Financially or Socially Disadvantaged
The social determinants of health are the circumstances and conditions in which people are born, grow up, live, work, and age. These determinants are shaped by various economic, social, and political policies and forces, and are important to good health. When people are disadvantaged due to factors like race, ethnicity, class and gender, their life chances and opportunities are often affected. Disadvantage can lead to exclusion from society. When people are excluded from society, they have limited access to economic and non-economic goods, services, activities and resources.
People who are financially disadvantaged have limited financial means to be included in society, and to access the services they need to live a healthy and fulfilled life. Those who are socially disadvantaged are typically alienated from friends and family, lack informal support networks, and may display challenging behaviours and/or isolate themselves. People who are financially or socially disadvantaged often have limited ability to access or maintain access to services. People often experience both forms of disadvantage at the same time.
Generally, people in lower socioeconomic groups are at greater risk of poor health, have higher rates of illness, disability and death, and live shorter lives than people from higher socioeconomic groups. Some groups in Australian society are more vulnerable to disadvantage and/or poverty than others. People at risk of financial or social disadvantage in Australia include Aboriginal and Torres Strait Islander people, those living in rural and remote communities, people living with disability or mental illness, newly arrived migrants (particularly those without English), older adults, and others disadvantaged by various economic, cultural, social or educational factors. Low income typically reflects more fundamental disadvantages in daily life.
Other factors which contribute to socioeconomic disadvantage include:
- not going to school
- not having post-school qualifications
- having low family income
- not owning a car
- having transport difficulties
- experiencing separation or divorce
- one parent families
- living in a lone person household
- living in an overcrowded home which requires more bedrooms
- having rental or home purchase stress
- renting government housing
- poor computer access
- living in a home without an internet connection
- having a long-term health condition
- needing help with core activities
- having criminal convictions and/or prison incarcerations
- experiencing trauma
- experiencing domestic violence
Multiple types of disadvantage often occur all at once. People who live with disadvantage tend to have limited means and opportunities to become and remain resilient. Multiple disadvantages can be more difficult to overcome than any single aspect of disadvantage. Multiple disadvantage can exist across generations. Aboriginal and Torres Strait Islander people are over-represented on virtually all measures of disadvantage, and experience far more social exclusion than other Australians. Disadvantage is a complex relationship between the characteristics of people living within a community (including unemployment and low income) and the social and environmental context within the community (including fewer social networks and less opportunities). Community disadvantage refers to the complex factors making it difficult for people living in certain areas to achieve positive life outcomes. Living in a ‘place’ or ‘neighbourhood’ that is disadvantaged can affect peoples’ life choices. National Legal Aid helps people with the costs of resolving legal problems and may provide advice, information, representation and negotiation.
Aged care considerations for financially or socially disadvantaged populations
Being financially or socially disadvantaged can be especially difficult for older adults who need aged care and end-of-life support. The Australian Government subsidises a range of aged care services so that all older people can access aged care. In Australia, older adults contribute to the cost of their care if they can afford to. However, people are not denied a service they need because they cannot afford it. My Aged Care has information about financial hardship assistance. Financial hardship assistance is available to people who cannot afford to pay their aged care costs for reasons beyond their control. Each case is assessed on an individual basis and the government will pay some or all of people’s fees and charges. Carer Gateway provides information on financial help. Friends of the Aged is a not for profit organisation seeking to help older Australians who experience discrimination and inequality due to social and financial hardship. They provide social visits to those living in the community or in residential aged care, and provide comfort and support towards the end of life.
Home care, respite care, and residential aged care for people who are financially or socially disadvantaged
The government provides assistance for home care packages, residential respite care or short-term care, and permanent residential care homes. Regarding assistance for home care, the government may pay some or all of a person’s fees if they started receiving a Home Care Package on or after 1 July 2014. The value of their assets is considered as part of the assessment process. Individuals receiving a Home Care Package before 1 July 2014 are not eligible for financial hardship assistance, but may be able to negotiate lower fees directly with their home care provider.
Regarding residential respite care or short-term care, financial hardship assistance may help to reduce a person’s basic daily fee. The value of their assets is considered as part of the assessment process. Regarding permanent residential aged care facilities, financial hardship assistance may help to reduce a person’s basic daily fee, means-tested care fees and/or accommodation costs. Basic daily fees cover living costs like meals, power and laundry. An assessment of a person’s income and assets determines if they are required to pay this fee. Some people will pay accommodation payment costs in full, while others have costs paid for in full or in part by the government. Others pay the accommodation price agreed with the aged care facility. Additional fees may apply where people choose a higher standard of accommodation or added services. Financial hardship assistance is not granted for extra and additional service fees, which vary across facilities. Click for more information on the aged care subsidies and supplements available to providers of aged care services in home care and residential care.
Supported residential placements, viability supplements and homeless supplements
Supported places exist for people who are not able to meet all or part of their accommodation costs. Accommodation supplements are paid to approved providers on behalf of residents. The level of supplement depends on means tested assessment and several other conditions relating to the aged care service. The proportion of supported residents increases with remoteness.
The Australian Government provides a viability supplement which aims to improve the financial position of smaller, rural and remote aged care services that have additional costs due to their location and are limited in their ability to offer services due to fewer beds. The viability supplement provides added funding for providers who provide services to Aboriginal and Torres Strait Islander people, or people who are homeless or who are at risk of becoming homeless, as there are often higher costs in providing care to these groups. The supplement is available to residential care services, home care services, Multi-Purpose Services and Aboriginal and Torres Strait Islander Flexible services.
A homeless supplement is paid to providers for each resident of an eligible aged care facility. Eligibility for the supplement is based on an aged care facility having more than 50 per cent of its residents who are identified as being homeless, or at risk of being homeless. The supplement is in addition to the funding provided under the viability supplement.
Residential aged care options are not always appropriate with respect to financial and social considerations for disadvantaged Australians. Providing the right aged care or home or community care options requires flexibility and an approach which is targeted to the unique needs of each older person. Veterans may be eligible to receive financial assistance through the Department of Veterans’ Affairs (DVA). To find out more, contact the DVA on 133 254.
Palliative care and advance care planning considerations for financially or socially disadvantaged populations
Where people live and their financial background determines what kind of palliative care services and end-of-life support they receive. Many people who have lower socioeconomic backgrounds experience barriers to accessing palliative care and end-of-life services and resources. Australians living outside of major cities have less access to community-based palliative care, and are more reliant on hospitals. Vulnerable Australians, including those with lower financial capacity and lower education, are more likely to have unmet information needs and to be dissatisfied with the information received from providers. This can present issues for advance care planning. People with lower socioeconomic status usually have higher levels of chronic illness and greater mortality, meaning there should be an even greater focus on providing best practice end of life care.
Most older Australians have preferences for a home death, however this may be more difficult for people from lower socio-economic backgrounds as they often lack informal support and may face financial difficulties in accessing appropriate formal supports. Many home-based palliative care services rely on informal care arrangements and provision; therefore, people who do not have strong informal supports may face barriers to home care options. Many Aboriginal and Torres Strait Islander people living in rural and remote areas and some culturally and linguistically diverse groups hold strong cultural and spiritual preferences for home deaths. However, they are often unlikely to achieve this due to a lack of local services and appropriate supports.
palliAGED provide information about planning for and providing appropriate care for people who are either financially or socially disadvantaged due to unexpected circumstances or circumstances beyond their control.