Contextualising the 'crisis in aged care' in Australia: a demographic perspective.

Hugo, Graeme

Introduction

The rapid growth of older populations in numerical and relative terms is one of the most pressing issues in OECD nations (Cotis 2005). One important element of this has been the 'ageing of the aged' involving those aged 75 and over growing at an even faster rate. While improved incomes, living conditions, health risk behaviour and health care has meant more people are entering old age in good health, inevitably the numbers who will eventually require relatively intensive in-home or institutional care will increase substantially. This is occurring at a time when due to low fertility, smaller family sizes, later child beating, increased family breakdown, increasing participation of women in work outside the home, and the greater likelihood that children will not live in proximity to their parents has meant that the extent to which this care can be given by family may be reduced. Hence, there will be an increase in demand for paid care workers (Jacobzone 1999).

Regardless of what levels of overall future population growth occur in Australia (McDonald and Kippen 2000) there will be a major shift in the composition of the population which will have significant implications for the demand for paid care in Australia. Changes in age structure will be especially significant but developments in areas such as workforce participation will also be influential. The present paper examines the shifts in population which are likely to occur over the next three decades in Australia and draws out some of their implications for the need for paid care. An attempt is made to estimate what the anticipated growth of the population aged over 75 will mean for the demand for paid care workers building an earlier work by the Australian Institute for Health and Welfare (AIHW) (2003; 2004; 2005).

The Current and Impending Growth of Australia's Aged Population

Population ageing is one of the most important processes which will influence Australia over the next three decades. As the Productivity Commission Report on the Economic Implications of an Ageing Australia (2005: xiii) states 'It will slow Australia's workforce and economic growth, at the very time that burgeoning demands are placed on Australia's health and aged care systems.'

Table 1 indicates the massive change which will occur in Australia's age structure over the next three decades. There will be a small decline in the numbers aged 0-14 and a slowing down in the growth of the workforce age groups from 1.07 percent per annum in the 2003-11 period to 0.12 percent per annum in the 2020s. On the other hand the population aged 65+ will increase by 2.72 percent per annum up to 2011, 3.48 percent per annum in the 2010s and 2.6 percent in the 2020s. Over the next three decades almost all of the growth in Australia's population is going to occur in the older ages.

Demographic ageing of the population is a function of two major demographic processes. Firstly, fertility is very influential both because historical fertility trends dictate the numbers moving into the older ages 65 years later; and, just as importantly, contemporary fertility influences the proportion that the old make up of the total population and shape the ratio of workers to older dependents. Australia's total fertility rate fell from 3.548 in 1961 to 1.891 in 1980. It has subsequently fallen to 1.806 in 2005 but in recent times has been relatively stable (McDonald, 2005).

The second demographic process shaping ageing is the improvement in longevity which has occurred in Australia. In the baby boomers' life time the life expectancy at birth of Australian men has increased from 66.1 to 78.1 years and for women from 70.6 to 83 years. Of particular significance, however, has been the fact that Australia has been adding extra years of life to the population aged over fifty. Over the 1901-72 period, only 2.8 extra years of life were added to Australian men aged 50 years and over and 4.6 for women. However, in the subsequent three decades, 7.6 extra years have been added to men aged 50 years or over and 6.3 for women. This represents a very significant change and is ensuring that a much greater proportion of Australians are surviving to retirement age and beyond. In Table 2 the projected growth of the 75-84 and 85+ age groups is presented since they are the groups that will have the greatest need for paid care. It will be noted that while there is growth in these high disability groups up to 2020 it is in the 2020s that the greatest growth will occur. The Productivity Commission (2005: XXXIV) has pointed out that the use of formal aged care increases rapidly after 80 years of age and that the proportion of the population aged 80 and over is expected to treble from 3.3 percent in 2002-03 to 9.1 percent in 2044-45.

