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Objectives: To assess changes following the 2013–21 Home Care Package (HCP) reforms in the rate of HCPs provided to Australians aged 65 years or older, the characteristics of people who have received HCPs, and the capacity of the program to meet demand for its services during 2018–21. Study design: Repeated cross‐sectional population‐based study; analysis of Australian Institute of Health and Welfare GEN Aged Care and Australian Department of Health Home Care Packages program data. Setting, participants: HCPs provided to non‐Indigenous Australians aged 65 years or older, 2008–09 to 2020–21. Main outcome measures: Changes in age‐ and sex‐standardised HCP rates (number per 1000 older people) and changes in proportions of recipients for selected characteristics, 2013–14 to 2020–21, overall and by care level; correspondence of proportional HCP supply and demand, 2018–19 to 2020–21, by care level. Results: A total of 490 276 HCPs were provided during 2008–21. The age‐ and sex‐standardised HCP rate rose from 9.23 per 1000 people aged 65 years or more in 2013–14 to 16.4 per 1000 older people in 2020–21. The increases in age‐ and sex‐standardised HCP rate between 2013–14 and 2020–21 were greatest for level 1 (from 0.19 to 5.05 per 1000 older people) and level 3 HCPs (from 0.35 to 3.62 per 1000 older people); the rate for level 2 HCPs declined from 6.75 to 5.82 per 1000 older people, and that for level 4 HCPs did not change. The proportion of culturally and linguistically diverse recipients rose from 10.8% to 16.2%; the overall proportion of recipients living outside major cities rose slightly, from 28.1% to 28.7%, but declined for higher care level HCPs (level 3: from 30.8% to 27.8%; level 4: from 29.6% to 25.2%). During 2018–19 to 2020–21, the proportions of lower level (1 and 2) HCPs generally exceeded demand, while the supply of higher level (3 and 4) HCPs generally fell short of demand. Conclusions: Despite the increased overall availability of HCPs, the supply of higher care level HCPs is still lower than the demand, probably contributing to suboptimal support for the ageing‐in‐place preferences of older Australians, especially in regional and remote areas. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates which local area characteristics, included in the Healthy Ageing/Vulnerable ENvironment (HAVEN) Index, are the strongest factors predicting transition into permanent residential aged care (PRAC) and mortality, and the geographic distribution of these factors. Methods: A retrospective cohort study of older individuals living in the community in Adelaide who received their first eligibility assessment for age care services between 2013 and 2015 (n = 16,939) was conducted. The study cohort, from the Registry of Senior Australians (ROSA), was linked by postcode to HAVEN Index items, selected following item response theory (IRT) analysis to determine the strongest local area factors associated with PRAC and mortality. Geospatial mapping of the factors determined the geographic distribution of these significant factors. Results: Fourteen HAVEN Index items were associated with entry into PRAC and mortality. Three area‐level items, lower educational attainment, financial housing stress and low levels of volunteering by older people, were risk factors for entry into PRAC and mortality while the remainder of the items identified were different for each outcome. The mapped local area risk factors for each outcome highlighted similar geographical areas of vulnerability. Conclusions: Local area characteristics are associated with entering PRAC and mortality. Our findings can inform area‐level responses to make neighbourhoods more age‐friendly, potentially allowing more people to age longer in place. Similar analyses, conducted for other areas, could provide evidence to support the widespread development of age‐friendly neighbourhoods reducing area‐level inequalities in ageing. [ABSTRACT FROM AUTHOR]

This study describes the development and testing of the Healthy Ageing/Vulnerable Environment (HAVEN) Index, a prototype composite spatial index for South Australia that reflects an area's age‐friendliness. The index incorporates over 40 indicator variables across six variable themes: income and employment; education; health and housing; social connectedness; geographic access; and physical environment. Based on the deficit accumulation approach, the modelling uses area‐level rather than individual‐level data and is compiled through quantitative geospatial methods. Analysis using the HAVEN Index of state‐wide mortality data and hospital emergency department (ED) presentations for Central Adelaide found that vulnerable areas were associated with a higher risk of mortality and ED presentation. Comparisons between the HAVEN Index and a widely used national area‐level measure of socio‐economic differences found that the HAVEN Index compares favourably and provides additional information about local areas, which can inform needs‐based approaches to support the reduction of spatial inequalities and the development of age‐friendly neighbourhoods. [ABSTRACT FROM AUTHOR]

Objective: To describe the economic and cost considerations of mobile X‐ray services (MXS) in residential aged care facilities (RACFs), according to stakeholders (involved in residents' healthcare), residents living in RACFs and informal carers (ICs) of residents. Methods: Semistructured interviews were conducted with 20 residents and 27 ICs recruited from six RACFs across metropolitan Adelaide (South Australia, Australia), and 22 stakeholders, on their perspectives of using MXS in RACFs. Data relating to economic and cost considerations were extracted and analysed using thematic analysis. Results: Residents' mean age was 85 years, 60% were women and 40% had experienced an MXS in the last 12 months. Most ICs were daughters (70%) and wives (11%) and 30% had a family member who had experienced an MXS in the last 12 months. Stakeholders included RACF staff, GPs, a hospital avoidance program clinician, paramedics, emergency department clinicians, MXS radiographers and manager, and a radiologist. Four themes were presented: (1) business considerations, where private providers found it necessary to charge residents a co‐payment to deliver MXS; (2) cost and payment process as a potential barrier to using MXS, with varied willingness and ability to pay for an MXS co‐payment, and equity concerns; (3) overcoming cost and payment barriers, with staff and consumers sometimes using strategies to overcome cost barriers; and (4) perceived cost benefits of MXS to the healthcare system, residents and ICs. Conclusions: Mobile X‐ray services providers charge residents an upfront co‐payment for business viability, which can be a barrier to some residents wishing to access MXS. [ABSTRACT FROM AUTHOR]

Aim: Home care packages (HCPs) facilitate older individuals to remain at home, with longer HCP wait times associated with increased mortality risk. We analyze healthcare cost data pre‐ and post‐HCP access to inform hypotheses around the effects of healthcare use and mortality risk. Methods: Regression models were used to assess the impact of delayed HCP access on healthcare costs and to compare costs whilst waiting and in the 6‐ and 12 month periods post‐HCP access for 16 629 older adults. Results: Average wait time for a HCP was 89.7 days (SD = 125.6) during the study period. Wait‐time length had no impact on any healthcare cost category or time period. However, total per day healthcare costs were higher in the 6 and 12 months post‐receipt of a HCP (AU$61.5, AU$63, respectively) compared with those in the time waiting for a HCP (AU$48.1). Inpatient care accounted for a higher proportion of total healthcare costs post‐HCP (AU$45.1, AU$46.3, respectively) compared with in the wait time (AU$30.6), whilst spending on medical services and pharmaceuticals reduced slightly in the 6 month (AU$7.1, AU$6.3) and 12 month (AU$7.2, AU$6.3) post‐HCP periods compared with in the wait time (AU$7.9, AU$7.1). Conclusions: Increased spending post‐HCP on inpatient care or non‐health support afforded by HCPs may offer protective effects for mortality and risk of admission to aged care. Further research should explore the association between delayed access to inpatient care for geriatric syndromes and mortality to inform recommendations on extensions to residential care outreach services into the community to improve the timely identification of the need for inpatient care. Geriatr Gerontol Int 2023; 23: 899–905. [ABSTRACT FROM AUTHOR]