Comprehensive day-to-day care and support needs of older Australians requiring government-funded home-based aged care: a scoping review

Rachel McKittrick; Elizabeth Manias; Martin Hensher; James Meroiti; Alison M. Hutchinson

doi:10.1071/AH24234

RESEARCH ARTICLE

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Comprehensive day-to-day care and support needs of older Australians requiring government-funded home-based aged care: a scoping review

Rachel McKittrick

^A ^* , Elizabeth Manias

^B , Martin Hensher ^C , James Meroiti ^A ^D and Alison M. Hutchinson ^A ^D ^E

+ Author Affiliations

- Author Affiliations

^A School of Nursing and Midwifery, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Vic 3220, Australia.

^B Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Road, Clayton, Vic 3800, Australia.

^C Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tas 7001, Australia.

^D Centre for Quality and Patient Safety Research/Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, Vic 3220, Australia.

^E Barwon Health, PO Box 281, Geelong, Vic 3220, Australia.

^* Correspondence to: rmckittrick@deakin.edu.au

Australian Health Review 49, AH24234 https://doi.org/10.1071/AH24234

Submitted: 30 August 2024 Accepted: 24 January 2025 Published: 17 February 2025

Abstract

Objective

This study aimed to locate and describe research studies in which the comprehensive day-to-day care and support needs of older Australians requiring home-based aged care have been measured and reported in detail.

Methods

A scoping review was conducted according to Joanna Briggs Institute guidance. A systematic search of peer-reviewed and grey literature was undertaken.

Results

Screening identified 2/866 eligible records. Researchers studying the ‘service needs’ of older people (n = 50) residing in a rural/remote Aboriginal and Torres Strait Islander community found a high need for home care (86%), transport (59%), and allied health (46%) services. In the second study, older people (n = 55) from a regional community had 38/79 ‘underlying care needs’ including for washing/bathing, managing urinary incontinence, and arranging/keeping appointments. The authors of each study took a different perspective of ‘needs’ – that is, their participants’ need for specific service types (e.g. transport) versus their fundamental underlying needs (e.g. arranging/keeping appointments) which give rise to service needs.

Conclusions

The findings suggest Australian aged care providers and policy-makers lack a strong evidence base about the comprehensive underlying day-to-day care and support needs experienced by older Australians, to optimally inform both the design of home-based aged care programs and services, and workforce skill and skill mix requirements for the sector. Future studies about the population’s underlying day-to-day care and support needs, with larger and more representative study populations (e.g. making use of routinely collected aged care datasets), would be beneficial. Such studies would provide important information to support the development of a government-funded home-based aged care system optimised to effectively and efficiently meet the needs of the population it is seeking to support.

Keywords: Australia, care and support needs range and prevalence, community aged care, home care, older people, service system design, workforce planning, workforce skill and skill-mix requirements.

Introduction

The Australian population is aging, and with this, demand for aged care will rise tremendously in the coming decades.¹ As the Australian Government substantially funds aged care services, this demographic trend will significantly increase government expenditure on such services. Furthermore, workforce requirements to deliver care will continue to rise.² Most older Australians would prefer to receive aged care services in their own home, if they come to require them.³ In Australia, there are currently two main home-based aged care programs (Table 1): the Commonwealth Home Support Program (CHSP) for people with ‘entry-level’ care and support needs and the Home Care Package (HCP) program for people with increasing complexity in their care needs. At the time of reporting this research, the Australian Government has proposed these programs be reformed and a new ‘Support at Home’ program is being designed.⁴ To determine how to structure an effective and efficient home-based aged care system, comprehensively understanding as much as possible about this population’s care and support needs is key.⁵ Furthermore, a system designed using a strong evidence base is important for aged care consumers and all Australians in the context of limited government funds and reduced workforce availability.⁶

Table 1.Australian government-funded ongoing (not short-term) home-based aged care types.²⁹

