 million program employed coordinators to support younger people to either move out of, or avoid entering, residential aged care.
This has not delivered on its objectives. Outcomes reported at a recent public forum included supporting two younger people to leave aged care and nearly 80 young people in residential aged care to become NDIS participants.
The National Disability Insurance Agency (the NDIA, which administers the NDIS) has introduced specialist planners and an accommodation matching team.
But this team has had limited success, with fewer than 90 young people in residential aged care moving into their own home or disability housing that meets contemporary standards in 2022.
What’s in the budget?
The federal budget allocates $56.4 million to an NDIA “home and living” panel. This aims to increase the capacity of the NDIA to make timely and consistent decisions for NDIS participants seeking funding for housing and support. This will improve the consistency and timeliness of funding decisions and is urgently needed.
The budget allocation specific to young people in residential aged care includes training ($3.6 million) for the people to support and influence the decision of young people living in residential aged care who don’t have a goal to move.
The other funding is to centralise decision-making for younger people seeking to enter aged care ($2.4 million) and an evaluation of the young people in residential aged care initiative to date ($1.3 million).
What’s missing from the budget?
The federal budget doesn’t address funding for the skilled workforce needed to support this group to transition out of residential aged care.
Currently, young people are given a list of generic NDIS-funded support coordinators who do not have the expertise or skills to support them to make an informed choice about where they live or to support the transition into age-appropriate housing. There are no minimum qualifications for support coordinators.
Each young person in residential aged care requires around 40 hours of expert support from an experienced allied health professional to make an informed choice about housing and support options, and to move into their new accommodation.
Of the 2,153 young people in residential aged care who are NDIS participants, only 26% (556 people) currently have a goal to move. The budget targets the 1,597 people who don’t have a goal to move and not the 556 who do have a goal to move. This is perplexing.
A more logical approach would be to work with both groups and demonstrate great housing outcomes for the 556 people who want to move and share these stories to build the hope and confidence of people who are unsure about moving.
The initiatives announced in the budget do not address the main barrier to young people in aged care getting better housing outcomes: skilled support to explore alternative housing and move out of aged care.
A new approach
The federal government needs to collaborate with organisations with a track record of supporting young people in residential aged care to move out, rather than continue to rely on generic support coordinators with limited expertise.
The NDIA needs to step up and provide timely funding for contemporary disability housing and support for NDIS participants who have put their hand up to move out of aged care.
For young people in residential aged care where there is no suitable disability housing located near family and friends, the NDIA needs to provide the specialist disability accommodation market with detailed demand data so new housing can be built.
The NDIS is failing younger people in, or at risk of entering aged care. A new approach is needed.
Dr Di Winkler AM is an Occupational Therapist who has worked with people with severe brain injury for more than twenty years. Di was the Chief Occupational Therapist at Ivanhoe Manor Private Rehabilitation Hospital prior to developing a private practice working with people with acquired brain injury in the community. Di completed her PhD at Monash University focusing on the social inclusion of young people in nursing homes.
Di is the CEO and Founder of the Summer Foundation, a not-for-profit organisation dedicated to the issue of younger people living in Residential Aged Care (RAC). The Summer Foundation focuses on practical research and seeks to provide workable solutions that improve the health and well-being of this population. Di is also a director of Summer Housing, a not-for-profit Special Disability Accommodation (SDA) provider.