One issue here however relates to whether or not the ABS assumptions on mortality prove to be accurate. The orthodox school of thought on future mortality has been that there will be small annual increments to life expectancy in Australia. Accordingly the ABS has used only a single set of mortality assumptions in their projections until the most recent series (ABS 2005a) in which a second, more optimistic, set of assumptions have been included in response to suggestions that the original assumptions may overstate death among the elderly. Table 3 compares the projected numbers aged 75+ and 85+ under the two sets of assumptions and the differences are marked. The number aged 85+ in 2051 are two thirds larger under the low mortality assumptions than under the standard assumptions. Thus we may be significantly under projecting the numbers of Australians who make it through to the oldest ages and hence future demand for aged care. Against this are some suggestions that obesity may be a factor in reducing life expectancy among baby boomers and younger generations (Olshansky, et al. 2005).

The Need for Care Among Older Australians

The incidence of disability increases with age. In the 2003 ABS Survey of Disability, some 22 percent of all older Australians (aged 65+) reported a profound or severe core activity (e.g. walking or dressing) limitation, increasing from 10 percent of those aged 65-69, 20 percent of those aged 75-79 and 58 percent of those 85+. Some 56 percent reported having any disability--around 1.4 million persons compared to 562,000 with profound disabilities. There is some debate as to whether the rate of disability is increasing among older Australians. Intuitively increasing improvements in availability of health services, better diet and increased longevity would suggest that the older population should be getting healthier. On the other hand the fact that breakthroughs in medical technology and practice are 'rescuing people from death' means that the incidence of disability can be expected to increase among the Australian elderly. In other words, people who in earlier generations would have died of cardiovascular or cerebrovascular disease are now saved by bypass operations, better detection and management of heart disease, introduction of intensive care units, etc. survive but often with a disability. Unfortunately we do not have any definitive evidence one way or the other because we do not have national health surveys that involve comprehensive medical examinations.

If 2003 incidence of disability is maintained over the next three decades, there will be a rapid increase of the number of older persons with a disability from 1.4 million in 2003 to 1.8 in 2011, 2.5 million in 2021, and 3.2 million in 2031. Of course one cannot be sure that rates of disability will stay the same but at the very least it does seem unlikely that there will be a major decrease in rates. Hence, the information must be seen as being indicative of the likely number of older Australians who are disabled over the next three decades.

Not all persons who report having a disability require care from another person. Table 4 shows that almost all with severe disabilities require some assistance in at least one of the core activity areas. We can apply these rates to the projected population with a disability to obtain a projection of the number of Australians who will require assistance in future years. These calculations are presented in Table 5 and a pattern of very substantial increase is in evidence with the number requiring assistance increasing from 956,635 in 2003 to 1,215,407 in 2011, 1,713,732 in 2021 and 2,215,041 in 2031. In 2003, of older persons needing assistance, some 64.5 percent indicated that their needs for assistance were fully met, while 28.8 percent said that they were partially met and 5.7 percent said they were not met at all. Hence, in considering the future need for care to be given to the aged in Australia, consideration not only must be given to the increased number of older people needing assistance but also to the significant numbers of the current generation of older people whose needs are not being fully met (363,400 persons) or not met at all (70,000).

Who Provides Care to Older Australians?

In contemporary Australia the majority of care given to older persons, children and persons with a disability is provided by the family (MHW 2003; 2004; 2005). Caring in Australia has been predominantly an unpaid, and family, role. The proportion of all older Australians aged 60 years and over who have disabilities living in cared accommodation fell from 13.5 percent in 1998 to 11.5 percent in 2003 while the reduction for those with a severe disability was from a third to 27.4 percent. Despite an increase of over 150,000 in the number of older disabled persons there were absolute declines in the numbers with acute disability living in cared accommodation (from 159,946 to 153,906) as there was for all reported disability (161,726 to 160,022). The bulk of older persons in cared accommodation have a profound disability (97 percent), which is to be expected since entry to such an institution involves a disability assessment. It is relevant to note, however, over the same period there was an the increase in the percentage of older persons with a disability who are living in 'other non-private dwellings', which includes among other things, 'self care units in a retirement village which may have cared accommodation onsite' (ABS 2005b: 75). The number of older disabled in this type of living arrangement increased by three times from 25,729 in 1998 to 79,316 in 2003. Twelve percent of older persons with disabilities lived in nursing homes and aged care hostels while 6 percent lived in non-private dwellings such as retirement villages (ABS 2005b: 76).