Care types	Level of care needs
Commonwealth Home Support Program (CHSP)^A^,^B	This group of people have straightforward or ‘entry-level’ care needs, and generally only require one, perhaps two, direct care service(s). These people do not require a service provider to coordinate their services for them. They are able to independently liaise with service providers regarding their care delivery in relation to day and time of services and tasks to be completed during the service.
Home Care Package (HCP) program level 1, 2, 3, and 4^A^,^C	This group of people have increasing complexity of care needs and generally require more than one direct care service to support them to remain living at home alone. Due to their increasing care complexity, they also require a service provider to coordinate or manage the delivery of their care, for example, by a care coordinator or care manager. HCP levels 1, 2, 3, and 4, respectively, equate to a basic/infrequent, low/regular, intermediate/frequent, and high/comprehensive levels of care and support, which include direct care services and care coordination/care management input. Importantly, HCPs are delivered on a Consumer Directed Care (CDC) basis, where services that a person receives via their HCP, as facilitated by their service provider, should be within their choice and control and ‘reflect and respect’ the person’s wishes and preferences.³⁰

^A A person is eligible for Australian government-funded CHSP services or a HCP when they meet the criteria set out in the My Aged Care assessment manual – for Regional Assessment Services and Aged Care Assessment Teams.³¹

^B The Commonwealth Home Support Program was introduced in 2015 (2016 in Victoria and 2018 in Western Australia – two different states of Australia). The precursor to the Commonwealth Home Support Program was the Home and Community Care Program, which was a state-run and funded community aged care program originally introduced in the mid-1980s.³²

^C The Home Care Package program was introduced in 2012. The precursor to the Home Care Package program was another Australian government-funded community aged care package program with different types of packages, where a Community Aged Care Package was equivalent to a Home Care Package Level 1 or 2, and the Extended Aged Care at Home/Extended Aged Care at Home Dementia packages were equivalent to a Home Care Package Level 3 or 4.³²

Care and support needs for older people wishing to receive home-based aged care can be understood and measured in different ways. Needs from the perspective of older people themselves can be measured. Dostálová et al. undertook a scoping review pertaining to the self-perceived care needs of older people receiving home care, including predominantly qualitative studies from the United Kingdom and Europe, identifying themes about care recipient needs and wishes, such as for autonomy and professional, respectful support that fitted into their routines.⁷ In the Australian context, McCaffrey et al. studied features of home-based support services important to older people, similarly finding people wanted to be able to exercise choice in aged care provider and services, and to receive clear information and effective communication from service coordinators.⁸ Understanding care recipients’ self-perceived needs and preferences is crucial when designing home-based aged care. However, it does not provide detailed insights about the day-to-day care and support needs that government-funded home-based aged care programs are intended to first and foremost address – for example, difficulty with mobility, daily tasks, and/or cognition.

Day-to-day needs can be understood indirectly by measuring service utilisation. In Australia, government-funded reports have highlighted that commonly used CHSP services included domestic assistance, allied health, and transport services and that HCP program service utilisation varied across HCP levels, with personal care more commonly used as HCP level increased. However, these reports were compiled to inform program administration and funding dynamics, rather than to enhance understanding of the population’s care and support needs.⁹^,¹⁰

Day-to-day needs can also be measured through direct assessment of a person’s underlying needs, for example, by a researcher for the purposes of a particular study, or by an aged care worker for the purposes of care planning. Abdi et al. undertook a scoping review to identify the day-to-day care and support needs of people requiring home-based aged care as experienced by older people living in the United Kingdom.⁵ They found older people commonly needed support for mobility, daily activities such as personal care, and mental and physical health changes, with the level of support required impacted by ‘environmental’ factors such as supportive relationships, availability of services, and assistive equipment and technology. However, the findings of this scoping review are not directly applicable to the Australian context, given differences in the health and aged care systems between countries. In the Australian context, researchers have studied certain aspects of the population’s care and support needs, including falls prevention, hospitalisations, and social isolation.¹¹^–¹³ While important, such studies do not provide insight into the comprehensive range of day-to-day care and support needs of people requiring home-based aged care, and no evidence synthesis from this perspective has been identified for the Australian context.

