The challenge of regulating care for older people in AustraliaBMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7310.443 (Published 25 August 2001) Cite this as: BMJ 2001;323:443
- John Braithwaite, professor ([email protected])
- Research School of Social Sciences, Australian National University, Canberra, ACT 0200, Australia
The crisis of care
From worldwide accounts in the media of the abuse and neglect of frail elderly people both in nursing homes and in community care it seems that Western governments and civil society are doing badly at meeting the challenges of caring for older people. Although horror stories provide evidence that the quantity and quality of services for frail elderly people need to improve, when they are put into historical perspective, the care of elderly people is a success story for both welfare and regulation. However, it is also one of failure for the neo-liberal policies of privatised care. (Neo-liberal policies seek to shift what were functions of the state to the private sector and the individual.) Australia provides a good example of this (box).
Care of frail elderly people in Australia
1788-1888 — The convict state: poor elderly people are incarcerated in asylums
1888-1988 — Rise of the welfare state: institutional care for elderly people becomes less prison-like
1950-1988 — Rise of the regulatory state: state government increases its role in inspecting nursing homes and setting standards
1988-1996 — Takeover of the regulatory state: Commonwealth government takes over and standards shift towards evaluating outcomes for residents; there is also a shift towards providing care at home and in the community
1996-2000 — Deregulation: experiments in deregulation and privatisation of care of elderly people
Before the welfare state existed in the West, families who were financially comfortable cared for their older relatives at home, often with love and with the responsive support of the family doctor; there was, however, often a cost to women who bore the burden of care. In some cases there was domestic neglect and abuse. Elderly people who were destitute were systematically neglected and abused during their incarceration in asylums. In Australia, poor elderly people …
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