**4. The residential aged care facilities in Australia**

### **4.1 COVID-19 in residential aged care facilities**

The COVID-19 pandemic was confirmed to have reached Australia on January 25th, 2020. Until now, there were 56,565 positive cases and 1,019 deaths confirmed in Australia. The Australian Government Department of Health reported positive cases and COVID-associated deaths on daily basis. The elderly account for a staggering 697 of those deaths. 61% of deaths occurred in residential aged care facilities. People who had picked up the infection in the nursing home where they were supposed to feel safe. **Table 4** here illustrated the positive cases overall and in residential aged care facilities for each subarea in Australia.

In the ACT, Northern Territory, South Australia, and West Australia, there're no active reported positive cases or death available in nursing homes. In other subareas, the number of positive cases and deaths is not as high as UK or US, but the percentage still may prove the severity of the outbreak at the residential aged care facilities. In Victoria, almost 80% of COVID-related deaths are from residential aged care facilities (**Figure 2**).

#### **4.2 The structure of nursing homes in Australia**

Aged Care in Australia is the provision of services to meet the unique requirements and needs of elderlies in Australia, which includes in-home care, residential care in aged care (nursing) homes, and short-term care such as respite care [20]. The aged care industry provides older Australians with a range of different services, allowing them to access appropriate and affordable care when and where they need it. In Australia, many aged care services are government-subsidized to help keep costs manageable and affordable [21]. Australians, who are eligible for government subsidies, will still be expected to contribute to the cost of services if they can afford to.


#### **Table 4.**

*COVID-19 in Australia (09/19/2021).*

#### **Figure 2.**

*COVID-19 in Australia's nursing homes (September 2021).*

The Australian aged care sector is large and complex. According to the Aged Care Financing Authority, the aged care industry is one of Australia's largest service industries, including over 350,000 employees, over one million consumers, and around 2,000 service providers. The aged care industry is essential to elderlies in providing a variety of care options for their later stages of life. In 2016/17, aged care services made up \$17.8 billion of Commonwealth expenditure, which is a significant public involvement [22].

There are over 2,000 aged care services in Australia, supplying three different types of aged care services: home and community care (HCC); home care; and residential care. HCC provides entry-level basic support for older people who need

#### *Challenges and Futures of Long-Term Care Industry after COVID-19 Pandemic DOI: http://dx.doi.org/10.5772/intechopen.104316*

assistance to live independently. Home care contains 4 levels of care provided to elderlies living at home, ranging from basic to high-care needs. Residential care provides accommodation and support for those who choose to live within residential care facilities, which is the one we focus on in this chapter. In 2013/14, residential care facilities generated 82% (14.8b) of total revenue and received 73% (\$9.8b) of total Commonwealth funding to the aged care sector, while residential aged care places represented only 18% (189,283) of total aged care places (**Table 5**).

A combination of for-profit, not-for-profit, and government service providers contributed to these three types of aged care services. Across all three types, not-for-profit providers supplied most aged care services, with the market share of these providers ranging from 52% in residential care to 74% in HCC [22].

Looking at the recent patterns and prominent factors, the growth of the aged care industry is a given without the hit of COVID-19. Apparently, the pandemic warned people to make a smart choice about their aged life. The aged care facilities, especially the residential aged care facilities, face quite big challenges before and after the COVID-19 pandemic.

#### **4.3 The challenges of the nursing home industry**

The first challenge is the changes of demands of the Baby Boomers. As Baby Boomers move into old age, this trend is set father greater momentum over the next three decades. Baby Boomers are a sizable cohort, accounting for nearly 5.6 million Australians [23]. The proportion of people aged 65 years or over is projected to increase from 13% in 2010 to 23% by June 2050 (**Figure 3**) [24].

Given that the number of seniors is continuously climbing and potential consumers are now exercising more control over the care packages and facilities, policymakers and service providers should focus on creating a sustainable system that supports the increasing volume of the elderly [25]. Compared with the new generations, Baby Boomer tends to be cautious and rational on consumption behavior. With the hit from COVID-19, it is possible to switch Baby Boomers' decision-making process and affect the demand of aged care facilities. Aged care service providers can consider investing in technologies such as Augmented Reality, Virtual Reality, Artificial Intelligence, Video Calling, CRM solutions and more to suit the varying demands of seniors.