Therefore, the aim of this scoping review was to locate and describe research reported in peer-reviewed and grey literature sources, where the comprehensive day-to-day care and support needs of Australians requiring home-based aged care had been measured and reported in detail.

Methods

Design

This scoping review was conducted according to Joanna Briggs Institute (JBI) guidance.¹⁴ The review protocol, developed prior to commencement of the review, was registered on the Open Science Framework (https://osf.io/fgm9r). Reporting of the review was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist (see Supplementary material Table S1).¹⁵

Eligibility criteria

The full inclusion and exclusion criteria for determining relevant literature are set out in Table 2. Studies needed to focus on older people requiring home-based aged care, where study participants’ full range of day-to-day care and support needs had been measured and reported in detail, and relate to the Australian context. The search was limited to literature published from 2012, when the current Home Care Package program commenced, until 26 November 2023.

Table 2.Inclusion and exclusion criteria.

Category of criteria	Inclusion criteria	Exclusion criteria
Population	Studies of older people aged 65 years and older. However, if a study or report included people aged less than 65 years, this did not preclude its inclusion, as long as a sufficient rationale could be determined. Sufficient rationale included: if the study population included Aboriginal and Torres Strait Islander peoples, this was deemed to be acceptable as this group of the population is eligible for aged care services from 50 years and older; in rare circumstances non-Indigenous people aged less than 65 years can require home-based aged care, so the inclusion of studies of people less than 65 years was deemed acceptable, as long as the predominant age of the study population was 65 years and older. ³¹	Studies about people predominantly aged less than 65 years.
Context	Studies about older people receiving, or on the waiting list for, ongoing Australian Government-funded home-based aged care services and support.	Studies focused on residential aged care or the hospital setting.
Context	Studies or reports focusing on sub-populations within Australia that might have included different socio-demographic groups, for example, different geographic locations or cultural backgrounds, that otherwise met the review inclusion criteria, could be included.	Studies focused on hospital discharge programs. These programs, while sometimes part of the process of setting people up with ongoing home-based aged care, tend to be focused on people who have just had an acute health issue. So, their care and support needs may relate to this acute situation rather than longer-term care and support needs.
Concept	Peer-reviewed and grey literature reporting empirical research studies where the study participants’ full range of day-to-day care and support needs were comprehensively reported. Day-to-day care and support needs here referred to mobility, functional, physical, cognitive, behavioural, psychological, and social needs, measured at the individual level. The assessment for these needs might have taken place for the purposes of the research, or for another purpose but reported in detail in the article.	Studies or reports focused on the care and support needs of people with specific diseases or conditions, such as dementia, cardiac or respiratory issues, or following a stroke.
		Similarly, studies or reports focused on particular aspects of care and support needs, such as social isolation, falls prevention, or continence.
		This is because we sought to understand the comprehensive day-to-day care and support needs of general populations or sub-populations of people requiring home-based aged care, rather than sub-sets of the population with particular diseases or conditions, or only specific aspects of care and support needs.
Type of study design for published literature	Quantitative primary studies.	Literature reviews of any kind, conference abstracts and studies where the full-text article could not be accessed.
Type of study design for published literature	Qualitative primary studies if they provided clear and detailed description regarding how information about care and support needs was collected.
Grey literature	Grey literature sources reporting primary research studies of the types described above, including research or data reports for policy purposes. The sources needed to describe the study design and the methods by which the study was conducted. The source needed to be available in a downloadable PDF format.	Position statements, policy documents (discussion papers, submissions, strategy documents etc), media releases, government budget submissions, opinion pieces, aged care service use reports, aged care financing reports, general aged care system information and ‘frequently asked question’ sheets, aged care program operations manuals.