Those living in cared accommodation predominantly are cared for by paid carets while those remaining (83 percent) in private houses are predominantly cared for by family members who are largely unpaid, although community care is of increasing significance. There is a significant gender differential in those two populations. A larger proportion of older men with disabilities live with a partner compared to their female counterparts (ABS 2005b: 76). On the other hand the percentage of residents of nursing homes who are women in 2001 was 70.9 and that in other cared accommodation for the retired or aged was 73.5 percent (ABS 2003c: 18).

Despite the reduced proportion of older Australians who are entering specialised accommodation for the aged the number of people in accommodation for the retired or aged increased from 27,400 in 1981 to 147,700 in 2001. However, the numbers in nursing homes has not increased rapidly and numbered around 75,400 in 2001. On the other hand there has been a rapid increase in the numbers living in self-care accommodation such as retirement villages (80,400 in 2001). Over the 1996-2001 intercensal period the number in self care accommodation increased by 37 percent while the numbers in nursing homes increased by only 2 percent (ABS 2003c: 18). While it is likely that there may be changes in the future in the proportion of older Australians with disabilities who live in cared accommodation, if current institutionalisation rates are maintained, the number of persons who will require cared accommodation in 2011, 2021 and 2031 would increase from 144,000 in 2003 to 370,848 in 2011, 495,315 in 2021 and 611,292 in 2031--an increase of 5.3 percent per annum between 2003 and 2031. Hence, even if the rates of need for cared accommodation are reduced (and it would seem unlikely that they will be massively reduced for people in the oldest ages) there will be a major increase in the demand for cared accommodation for older Australians.

Despite the significance of cared accommodation, the majority of disabled older Australians needing care receive that care in a private household and the bulk of that care is delivered by family members. The ABS 2003 Survey of Disability, Ageing and Carers found that 2.5 million Australians provided care to 2.1 million older Australians aged 60 years and over. Some 92 percent of older people living at home with a disability were assisted by family, 17 percent by friends and 8 percent solely by friends (ABS 2005b: 39). The likelihood of being the carer of an older disabled person increases with age peaking in the 55-64 years age group reflecting the significance of children and partners as carers. It is important to note that the likelihood is greater for women then men in ages 25-64 reflecting the significance of daughters (and daughters-in-law) as carers as well as younger wives caring for older disabled partners. The rates are higher among males in the older ages reflecting partly the much smaller number of men in these age groups. In 2003, 69 percent of Australian men aged 75 and over were living with a wife while only 34 percent of women in that age group were living with a husband.

A distinction is made between primary and non-primary caregivers by the ABS and only 19 percent of the carers (475,000 people) were the main carer of the disabled older person. Primary carers are generally older than non-primary carers with a median age of 52 compared with 47 (ABS 2005b: 40), female (71 percent compared with 50 percent) and less likely to be in the workforce (39 percent compared with 60 percent). They had lower median gross incomes ($237 per week compared with $327) and were more likely to have a government pension or allowance as their main source of income (55 percent compared to 35 percent). Of the primary carers, 24 percent were wives, 17 percent husbands and 18 percent daughters. The carer rates for different age sex groups in 2003 were applied to the projected age sex distribution in 2011, 2021, and 2031 to estimate the number of carers that will be available if current levels of primary caring are maintained in Table 6. They suggest the availability of primary carers in relation to the numbers needing assistance will decline significantly. This of course is a function of the smaller number of children that future generations of older Australians will have compared with the present older population.

However the availability and/or the propensity for family members to provide care may be reduced in the next few decades because ... Increased mobility means that there is a greater likelihood that the smaller number of children will not be living close to their older parents needing care. Increased incidence of divorce and separation means that a smaller proportion can be expected to have a partner who is co-resident and able to provide support than has been the case for the present generation. If policies designed to increase participation rates in the formal workforce among women, older Australians and other groups are successful it will mean a smaller proportion will be available to provide care (Hugo 2006a). Indeed the need to provide care may militate against contemporary policy imperatives to increase workforce participation, especially among older people.

