The Realities of Ageing in Place in Australia
More Australians are living longer, and our birth rate is declining! It’s the classic definition of an “ageing population”. In fact, the AIHW predicts that by 2057, around 20% of our population will be in the 65 years and over age bracket.
This is placing additional strain on our aged care system, and many older Australians are weighing up the pros and cons of “ageing in place” vs. moving into residential care. But – what are the realities of ageing in place in Australia?
The Growing Demand for Ageing in Place
Not only is our population ageing, the demographic of that ageing population is also changing. Many of our older citizens now are baby boomers, a generation of hard workers that enjoyed more independence than their ‘silent generation’ parents. They want to continue being independent and self-reliant for as long as possible.
Following in their footsteps are the ultra independent and self-reliant Gen X'ers, who start turning 65 from 2030, only 5 years away. They’re probably going to be even more determined to hang onto self-sufficiency.
Ultimately, that means this trend of increasing independence and self-reliance amongst older Australians is only going to get more prevalent. And that’s going to create a growing demand for access to a diverse range of facilities and services that will allow older Australians to ‘age (gracefully) in place’.
Why do Seniors Prefer to Stay in Their Homes?
Independence...familiarity...comfort… privacy…affordability…
Our increasingly independent, self-reliant older Australians want to stay that way well into their twilight years. They don’t want 'institutionalised or segregated care’, and we don’t blame them. Some of the many reasons people choose to stay at home include
· There’s ample evidence to suggest ageing in place improves overall quality of life.[1]
· Residential aged care is expensive and many seniors have built up considerable equity in their homes. In many cases, it's cheaper for them to keep that home and continue living in it, or downsize.
· The Covid pandemic underlined another unfortunate reality of residential aged care. Namely, it’s very hard to keep infectious diseases out of these facilities, and almost impossible to contain them once they get in! Encouraging seniors to age in place both reduces their exposure risk, and is easier to manage if they are exposed.
· Cultural considerations – Australia is one of the most ethnically and culturally diverse nations on earth. Ageing in place allows the increasing number of senior Australians from different ethnic backgrounds to continue living as their culture or religion dictates.
However, despite its many benefits, ageing in place comes with some significant reality checks.
The Realities of Ageing in Place
It’s one thing to want to remain independent and self-sufficient for as long as possible but making that a reality is quite another, and sometimes easier said than done. Specifically, someone who wants to age in place will eventually have to think about the health and mobility challenges involved with this. Do they have enough support to cope? Will it require home modifications to improve accessibility?
Health and Mobility Challenges
Even the most active and independent of us face physical and health-related changes as we age. These can make it very challenging to age in place without significant support.
Reduced mobility for example impacts our ability to do even simple, basic activities like dressing, bathing, cooking… Sure, accidents and illness can incapacitate us at any time regardless of age but ageing and mobility tend to have an inversely proportional relationship! As one goes up, the other goes down…
Indeed, by the time we reach our senior years most of us are dealing with some type of chronic health condition, most often arthritic changes. Or we may be grappling with cognitive decline. We’re also more likely to be on medications for these conditions on top of coping with daily living activities.
Translated, that means most of us increasingly require support, either from family and friends, or healthcare support workers. It may help with those daily activities we can no longer safely do on our own, or just making sure we take our medications.
Necessity for Home Modifications and Accessibility
Home modifications also become a very real consideration as our mobility deteriorates. From modifying doors, to installing ramps and handrails, or putting down non-slip flooring – these all significantly improve home safety and accessibility.
However, some modifications are not cheap or easy to do! Widening doors for wheelchair access for example could be a major structural undertaking. Remodelling a bathroom can be expensive depending on how much work is required. Installing ramps or stair lifts is also pricey. If we need a home care bed, it may not fit without yet more modifications to the home. And so on...
Nevertheless, these types of home modifications are key to safe ageing in place because they reduce the risk of falls and other injuries.
Financial Implications and Affordability of Ageing in Place
It’s also tempting to assume that remaining at home is more cost-effective than going into residential care. However, ongoing in-home care, home modifications, and support services do start to add up so is it really?
Ageing in Place vs. Residential Care – Which is More Affordable?