Search strategy and selection of evidence sources

To locate potentially relevant peer-reviewed literature, the first author (RM) conducted a search using MEDLINE, CINAHL, AgeLine, and the Health Policy Reference Center on 26 November 2023 (search strategy depicted in Table 3). To locate potentially relevant grey literature, six separate Google searches and a search of the Australian Policy Reference Centre (APO) were conducted (Table 3). Managing the grey literature search results involved tabulation in Microsoft Excel (version 16.83) of the top 50 results from the Google searches and the 48 APO search results, and then screening for relevance based on the title and brief description provided with the Google or APO search results. For the Google searches, where likely relevant sources were still being identified in the last 10 results, the next 10 results were also tabulated and screened, up to a maximum of 100 results. Additionally, consultation and research papers pertaining to Australia’s 2018–2021 Royal Commission into Aged Care Quality and Safety underwent a similar initial screening process based on the title.

Table 3.Peer-reviewed and grey literature search terms and strategy.

Source	Search terms and strategy
Peer-reviewed literature	Search terms and strategy for Medline Complete (this search was then adapted for CINAHL, AgeLine, and Health Policy Reference Centre)
Peer-reviewed literature	TI elder* OR AB elder* TI aged OR AB aged TI ageing OR AB ageing TI aging OR AB aging TI older N1 (adult* OR person* OR people) OR AB older N1 (adult* OR person* OR people) TI “community dwelling older” N1 (people OR person) OR AB “community dwelling older” N1 (people OR person) (MH “Aged+”) S1 OR S2 OR S2 OR S4 OR S5 or S6 OR S7 TI need* OR AB need* TI “unmet need” OR AB “unmet need” TI complex N2 (care OR need* OR support OR client OR person OR adult) OR AB complex N2 (care OR need OR support OR client OR person OR adult TI complexit* OR AB complexit* TI care W1 support OR AB care W1 support TI activit* W1 “daily living” OR AB activit* W1 “daily living” S9 OR S10 OR S11 OR S12 OR S13 OR S14 TI (home OR community) W3 (based OR care OR services OR package) OR AB (home OR community) W3 (based OR care OR services OR package) (MH “Australia+”) TI Australia OR AB Australia TI Victoria OR AB Victoria TI “New South Wales” OR AB “New South Wales” TI Queensland OR AB Queensland TI Tasmania OR AB Tasmania TI “Northern Territory” OR AB “Northern Territory” TI “Australian Capital Territory” OR AB “Australian Capital Territory” S17 OR S18 OR S19 OR S20 OR S21 OR S22 OR S23 OR S24 S8 AND S15 AND S16 AND S25 S8 AND S15 AND S16 AND S25 Limiters – Publication Date: 20120101–20231231
Grey literature	Search terms and strategy for Google:
	The following search string was used:
	(“older people” OR “older Australians”) (“care needs” OR “support needs” OR “needs” OR “needs assessment”) (“Home Care Package” OR “HCP” OR “community aged care” OR “home care”) <site> file:PDF
	Across the following sites:
	site: gov.au, org.au, asn.au, uts.edu.au, nari.net.au
	E.g. (“older people” OR “older Australians”) (“care needs” OR “support needs” OR “needs” OR “needs assessment”) (“Home Care Package” OR “HCP” OR “community aged care” OR “home care”) site:gov.au file:PDF
	Search terms and strategy for the Australian Policy Observatory platform:
	(“care needs” OR “support needs”) AND “older people” AND (“community aged care” OR “home care”)

TI, title; AB, abstract; MH ‘…’, medical subject headings (MeSH) term; MH ‘….+’, exploded MeSH term.

All results identified through these search processes were imported into Covidence (Veritas Health Innovation, Melbourne, Australia), where peer-reviewed literature duplicates were removed. Two reviewers (RM and JM) working independently completed title and abstract screening and full-text review. Disagreements between the two reviewers were resolved through discussion, with the final decision recorded in Covidence.