The 2003 survey found that 61 percent of primary carers were not in the labour force and another 21 percent worked part time. Moreover one third of those not in the workforce (90,500 persons) had been employed just prior to taking on the caring role and more than half of those indicated they left the workforce to take on this role. Some 23 percent of employed primary care givers had reduced their working hours to commence care giving (ABS 2005b: 41).

While the bulk of primary carers are not paid professionally as carers, two thirds received some form of government pension, payment or allowance and for 55 percent this was the main source of income (ABS 2005b: 43). Income support for carers was introduced in Australia in 1985 and has been modified several times since. Some 19 percent of primary carers receive a Carer Payment which provides an income equivalent to the Disability Pension to people who cannot participate in the workforce because of their carer role. Some 17 percent received the carer allowance--an income supplement for people caring for a person with a disability. (1)

Paid Carers and Older Australians

It is difficult to establish the precise size of the paid care for the aged workforce in Australia. Richardson and Martin (2004) and Healy and Richardson (2003) have assessed data from a number of sources (ABS, National Centre for Vocational Education Research, Australian Institute of Health and Welfare) as well as surveying Aged Care Facilities to estimate of the number of direct care workers in Residential Aged Care and made the following estimates of the workforce in aged care facilities in 2004 as:

Total: 155,000

Direct Care Workers (nurses, allied health and personal care attendants): 116,000

Direct Care Workers (fulltime equivalents): 76,000

We can express this as a ratio to the 160,022 older people with a disability in cared accommodation at the 2003 ABS Survey of Disability, Ageing and Carers: there are 47.5 full time equivalent direct care workers for every 100 older persons in cared accommodation. Applying these to the projected numbers in cared accommodation we can project what the need will be for full time equivalent direct care workers in aged care accommodation. These projections are presented in Table 7 and the increased level of demand is clear.

One important group of direct care workers in cared accommodation for the aged are nurses. Although there was a 10.2 percent increase in the numbers of nurses between the 1986 and 2001 census this was not as fast as the population increase and the ratio of nurses per 1000 population fell from 10.8 to 9.8. The nursing situation in aged care is especially concerning with an absolute decline in the number of nurses working in this sector by 22.3 percent over this period. Aged care nursing was identified as a major area of crisis in the 2002 Senate Inquiry Into Nursing (Australia Senate 2002). This problem is exacerbated by the high and increasing proportion of nurses who work on a part time basis so that more nurses are needed to provide the same level of services. (2) Even if the situation in 2001 is accepted as the standard the number of aged care nurses who will be required by the increasing number of older people requiting cared accommodation will increase. The ratio of nurses to this group in 2003 was 14.6 and if these are applied to projected numbers in accommodation the number of nurses required in aged care accommodation will quadruple by 2031.

Paid care workers are playing an increasing role in the support and care of older disabled persons who remain in private households, often in collaboration with informal care givers. It is difficult to separate paid carers working with older Australians from persons concerned with the provision of care to non-elderly persons in the census data. Nevertheless, the numbers in non-residential care services increased by 5.2 percent per annum between 1990 and 2001. This compares to little or no increase in the numbers working in the institutionalised age care sector. Hence the large increase in employment in providing aged care services has come outside the cared accommodation sector.

In Table 8 the ratios of the numbers of residential and non-residential workers to the numbers of Australians aged 75 years and over in 2001 are used to give an indication of the likely demand for such workers in the future. This ignores changes in the way in which care services are supplied, the incidence of need within the 75+ age group, etc. but it is indicative of the challenge which Australia faces in the demand for paid aged care workers. This should be put together with knowledge that the availability of family informal care could well be reduced in the future. The ratio of non-residential workers to population aged 75+ in 2001 was .074 and the ratio of residential workers to population aged 75+ in 2001 was .038. These are applied to projected number of people aged 75+ since they are the main age groups in need of care. When applied to projections of older people they indicate that the numbers of non-residential and residential workers will increase by 3.0 percent per annum between 2001 and 2011 and 3.2 percent and 3.9 percent per annum over the next two decades. In all, over the three decades there will be an extra 69,954 workers needed in the residential area and 136,457 in the non-residential area. A large challenge indeed.

