An international census provides an insight into service provision of the future, writes Paul Gregersen.

From Glasgow in Scotland to Gisborne in New Zealand, the care and clinical needs of more than 26,000 residents in 438 aged care facilities in the UK, Spain, Australia and New Zealand have been recorded by those carers involved most closely in their day-to-day care.

The recent Bupa Care Services survey of resident health presents unique insights and offers food for thought when it comes to designing future care services.

This has been an exercise in understanding ageing and the challenges faced by our residents and carers. No other aged care provider has our international footprint and, consequently, we are uniquely placed to carry out this kind of exercise internationally.

The power of the collaborative approach means we can capture the detail of health and disabilities in our markets, compare results, explore differences and share knowledge. The data reveals some striking similarities and dramatic differences in the care needs of residents in each country.

Similarity and disparity

The census is the third carried out by Bupa in six years. The first was conducted in 2003 when Bupa’s aged care business was purely a UK operation. The next survey, in 2006, provided findings which were broadly similar but one analysis revealed there was a profound difference in the prevalence of dementia – with Glasgow reporting twice as many cases as Kingston, in the south of England.

Having found such a disparity between facilities operating in similar environments barely 640 kilometers apart, surely the contrast between those operating on different continents, in different cultures and within different clinical frameworks, would display an even more dramatic variance?

2009 aged care census findings

One of the most striking findings has been the similarity in the characteristics of people in care internationally. But how, why and when people use residential care varies considerably.

For instance, there is little variation in the average age of residents across the Bupa global division, with Australians having the highest average age at 83.6, followed by Spain (83.5), UK (82.8) and New Zealand (82.4). The average resident age across the four countries is 83.

However, Australia and New Zealand have the highest average length of stay, at 30.1 months. One of the contributing factors is that transition care is more established in the UK and Spain, with both countries showing a bigger percentage of temporary stay.

In Australia, there are only 2 per cent of residents without a clinical driver for care, compared to the global average of 5 per cent. In other words, only 2 per cent of Australian residents presented a normal mental state and were fully mobile and fully continent.

The census has presented interesting data that warrants further exploration. For example, incidences of stroke in Spain (9 per cent) are less than half of those in New Zealand (23 per cent). Are the benefits of a Mediterranean diet really that significant?

Dementia is constant across the four countries, at a total average of 46 per cent. It has and will continue to grow in importance in line with an ageing population and the resulting rise in dementia numbers.

In the UK, cases of heart disease have more than doubled to 21 per cent of the resident population in the six years since the first census. Bupa believes this is due to a more complete diagnosis, rather than a real increase in the disease. However, 38 per cent of residents in Australian facilities have been diagnosed with heart disease. It is a variation Bupa attributes to the degree of detail required in the assessment undertaken before a resident enters a facility in different parts of the world.

In Australia there is a formal medical assessment, under ACFI, before admission while in the UK residents typically transfer from a hospital where the lead diagnosis may be dementia and heart disease might not be adequately recorded.

ACFI is a driving force behind Australia’s impressive detection record. There is some evidence that the tools we use in Australia lead to better diagnosis, which in turn leads to better care and planning.

Australian residents are also more likely to be diagnosed with sight and hearing impairments than their counterparts in the UK, Spain and New Zealand.

However, the survey does suggest that the government’s imposed low and high care ratios is out of step with the rest of the world.

Looking into the future.

The census has given us an insight into the aged care facilities of the future. Long term care will remain at the heart of our business but the development of specialist dementia care provides an example of how we are likely to differentiate our services. It is possible that we will also refine and develop further our services for end of life care, rehabilitation and more widely in chronic disease care.

Using the census data we can identify where variation can be explained by local assessment criteria or a material difference in the condition of residents. We will also use it to inform policymakers and politicians.

This data accelerates our drive towards a greater understanding of the individual needs of each resident. But we must remember that behind each of the census numbers is a person with a unique story and a health characteristic that requires highly individual personal care.

While the numbers tell us what skills and support our customers need, it is our caring teams who bring this to life. Blending personalisation and professionalism to provide a uniquely individual service must be at the heart of care.

Paul Gregersen is managing director, Bupa Care Services Australia.