Intended for healthcare professionals

Education And Debate Regulating nursing homes

The challenge of regulating care for older people in Australia

BMJ 2001; 323 doi: (Published 25 August 2001) Cite this as: BMJ 2001;323:443
  1. John Braithwaite, professor (
  1. Research School of Social Sciences, Australian National University, Canberra, ACT 0200, Australia

    This is the first in a series of three articles

    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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