However the above does not convey the full scale of the challenge. The table only indicates the net increments which are likely to be required. It does not take into account any attrition that will occur among the existing workforce which in fact is likely to be considerable. While we do not have actual data on attrition some clues can be obtained from examining the age structure of the current workforce. Figure 1 overlays the age-sex structure of the aged care workforce with that of the total Australian workforce and shows there is an 'excess' in the older age groups and a 'deficit' in the younger age groups. There will be a substantial attrition due to retirement in the aged care workforce over the next two decades and this will be particularly marked in the residential care part of that group. The ageing, which is occurring in the aged care workforce, is apparent if we overlay the age-sex structures of the workforce in 1996 and 2001. Figure 2 shows that the bulk of the intercensal increase in workers in the sector has not been in younger ages.

[FIGURES 1-2 OMITTED]

Meeting the Increased Demand for Paid Care Workers

How can this manifest demand for paid care workers which Australia will face over the next three decades be met? Firstly it needs to be pointed out that the numbers making the education to work transition will gradually decrease over the next three decades. It is estimated that increments to the workforce will decline from around 170,000 annually at present to around 125,000 over the entire decade of the 2020s (Access Economics 2001). Other things being equal, therefore, there will be a tightening of the labour market over this period. Hence, there will be a rapid expansion in the demand for paid carers at a time when the growth rate of the workforce is likely to be slowing down. Moreover the lack of new recruits to the industry both in the skilled and unskilled areas from younger workers in recent years suggests that there may be some barriers to recruiting young workers. Clearly these need to be addressed. One key characteristic of the industry is that there are substantial numbers of unskilled and semi skilled jobs as well as managerial, professional and associate professional jobs.

With an increasingly credentialed and skilled native workforce in Australia there may be greater difficulty in recruiting younger workers and new entrants to the workforce to the unskilled and semi skilled areas than to the skilled areas. There is clearly an issue of image and/or of conditions/salary which are barriers to young workers being attracted to the industry. This is common in high income countries where demographically induced tightness in the labour market, higher levels of education and cultural changes which assign low status to jobs which are low paid and involve manual work have led to considerable amount of labour market segmentation (Hugo 2005). In the Australian context there needs to be a cultural change as well as changes in work conditions and salaries which makes jobs in the aged care industry more attractive to young workers--skilled and unskilled.

There are some other alternatives which will also need to be considered in seeking to recruit workers into the aged care industry at a time of significant loss of workers through retirement as well as the overall expansion in labour demand in the industry. There is a need for, and policies designed to, increase workforce participation levels among older age groups and to draw into the workforce, groups which are currently disengaged from it. It may be that the aged care industry will need to target both of these types of workers. Firstly, with respect to mature age workers, it may be that many of the types of the work in the industry can be done by workers in their 50s and 60s perhaps as a second career or a transition career between working and retirement. Similarly, efforts to bring in potential workers among groups currently excluded from the workforce would be rewarding not only from the perspective of the industry but also in achieving social inclusion and equity objectives (Hugo 2006a). In the case of both types of workers, it will require new, innovative and tailored initiatives to achieve these goals but such initiatives are going to be necessary in other industries as well.

Another alternative strategy to recruit workers into the aged care industry is via immigration. Australia uses immigration, both permanent and temporary, to make up shortages in its labour market more than most nations with 24.7 percent (2004) of its workforce currently made up of overseas-born persons (ABS 2005c). Moreover, it has been estimated that at any one time temporary labour migrants make up around 4 percent of the Australian workforce (Hugo 2006b). However, the extent to which the aged care industry will be able to draw upon this source is limited. This is because both the permanent and temporary migration programs are overwhelmingly (and increasingly) skill based in their selection. Unskilled and semi-skilled aged care workers are unlikely to qualify for the permanent skilled migration program or the 457 temporary visa business migration program. Some carers may be recruited around refugee-humanitarian and family migration streams and from among the significant influx of New Zealanders but the numbers will be limited. Some may also be attracted from among the Working Holiday Makers and Student Migration program but again, the numbers are likely to be small.