Data extraction

Data were independently extracted by the same two reviewers (RM and JM) using a Microsoft Excel data extraction form, after which each version of the extracted data was compared and discussed to resolve any conflicts before agreeing on a final data extraction table.¹⁶

Data presentation and synthesis

Differences in the aims of included studies and types of data collected limited options for synthesis of the data. Day-to-day care and support needs identified by each source were tabulated against a simple framework based on commonly used groupings of care and support needs of older people: basic activities of daily living and instrumental activities of daily living,¹⁷ mental/cognitive needs, health/physical needs, plus an ‘other needs’ category (Table 4).

Table 4.Needs identified in included studies.

Types of needs ^A	Thomas et al. (2023) ¹⁸	Harrison et al. (2014) ¹⁹
	Study population: n = 50	Study population: n = 55
	Investigated nine service needs ^B	Investigated 79 underlying care and support needs using the CARENAP tool across eight care domains ^D^, ^E
Basic activities of daily living (ADLs)	Personal care (22% ^C)	Mobility (eight needs measured) including: assistance for steps and stairs, walking outdoors, balance and falls concerns ^D
Basic activities of daily living (ADLs)	Personal care (22% ^C)	Self-care and toileting (10 needs measured) including: washing, dressing, urinary continence ^D
Instrumental ADLs	Housework (86% ^C), transport (59% ^C), shopping (44% ^C), meal preparation (34% ^C)	Maintaining the home (nine needs measured) including: housework, laundry, shopping, running errands ^D
Instrumental ADLs		Nutrition (six needs measured): transport, cooking, weight/dietary concerns, eating ^D
Mental/cognitive needs	Not discussed	Mental health (14 needs measured), for example: making decisions and planning ahead, anxiety, memory/cognition, sleep, mood, and motivation ^D
Health/physical needs	Palliative care (14% ^C), allied health (46% ^C)	Health (13 needs measured), for example: eyesight, hearing, pain, medication management, skin care, breathing, dental care ^D
Other needs	Social support (32% ^C), respite (26% ^C)	Social behaviour/community living (seven needs measured), for example: socialise, pursuing interests, maintaining relationships ^D
Other needs	Social support (32% ^C), respite (26% ^C)	Life skills/opportunities (nine needs measured), for example: arranging and keeping appointments, arranging and managing exercise ^D

^A ‘Types of needs’ categories informed by Katz.¹⁷

^B Thomas et al. ¹⁸ examined service needs, not the underlying care and support needs that lead to a service need.

^C These percentages relate to the proportion of the total study population with the specific service need.

^D CARENAP is a licensed tool, and so all of the needs assessed within each domain are not provided by the study authors, nor are they accessible without a license to access the tool – see information about the CARENAP tool in Cameron and O’Neill.³³

^E Unlike Thomas et al.,¹⁸ Harrison et al.¹⁹ did not report the proportion of the total study population with each specific underlying care and support need assessed for using the CARENAP tool, nor did they provide sufficient details for this information to be calculated for this review. Instead, they reported the average number of needs identified per person in each of the CARENAP tool’s eight care domains, along with the needs that were most common for their study population in each of the care domains. It is this latter information that is used in this table.

Ethics

Ethical approval was not sought as it is not applicable for a scoping review.

Results

Literature search results

In total, 1324 peer-reviewed records were identified across all four databases. Once 493 duplicates were removed, 866 records remained for title and abstract screening. The grey literature search identified another 35 potentially relevant records. After title and abstract screening, the remaining 25 peer-reviewed and 5 grey literature records underwent full-text review. This process resulted in two included records (Fig. 1).

Fig. 1.

PRISMA for scoping reviews flow chart for included/excluded review records.

