Aged Care Issues
Special needs status under the Aged Care Act
In 2001 veterans were assigned special needs status under the Department of Health and Ageing’s Aged Care Act 1997. The effect of this is that aged care providers need to consider the 'special needs' of the veteran community in the provision of care, and planning authorities must consider the aged care requirements of the ex-service community.
The assigning of special needs status was based on:
- the rapid ageing of the veteran population
- their service, sacrifice and hardship
- their unique cultural identity.
See: 2011 Aged Care Approval Round (ACAR) related submissions to Aged Care Planning Advisory Committees (ACPACs):
What is the veteran community?
Three generations of Australians had their lives substantially shaped by the experience of Australia’s involvement in two world wars. In the decades since, Australians have participated in over 50 wars, conflicts or peacekeeping activities, or been members of the Australian Defence Forces.
The meaning of the word 'veteran' depends both on the individual and the context of the term. For the Department of Veterans’ Affairs (DVA), a veteran holds a health entitlement card and/or a pension card, or is a war widow/er or dependent holding such cards. Under the Aged Care Act 1997, a member of the veteran community is more broadly defined as '…a veteran of the Australian or allied defence force; or a spouse or widow/er of a person mentioned above'.
As at 31 December 2010, the DVA beneficiary population (defined as a veteran or war widow/er in receipt of pension(s), allowance(s) or health care under the Veterans’ Entitlement Act) was 358,991. Of those, 68.5% were aged 70 years or older and 55.6% were aged 80 years or older. Over the next decade, by 30 June 2020, the DVA beneficiary population it is forecast to decline by 42.6% to 205,900.
The DVA treatment population (defined as a veteran or war widow/er issued with a Repatriation Gold or White health card ) is also declining at a significant rate. As at 31 December 2010 this cohort represented 251,887 DVA clients with an average age of 76.4 years. Of those, 64.5% or 162,394 were aged 75 years or older and 42.4% or 106,894 were 85 years of age or over.
Over the next decade, by 30 June 2020 this treatment cohort is forecast to decline by 40.9% to 148,900 clients. Of these 22.2% are forecast to be aged 90 years old or over.
The rate of decline is due to the advancing ages of surviving World War II (1939 – 1945) veterans and the absence of any recent conflicts involving large numbers of Australian servicemen and women.
Given the number of servicemen and women who served during World War II (approximately 1,000,000), it is not surprising that the veteran population makes up about a quarter of the residents of aged care facilities. While nearly half the Australian male population over 80 years of age are veterans, some people might be surprised to learn that as at 31 December 2010 male recipients of Gold health cards only out-numbered female recipients by 0.5%. For further information about Australians and World War II please visit: www.ww2australia.gov.au
Free downloads of education resources about Australia’s wartime history are available at www.dva.gov.au/commems_oawg/commemorations/education/Pages/education%20resources.aspx
See: State specific demographic information
Back to top
During World War II, one in seven of the total Australian population enlisted.
Whether serving overseas or in Australia, taking on new occupational roles in the absence of so many, or knowing family and friends were at risk, the experience of war was a defining experience for today’s older Australians. For many, this shared history and hardship has lead to identification with a distinctive cultural group.
Cultural attributes often seen in the veteran community include:
bonds of mateship formed in times of danger
- bonds of mateship formed in times of danger;
- commemoration of sacrifice of the fallen;
- provision of welfare support for their mates and the wives and dependants of deceased comrades;
- high membership of ex-service organisations (ESOs) and other social groups; and
- participation in commemorative activities, such as Anzac Day and Remembrance Day.
Back to top
Veterans have higher rates of health risk factors compared to their non-veteran counterparts, including:
- lack of exercise;
- obesity; and
- long term use of cigarettes and alcohol.
Veterans are more likely to:
- experience a short or long term illness;
- develop cancer; or
- suffer from diseases of the digestive, nervous, circulatory and musculoskeletal systems.
Veterans are also prescribed more medications than non-veterans, even allowing for disabilities.
Increased rates of mental health problems are apparent in the veteran community. More than a quarter of the treatment population have mental health conditions, about half of which are accepted as being due to military service. Veterans have much higher rates of conditions such as posttraumatic stress disorder, although this diagnosis might not have been made in older veterans. War-related memories may have a negative affect on those with dementia, and this issue should be considered in care planning for older veterans.
Three types of health cards are issued by DVA:
- Gold cards are issued to eligible veterans or their war widow/ers, and cover all medical conditions.
- White cards are issued to eligible veterans, and cover specific service-related disabilities.
- Orange cards are issued to eligible Commonwealth and Allied veterans, and cover pharmaceutical benefits only.
Back to top
Special needs of the veteran community
Aged care services can contribute to better care of veterans by considering issues related to their special needs:
- Identify all veterans and their widow/ers (regardless of cards or entitlements) on admission.
- Ensure the veteran or war widow/er is aware of their DVA entitlements.
- Provide DVA contact information for the resident or family members.
- Contact DVA to check entitlements.
- Collect a detailed service and cultural history soon after admission.
- Ensure ongoing contact with ESOs as desired.
- Help the veteran and/or family members to observe commemorative days of national and individual significance.
- Consider the veteran’s service and subsequent history when managing challenging behaviours and potential triggers.
- Look for mental health issues in veterans and link to appropriate psycho-geriatric services.
- Ensure health providers are aware of the resident’s entitlements, status and history.
- Identify staff training opportunities in veteran issues and services.
Ex-service organisations (ESOs)
Many in the veteran community associate closely with ex-service organisations (ESOs).
ESOs in various states and regions have differing levels of involvement in the provision of welfare and other services, including residential or community aged care. Some ESOs may be able to help veterans in residential aged care facilities through the provision of advocacy, advice or assistance, or visitation programs. Further, ESOs may be able to assist residential aged care providers by advising on commemorative activities in which veteran residents might like to participate. A small number of ESOs also offer training programs for personnel of residential are facilities.
Back to top