The demand for aged care workers, skilled, semi-skilled and unskilled will be large in Australia over the next three decades. This is regardless of changes in the health and disability levels among the aged and of changes in the management and delivery of aged care. Meeting this need will necessarily involve taking initiative on a number of fronts--ensuring family carers are nurtured and encouraged, attracting younger workers to the industry, attracting older workers to the industry and perhaps modifying Australia's immigration program.

Conclusion

Australia is facing at least a doubling of the numbers of disabled older persons who will require care in the next 25 years. In fact it is likely to be significantly higher. There has been a successful move by government to encourage and support older Australians to remain in independent living situations and only move into aged care accommodation when they are significantly disabled. This has dramatically reduced the propensity of older Australians of all ages to enter aged homes. Nevertheless the increasing numbers of older Australians means that the stabilisation of numbers in such accommodation which has characterised the last decade will soon come to an end, and despite decreasing rates of institutionalisation, the numbers will recommence increasing and do so sharply. Hence, the stabilisation of numbers working in direct paid care in these institutions will end and the numbers of workers in aged care institutions will need to increase substantially. At the same time the demand for paid carers for aged people living in private houses will increase not only through the growth in numbers of older people with disabilities who can remain at home but also probably through a reduction in their ability to call on family. This is a similar situation to that being faced in all OECD nations although in Australia the situation is not as pressing as in some countries and the real 'crunch' is likely to come somewhat later--in the 2020s. However, that is no reason for complacency. There is going to be an increase in the demand for paid carers of older people and developing strategies to ensure that those carers are available is going to require careful planning and time to implement effectively. The present paper has had to rely on less than ideal data regarding the paid care workforce and as a result the projections made are indicative rather than definitive. An essential and preliminary part of the work that needs to be done in planning for an increase in the paid care workforce is a deeper, more disaggregated and more nuanced understanding of the present paid care workforce.

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Endnotes

(1) In 2002 Centerlink reported that 26,333 persons received carer payments for looking after people aged 65+ and 91,768 a carer allowance (AIHW 2004, 69-70).

