In a comparison of the aged care sector in 22 countries, Australia scored poorly, compared to smaller, more home-like European facilities.

Countries providing high-quality aged care easily outspend Australia and focus more on providing assistance within the home environment, a new study has found.

Researchers at Flinders University examined aged care systems in 22 countries in preparing a report for the federal royal commission into aged care.

They pointed to Denmark and Sweden as countries with good-quality, long-term systems where government spending was more than four per cent of gross domestic product.

By comparison, Australia spends about 1.2 per cent of GDP, placing it towards the bottom of all the countries examined.

Australia also scored poorly in relation to a number of other comparisons.

It was found to have lower levels of total staffing and nurses employed in residential care while Australians receiving assistance reported the highest level of dissatisfaction with the care provided.

Australia was also the second-highest for the percentage of older people who experienced cost-related problems in accessing health care.

The study further revealed Australia had a relatively high number of older people in residential institutions with other countries relying more on home and community care.

Of people aged 80 and over, almost 20 per cent of Australians were living in institutions compared to 14.6 per cent in New Zealand, 7.4 per cent in Japan and just 6.1 per cent in the US.

A separate research paper suggested Australia examine a range of alternative approaches to care including the use of smaller homes, that maximised the independence of residents and their participation in daily activities.

"A number of small-scale living models of residential aged care exist, where residents live in homes of, for example, up to 16 people," the study said.

"Small-scale living models of care have many features in common, including a focus on a domestic, homelike, familiar or normalised environment, where medical equipment is hidden and staff do not wear uniforms.

"The residents have the opportunity to engage in domestic or regular duties, staff members are allocated to work in specific living units and there is a focus on maximising resident independence and quality of life."

The second paper also backed remote support for those living independently through the development of "health smart homes" that used sensors to monitor a person's condition and activity to determine if greater assistance was required.