Aged care is not cheap whichever way you look at it. If your assets exceed any of the applicable thresholds it definitely isn't! And even if they don’t, there are still ongoing expenses that may be difficult to comfortably afford on a pension.
Ageing in Place Expense Considerations
For someone considering staying at home, key expenses are likely to include:
· Home modifications: these will vary depending on the modifications required. But it will likely include grab rails, ramps, some bathroom changes, and flooring considerations.
. Home maintenance: chores like cleaning, gardening, repairs and various other maintenance jobs get more challenging the older we get. These are not always covered by government subsidies.
· Utilities: many utility companies offer rebates for seniors and pensioners but even so, there is still a need to budget for these ongoing costs if remaining at home.
· Property rates and taxes: local councils still want senior homeowners to pay their property rates! Some may offer rebates for seniors or allow them to defer payment but usually it’s an ongoing expense to factor into the budget.
· Rent etc: not everyone owns their own home and rent doesn’t stop or reduce just because someone is getting old!
· Home care services: the cost of these can vary considerably depending on assessed assets, level of care required, and whether additional support is needed over and above what is included in a home care package.
Residential Care Expense Considerations
The Federal Government subsidises residential aged care for eligible pensioners. The amount though depends on financial circumstances and the type of care needed. But, typically, residential care expenses include:
· An Accommodation Fee: this covers accommodation, including room, meals, and basic care services. It can be paid as a Daily Accommodation Payment (DAP), or via a lump sum Refundable Accommodation Deposit (RAD).
· A Daily Care Fee: the care fee is payable over and above the accommodation fee and covers ongoing care in the facility. It includes services like personal care, nursing care, and medication management.
· A Means-tested Care Fee: residents with assets or income above a certain threshold may also have to pay an additional means-tested care fee.
· Additional fees: most residential care homes provide additional services and benefits (access to various activities, hire of personal items or equipment, extra services, special diets and so on) but they also come at an additional cost.
· Other assets: although seniors can sell the family home or other assets to pay for their residential care, this isn’t always an option. If a partner is still at home, or there are other assets they can’t or don’t want to sell, there may be ongoing expenses involved with these – rates, land tax, and so on.
So, the affordability of either option really does depend on individual circumstances – pensioners may find government-subsidised residential care is more affordable for them. Conversely, self-funded retirees or those with assets above the various thresholds may find ageing in place more affordable.
Technological Innovations Transforming Home Care
In the past, some of the biggest hurdles for many who want to age in place have been difficulties accessing regular health care along with home care and regular monitoring. Some seniors for instance are not in a position to have someone take them to medical appointments, visit every day to check on them, or move in. Also, not everyone necessarily wants this type of ongoing intrusion in their life, essential though it may be!
Luckily, thanks to advances in technology, services like telehealth and remote monitoring are now a reality. It means individuals can retain their privacy and independence at home yet know that medical care and emergency help are only a phone call or alarm button away should they need it.
Then there are smart homes and AI…
Telehealth and Remote Monitoring
Covid showed us we could manage many aspects of our lives remotely! From video conferencing to health services…
This technology is being put to good use with a range of telehealth services that make it easier and faster for older Australians to access health care from home. Seniors can for example use video or audio conferencing to:
· Consult with a doctor or specialist outside their local area
· Develop treatment plans
· Obtain prescriptions
· Avoid unnecessary travel and long waiting times.
They can also opt to use some type of remote monitoring system, either a wearable device like a smart watch, or sensors on their person. These devices can:
· Track vital signs
· Monitor activity
· Detect falls
· Provide medication reminders
· Alert carers or emergency services
Smart Homes and AI
Once upon a time, remotely controlled or voice-activated homes were the stuff of movies! Today we call them ‘smart homes’. These are homes where everything that turns on or off, or opens and closes, is automated or voice-activated, or can be remotely accessed and monitored!
Whilst it’s amazing technology and still somewhat of a novelty for many, it has very real potential to make life a whole lot easier for senior Australians who want to age in place.