Characteristics of included articles

Table 5 presents the study and participant characteristics for the two included records. Both study populations comprised community-dwelling older people requiring Australian Government-funded home-based aged care, with small sample sizes, from specific sub-groups of the population. Thomas et al.¹⁸ conducted their study in 2020 and 2021 using a mixed methods approach with study participants living on the Eyre Peninsula, a rural/remote location in South Australia. Their 50 study participants were Aboriginal and Torres Strait Islander peoples, some aged less than 65 years (lowest age was 50 years). Harrison et al.¹⁹ undertook a quantitative study involving collection of a range of care needs measures using scaled assessment tools, administered during an interview by a research nurse (see Table 5). Their study was conducted in the years 2010 and 2011, with 55 people from the Illawarra/Shoalhaven area, a regional part of New South Wales. Their 55 participants also included some who were aged less than 65 years (age range 63–92 years).

Table 5.Study and participant characteristics.

Authors (year of publication)	Year of data collection	Research aim	Research approach and key design features	Context	Region of Australia in which the study was conducted	Study sampling criteria	Study sample size	Age range (years)	Other defining characteristics about study participants
Thomas, Dettwiller, and Gonzalez-Chica (2023) ¹⁸	August 2020 – October 2021	To explore CHSP and HCP service needs and current use among Aboriginal and Torres Strait Islander peoples living in rural and remote South Australia	Mixed methods: semi-structured group interviews were conducted via yarning circles. This involved the administration of a questionnaire consisting of multiple-choice questions, Likert-scale ratings, and open-ended questions.	Community-dwelling older people requiring OR receiving CHSP or HCP program services	Eyre Peninsula – rural and remote South Australia	Aboriginal and Torres Strait Islander peoples aged 50 years or older, with a residential address in the Eyre Peninsula, able to communicate directly or through family/other relatives, without any neurological condition affecting their capacity to understand the project objectives	50	Not explicitly reported, but appears to be 50–89 ^C	Most participants aged <80 years (74% 60–70 years old), most were females (68%), only small proportion were using CHSP (8%) and HCP (26%) services
Harrison, Low, Barnett, Gresham, and Brodaty (2014) ¹⁹	2010–2011	To investigate the relationship between objectively clinically assessed care needs and expectations for care of older people assessed as eligible for a CACP/EACH/EACHD package (pre-cursor to HCP program) and their carers (before the commencement of these services)	Quantitative: cross-sectional baseline data from the Community care for the Elderly: Needs and Service Use Study (CENSUS) was used for this study. Data were collected using a range of assessment tools ^A administered during an interview. Number of hours of current formal services and informal help were also collected.	Community-dwelling older people eligible for but not yet receiving a CACP/EACH/EACHD package	Illawarra/Shoalhaven – regional New South Wales	Community-dwelling older people, aged 65+ years, providing informed consent to participate in the study either directly or via a carer providing proxy consent, assessed by an Aged Care Assessment Team as eligible for a CACP/EACH/EACHD package, participant or carer required to have the ability to complete interviews in English	55 ^B	63–92 ^D	Average age of participants was 80.7 years (standard deviation: 7.0 years); 66% were female; 51% were married, and 42% were either separated, divorced or widowed; 87% were English speaking; 66% were Australian born, 13% were born in the United Kingdom, 16% were born in Europe, and 6% were born in ‘other’ countries; 20% had impaired cognition

Commonwealth Home Support Program (CHSP); Home Care Package (HCP); Community Aged Care Package (CACP), or Extended Aged Care at Home (EACH)/Extended Aged Care at Home Dementia (EACHD). Refer to Table 1 (including footnotes) for explanations about these home-based aged care programs.

^A Seventy-six items from the Care Needs Assessment Package (CareNAP Version 2) assessed needs across eight domains of functioning (mobility/health/nutrition/self-care and toileting/mental health/social behaviour and community living/life skills and opportunities/maintaining the home – each domain had a varying number of needs); Global Deterioration Scale (cognition); 13-item Quality of Life-AD; carers rated care recipients on 12 neuropsychiatric symptoms using the Neuropsychiatric Inventory. Carer needs were also assessed but findings regarding this participant group are not relevant for this review.

