The Royal Commission into Aged Care has heard calls for a major shift in how Australians care for the elderly.
Senior Counsel Assisting Peter Gray QC said the overwhelming majority of elderly people would prefer to age in their own homes.
But by the time they turn 80, one in five will be living in residential aged care.
The commission was told that Australia has one of the highest percentages of elderly people living in institutional care of any developed country.
"The figures … do suggest our system is distorted towards institutional care and away from community and home care," Mr Gray said.
"There should be far more urgent efforts to prioritise home care over residential care."
He said there will always be a place for high-quality residential care but research showed it was not generally the setting a person would choose.
The inquiry heard the COVID-19 pandemic was likely to reinforce the general preference to remain at home.
Mr Gray said the latest figures showed there have been seven deaths among nearly a million people receiving Federal-subsidised home and community care during the pandemic.
By comparison, there have been 412 deaths among the 200,000 people in residential aged care in Australia.
Over the next three days, the royal commission will examine what needs to be put in place to deliver high-quality and safe care to older people in their homes and in the community.
The inquiry heard a 2015 study found that each hour of additional home care each week, there was a 6 per cent reduction in the chance of that person every having to enter residential care.
"Home care should in this manner act as a stitch in time, preventing or at least allaying much more weighty problems for the individual and much more costly forms of care," Mr Gray said.
The inquiry heard that while the number of people who want to be cared for in their own home is rising, many are not getting the help they need in a timely fashion.
More than half of those who have applied for home care packages for more complex needs have been waiting more than a year.
The royal commission will look at whether family members caring for elderly relatives at home and in the community could be given access to extra leave and flexible working arrangements.
As the hearing was underway, the Federal Government announced more than $70 million in extra funding to support older Australians who are temporarily moving out of residential aged care to live with their families due to concerns about COVID-19.
'It's a job'
Angela Finn has been caring for her 87-year-old mother, Pam, since bringing her home from residential aged care in April due to the pandemic.
Working from home has made it possible but she's had to cut back her work hours to four days a week.
"That's been a financial loss but we're wearing it because caring for mum is just like having a child, it's a job," she said.
She said having access to extended leave and flexible hours would make a big difference.
"That would be so beneficial because people wouldn't have to sacrifice financially," she said.
Ms Finn said in between work and caring for her mother, it was hard to find the time to research what services are available.
"There's so much out there, it's so hard to navigate," she said.
"Extra leave would have been good so I could have accessed the services quicker."