Amongst other things, smart home technology can:
· Monitor home environments and provide information about temperature, humidity, air quality, energy use, security, safety etc
· Make it easier for seniors to control lights, doors, air conditioning etc by voice or remote access
· Maximise energy efficiency in the home and reduce energy bills
Likewise, artificial intelligence (AI) is another fast-growing area that looks set to make a major impact on ageing in place. Specialised AI programs for example can ‘learn’ routines and habits, and be programmed to alert carers in real time if there are any variations to the norm.
AI can also perform a range of duties like:
· Help with daily routine activities such as medication reminders
· Assist with home automation
· Provide companionship, mental stimulation, and cognitive training through virtual AI assistants and chat bots
· Analyse data from wearable devices and suggest dietary adjustments or customised exercise plans
Indeed, its uses are probably going to be limitless!
But right now – it can help reduce the burden on carers, support seniors ageing in place, and contribute to bettering their overall quality of life.
Social and Emotional Wellbeing
Ageing in place can be a very rewarding experience but it also poses challenges, especially for seniors with limited mobility or cognitive issues. And while smart homes and AI certainly offer valuable technological solutions for the practical aspects of ageing in place, they don’t address social and emotional well-being needs. Or not yet anyway!
Maintaining Community Connections
Staying connected with local communities and avoiding social isolation is particularly important for seniors who choose to age in place. Limited mobility, lack of transport, poor health etc can all restrict their social interaction, especially if they don’t have a strong support network.
Even so, there are still many simple but effective options out there for resourceful seniors ageing in place to consider. For instance:
· Local interest and community groups are always looking for members and supporters.
· A favourite cause may want volunteers, even if it's just manning a display stand or talking to people.
· Our increasingly tech-savvy seniors can participate in online communities – there's one out there for just about every type of interest or hobby. If there isn’t, they could start one…
· Or, they can just get out and about around the local neighbourhood and get to know their neighbours.
Mental Health Support
Mental health is just as important as physical health, especially as we age. Seniors ageing in place though may not always recognise the signs of mental stress or know how to address them effectively, particularly if they're on their own. So it may be necessary to help them identify early warning signs – elevated anxiety, depression, changes in mood, sleeping patterns, appetite, or social behaviour – and develop effective coping mechanisms.
Even simple activities can be incredibly effective for proactively managing mental health and maintaining a positive outlook. It may include:
· Practising relaxation techniques
· Engaging in enjoyable activities
· Maintaining social connections
· Seeking support from friends, family, or mental health professionals
Challenges for Non-Homeowners
Thus far, we’ve mostly considered the challenges for homeowners. Non-homeowners though face additional challenges. Unless they’re renting in a retirement village or community, the property in all probability isn’t designed for ageing residents. And if that is the case, finding long-term accommodation suitable for ageing in place could be challenging.
Vulnerability and Access to Care
Renters often also:
· Have limited control over what home modifications, if any, they can have done. Not many landlords are willing to let their rental properties be modified just to suit a current tenant!
· Are financially vulnerable to rent increases, lease renewals, or even potential evictions. All these can create stress and disrupt their long-term plans for ageing in place.
· May face limited access to in-home care services
These issues may force seniors to relocate which disrupts their support networks and established routines. It can also increase their dependence on government assistance, or push them into residential aged care facilities because they simply don't have any other housing options.
The Future of Aging in Place in Australia
As we pointed out at the start, baby boomers and Gen X’ers will make up an increasingly large proportion of Australia’s senior population over the coming decades. These independent, self-reliant demographics are almost certainly going to drive up the demand for ageing in place as they choose to stay at home rather than move into residential aged care.
Government policies, investments in-home care services, and advancing technological innovations are also supporting this trend.
Long-term Sustainability
Will this be sustainable long term?
If challenges around access to care, affordability, and suitable housing availability are adequately addressed, there’s no reason why it shouldn’t be. But – developing feasible solutions that support older Australians in their quest to age in place will require collaboration between the government, healthcare providers, and the private sector.
The growing trend towards ageing in place is a direct reflection of Australia’s ageing population, and a shift in demographics towards more independently-minded, self-reliant seniors. Whilst it presents some challenges, expansions to services that support ageing in place and technological innovations should all help make this a viable option for many more senior Australians.
--
[1] https://www.royalcommission.gov.au/aged-care
[2] https://onlinelibrary.wiley.com/doi/full/10.1002/casp.2669