(2) In 2001 only 50.8 percent of nurses worked full time compared with 63 percent in 1986 (ABS 2005b, 121) Table 1. Projections of Australia's Aged and Working Age Population Number by Age Year 0-14 15-64 65+ 65+ as 15-64 2003 3,981,538 13,344,685 2,546,423 19.1 2011 3,840,000 14,532,900 3,155,600 21.7 2021 3,752,700 15,172,300 4,443,400 29.3 2031 3,826,400 15,348,100 5,741,000 37.4 Annual Growth Rate (%) 2003-11 -0.45 1.07 2.72 2011-21 -0.23 0.43 3.48 2021-31 +0.19 0.12 2.60 Source: ABS 200a and b Table 2. Australia: Projected Growth of the Population Aged 75-84 and 85+ 75-84 85+ Year No. % Growth per No. % Growth per annum. annum 2001 905,742 288,846 2011 1,029,943 1.6 431,806 5.2 2021 1,418,022 3.2 584,403 3.1 2031 2,082,350 3.0 856,061 3.9 Source: ABS Estimated Resident Population data and 2005 Projections, Series B Table 3. Different Mortality Assumptions' Effects on the Growth of Australia's Future Aged Population, 2021-2051 75+ Year Low High % Difference 2021 2,056,942 2,002,425 2.7 2041 4,501,591 3,717,251 21.1 2051 5,659,365 4,186,742 35.2 85+ Year Low High % Difference 2021 608,816 584,403 4.2 2041 1,809,956 1,293,734 39.9 2051 2,690,042 1,619,958 66.1 Source: ABS 2005 Projections Table 4. Australia: Assistance Needed by Older People with Disabilities Living in Households(a), 2003 With All with reported disability profound/ severe core 65-74 75-84 85 years Total activity years years and over limitation % % % % % Self care 51.0 13.7 17.4 27.4 16.9 Mobility 83.5 18.7 31.0 50.7 27.6 Communication 9.3 2.5 2.6 6.7 3.1 Health care 70.4 29.1 43.5 57.9 38.5 Transport 73.4 24.7 40.4 66.9 36.2 Paperwork 31.8 7.6 15.9 28.7 13.6 Housework 69.2 25.8 40.3 56.9 35.5 Property 71.5 38.3 51.0 65.7 46.8 maintenance Meal preparation 36.0 7.2 15.2 32.1 13.5 Cognition and 26.3 10.0 11.8 17.8 11.7 emotion At least one of 99.6 60.4 73.3 86.4 68.8 the above activities '000 '000 '000 '000 '000 Total(a) 407.7 576.6 507.4 148.2 1232.2 (a) All older people with disabilities except those living in cared accommodation. Source: ABS 20056: 77 Table 5. Australia: Projected Number of Older Disabled Persons Needing Assistance, 2003-2031 2003 2011 Age No. with % No. Projected % Growth Disability No. 2003-2011 65-74 594,402 60.4 359,019 460,043 3.1 75-84 564,999 73.3 414,144 481,247 1.9 85+ 231,057 86.4 199,633 307,045 5.5 Total 1,390,458 68.8 956,635 1,215,407 3.0 2021 2031 Age Projected % Growth Projected % Growth No. 2011-2021 No. 2021-2031 65-74 669,668 3.8 771,277 1.4 75-84 658,012 3.2 973,685 4.0 85+ 415,553 3.1 608,721 3.9 Total 1,713,732 3.5 2,215,041 2.6 Source: Calculated based on ABS Surveys of Disability, Ageing and Carers, Catalogue No.4430.0 and ABS 2005 Projections, Series B Table 6. Australia: Projected Numbers of Primary Carers who will be Available to Provide Care to Projected Number of Disabled Older Number of Primary carers Number of Ratio of Disabled Primary Carers Aged to Older Disabled Year Male Female Total Needing Needing Assistance Assistance 2003 136,300 338,400 479,600 956,635 0.50 2011 165,656 385,408 551,064 1,215,407 0.45 2021 201,767 455,667 657,434 1,713,732 0.38 2031 237,841 500,197 738,038 2,215,041 0.33 Source. Calculated based on ABS Surveys of Disability, Ageing and Carers, Catalogue No.4430.0 and ABS 2005 Projections, Series B Table 7. Australia: Projected Full-time Equivalent Direct Care Workers Needed for Aged Care Accommodation, 2003-2031 Year Projected No. Projected No. Percent Change of Disabled Older Persons of Direct Care per annum Needing Cared Accommodation Workers Needed 2003 144,000 68,400 2011 370,848 176,153 12.6 2021 495,315 235,275 2.9 2031 611,292 290,364 2.1 Source: Calculated using ABS 2005 Projections, Series B and ABS Survey of Disability, Ageing and Carers, Catalogue No. 4430.0 Table 8. Projected Numbers of Paid Care Workers Needed for the Australian Aged Population, 2001-2031 Number of Non Numbers of Projected Residential Care Residential Care Number of Workers (2) Workers (3) 75+ (1) Year Population No. % Increase No. % Increase p.a. p.a. 2001 1,090,708 80,551 41,294 2011 1,461,749 107,953 3.0 55,342 3.0 2021 2,002,425 147,883 3.2 75,812 3.2 2031 2,938,411 217,008 3.9 111,248 3.9 Total Increase Year Non- Residential Residential 2001 -- -- 2011 27,402 14,048 2021 39,930 20,470 2031 69,125 35,436 (1.) Obtained from 2001 Census and ABS 2005 Projections Series B (2.) Based on ratio of non-resident Workers to population aged 75+ in 2001 (3.) Based on ratio of residential Workers to population aged 75+ in 2001 Source: Calculated from ABS Population Census data