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Aim: To examine associations between amount of social welfare payments received and entry into permanent residential age care (PRAC) among older individuals accessing aged care nationally, stratified by homeownership status. Methods: A national retrospective cohort study was conducted using the Registry of Senior Australians (ROSA) Historical Cohort, integrating national health, aged care, and social welfare data. Individuals aged 65-105 years with a first-time aged care eligibility assessment between 01/01/2010 and 30/06/2021 were included. Social welfare receipt in the year prior to assessment was categorised into quartiles. Associations between social welfare quartile and rate of PRAC entry, by homeownership status, were assessed using inverse probability of treatment weighted, cause-specific Cox proportional hazards models. Sex-specific analyses were also conducted. Results: The cohort included 687,853 individuals (median age 82 years; 56.5% female; 69.5% homeowners), of whom 92.1% received social welfare payments in the year prior to assessment. Higher levels of social welfare were associated with an increased rate of PRAC entry among homeowners (hazard ratio (HR) 1.08; 95% confidence interval (CI): 1.06-1.10) and non-homeowners (HR 1.08; 95%CI 1.05-1.12]. Findings were consistent among males. Among females, only those in the third quartile had a higher rate of PRAC entry. Conclusions: Greater reliance on social welfare, a proxy for financial vulnerability, was associated with higher rate of PRAC entry across homeownership groups; complex relationships were also observed among older females. These findings highlight potential socioeconomic inequities and suggest the need for policies that strengthen financial security to support ageing in place effectively.
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