^B Of the study participants, 37/55 had their carers also involved in the study as study participants, but their findings were not relevant to this review.

^C Aboriginal and Torres Strait Islander peoples are eligible to access Australian government-funded aged care services at 50 years (compared to other Australians who must be 65 years).

^D No explanation was provided by Harrison et al.¹⁹ as to why some participants were aged under 65 years; however, based on the ‘population’ inclusion and exclusion criteria as described in Table 2, this study was deemed eligible to be included.

Care and support needs of people requiring home-based aged care

Thomas et al. explored the service needs and current service use, such as for housework, transport, and allied health services, among Aboriginal and Torres Strait Islander peoples requiring the CHSP and HCP program (Table 1). Within the study population, Thomas et al. found a high level of service need.¹⁸ The nine assessed service needs and their prevalence are shown in Table 4. The most commonly reported service needs were housework assistance (86%), transport (59%), and allied health input, e.g. physiotherapy and occupational therapy (46%), with the least common being personal care (22%) and palliative care (14%). Overall, 88% of study participants had a service need of some kind, with a median number of three service needs (interquartile range of 2–6 needs) across the study population. Ten percent of participants had all nine assessed service needs, with this being more likely in people of older age (70–89 years compared to 50–69 years).

Harrison et al. collected data on participants’ underlying care and support needs.¹⁹ The researchers assessed 79 underlying needs categorised within eight different domains (mobility, self-care and toileting, maintaining the home, nutrition, mental health, health, social behaviour/community living, and life skills/opportunities), finding that participants, on average, had 38 (range 11–69) of the 79 care needs. Frequencies of care needs were not reported – instead, the number of met and unmet needs identified in each domain was specified, along with the most common needs from each domain (Table 4). Most needs were identified in the mobility and home maintenance domains, such as walking, balance/falls, housework, and laundry. Fewer needs were identified for the self-care and toileting, mental health, and life skills/opportunities domains; however, most people had certain advanced needs within those domains: for example, washing/bathing/getting dressed, managing urinary incontinence, and arranging/keeping appointments.

Discussion

Despite the comprehensive search for peer-reviewed and grey literature, only two studies met the inclusion criteria. While only two studies were located, they provide important knowledge in relation to the comprehensive care and support needs of specific sub-population groups. A key finding was the different perspectives of ‘needs’ taken by the authors of the included studies. Thomas et al.¹⁸ investigated the service needs of their rural/remote study population, which were commonly services for housework, transport, and allied health input. Conversely, Harrison et al.¹⁹ investigated underlying care and support needs in their regional study population, finding people commonly had daily living needs in the domains of mobility, maintaining the home, social behaviour and community living, and nutrition, followed by health and mental health, life skills and opportunities, and self-care and toileting. While this different perspective of ‘needs’ limited ability to synthesise study findings, there was some relationship between the service needs and underlying care and support needs found between both studies, as shown in Table 4. By exploring underlying care and support needs, Harrison et al.¹⁹ generated greater depth and breadth of knowledge about the fundamental needs that give rise to the requirement for home-based aged care support. Understanding the underlying care and support needs of older Australians is necessary to gain better visibility of system deficiencies in addressing such needs.²⁰ Such knowledge will help to shed clearer light on gaps between underlying needs and available services, as well as on workforce skills and skill mix required to meet these needs, and help prioritise decision-making about resource allocation regarding such issues.⁵^,²⁰^,²¹

Another key finding of this review is that only two relevant studies were located, highlighting a gap in research about the full range and prevalence of day-to-day care and support needs of older Australians requiring home-based aged care. This finding is important, since, as Abdi et al. contend, the configuration of service and service delivery systems should be based on a deep understanding of the care needs of older people.⁵ Services provided through the current home-based aged care system have not significantly evolved since the mid-1980s when the first community aged care program was introduced.²² With a deeper understanding of underlying day-to-day care and support needs, innovative service types could be identified, which might include various ways to improve access to episodic allied health type services to maintain or restore a person’s independent function, and ways to facilitate better integration of health and aged care in optimising the management of health issues, and enable access to technology.²³^–²⁵