The second challenge is the lack of skilled staffs and how the aged care facilities attract them. The Aged care sector is heavily dependent on the skills of the workforce. From the population perspective, for every couple of retirement age, there were 15 people in the working-age population in 1970. This number dropped to 10 by 2010 and is projected to decline to 5 by 2050 [26]. Apparently, the number of skilled workers leaving this industry is rising. Increasing workload and stress, less career growth opportunities, extended working hours and dissatisfaction from the remuneration are some of the main reasons responsible for the drain of skilled employees [25].


#### **Table 5.**

*Basics about the Aged Care Facilities in Australia.*

**Figure 3.** *Estimates about the percentage of elderlies by 2050. Source: Australian Government [24].*

The COVID-19 pandemic is possible to make this situation even worse. According to a survey of the Australian nursing, midwifery, and care worker workforce, which was completed by Rosemary Bryant AO Research Centre in May 2021, around half of the survey respondents were moderately or extremely concerned about having adequate staff (53.18%), the welfare of their colleagues (52.15%) and having the right skills mix in the workplace (51.43%). The workload for nurses has significantly increased since the pandemic. During the pandemic, working at an aged care facilities means the highest levels of workplace demand, role conflict, work-life conflict, and lowest job satisfaction, as well as the lowest clarity compared to other workplace groups [27].

Another problem is to attract qualified and skilled workers. Recruitment of a skilled workforce such as certified care givers and nurses for the aged care facilities is also a big challenge as well. Under situations with high workloads and low job satisfaction during the pandemic, attracting a qualified workforce becomes even harder. The aged care service provider may invest in some high-quality technology solutions and create a robust infrastructure to manage the situation. For example, they can offer the remote working options or proper transport facilities by arranging private vehicles or an appropriate bus facility [25].

### **5. Conclusion**

Starting from the early months of the COVID-19 pandemic, the long-term care facilities have experienced an extremely tough period all over the world. Suddenly, the nursing home industry, which has been long operated out of public view, finds itself at the center of scrutiny. During a crisis like this pandemic, it becomes especially critical to preserve the necessary functions for long-term care facilities. It is essential for aged care centers to maintain their size, the number of beds, recourses, manage external emergency circumstances, and also boost the potential demands. Based on our findings from the UK, the US, and Australia, we can say that the COVID-19 outbreak will likely push potential or existing residents and their families to question and reconsider whether the residential long-term care facilities, such as nursing homes, senior centers, or aged care facilities, are the best or safest options for them to be.

The pandemic challenged and changed the way of operations for almost all the long-term care facilities all over the world. Even the number of elderlies is rising in the future, the diverse format of retirement life care and the decreasing trend

*Challenges and Futures of Long-Term Care Industry after COVID-19 Pandemic DOI: http://dx.doi.org/10.5772/intechopen.104316*

of public financial supports have already dropped the demand for residential long-term care facilities before the COVID-19 pandemic. Due to the rising number of confirmed COVID cases and deaths in nursing homes, not only the potential patients, but also the qualified staffs and workers may have second thoughts about continuing their works in nursing homes. Meanwhile, the entire long-term care industry has been lacking qualified and skilled staffs and nurses all the time even without the pandemic. Although, in some countries (such as UK), potential students who may dedicate their will to become a nurse or font-line medical workers after seeing and understanding the meaning and importance of medical-related work. Unfortunately, this is not happening in most of the countries.

After the COVID-19, for potential elderlies or demanders who may need residential care, there're many other new options that can provide sufficient and affordable care. All options for later-life care, including assisted living facilities, home healthcare, and community-based care, need to be reviewed and re-evaluated after COVID-19. As the major financial supporters of long-term care, each government may also need to consider how to adjust the residential aged care facilities and adapt them into the new business norm after COVID-19. And also, potentially speaking, home- and community-based care are highly possible to become the new dominants for the post-COVID long-term care industry.