When it comes to workforce planning, information about the needs of populations is an important demand-side factor in workforce planning supply and demand frameworks, alongside other demand components (for example, historical utilisation patterns) and supply components (for example, training places).²¹^,²⁶ For home-based aged care, improved knowledge about changing patterns of underlying day-to-day care and support needs would inform necessary changes to the skill base required for certain roles in relation to the needs of the population of interest, which it would be important to incorporate into home-based aged care workforce planning and modelling.

Implications

This scoping review has revealed a substantial gap in research about the range and prevalence of the underlying day-to-day care and support needs of Australians who require home-based aged care. This knowledge gap could mean that Australian aged care providers and policy-makers lack key information to enable them to optimally design contemporary service-delivery models that effectively and efficiently meet the broad range and prevalence of day-to-day needs experienced by Australians requiring home-based aged care, ultimately impacting the quality of care they receive.²⁷ This knowledge gap could also affect aged care workforce planning, as without direct measurement of the range and prevalence of day-to-day care and support needs of people requiring home-based aged care, skills and skill mix requirements to address the needs are not overtly apparent.

Further research to address this gap is imperative and should include large-scale quantitative studies of representative populations, which while challenging to design and conduct, would provide results that could be generalised to the broader population. Such research could be conducted by making use of de-identified, routinely collected aged care provider and Australian aged care assessment program datasets. Given Australia’s socio-economically diverse, multicultural, and predominantly metropolitan-based population,²^,²⁸ studies on this topic must be as representative of this demographic variation as possible. Qualitative studies to provide a nuanced understanding of the topic are also required. Studies such as that by Harrison et al.¹⁹ about specific sub-population groups can provide insights for aged care providers at the local level, and studies with larger, more generalisable population samples can support government-level home-based aged care program design.

Study limitations and strengths

Only two publications met the inclusion criteria. However, a wide range of databases, including grey literature sources, were searched to locate relevant Australian literature for this review. The review was conducted using a systematic, rigorous, and transparent approach.

Conclusion

This scoping review has identified that comprehensive day-to-day care and support needs can be understood and assessed differently – that is, as services needs or underlying needs. It is suggested that knowledge about underlying needs provides greater insight into this population’s fundamental needs which lead to the requirement for home-based aged care and hence are important to understand. Overall, this scoping review has revealed a paucity of research to enable such an understanding. Future research should aim to understand older Australian’s underlying day-to-day care and support needs rather than service needs alone. Studies with large, representative samples are required that are able to provide generalisable findings that can inform program design at the government level. Research with sub-population groups is also important to guide care delivery and workforce approaches for aged care providers and practitioners working with different population groups. Such research will provide crucial evidence to inform the development of a contemporary, effective, and efficient government-funded home-based aged care system and workforce requirements able to address the needs of Australians requiring home-based aged care.

Supplementary material

Supplementary material is available online.

Data availability

Data sharing is not applicable for this review article. No new data were created for this study. Instead, information was obtained from included studies.

Conflicts of interest

RM is a registered nurse working as an Assessment Clinician with an Aged Care Assessment Service in Victoria, Australia, where she assesses eligibility for Australian Government-funded aged care; MH is a board director of Glenview Community Services, a not-for-profit residential and home-based aged care provider based in Tasmania, Australia.

Declaration of funding

RM was supported by a Deakin University Postgraduate Research Scholarship (Domestic) to undertake this research. The Australian College of Nursing also provided the first author with grant funding via the Centaur Nurses Memorial Scholarship 2022, as did the Australian Nursing and Midwifery Federation (Victorian Branch) via their Annual Higher Education and Research Grant 2023.

Acknowledgements

This scoping review forms part of the PhD program for RM.

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