Funding and policy in residential care in Australia

[Extract] Since the early-to-middle 1980s there has been significant change and major reform on all these fronts, leading to the emergence of a more coherent and streamlined national approach. This chapter describes those changes and discusses where they are leading the industry and the aged people who do or will depend on it for care in their later years.

Residential aged care, once of interest only to a narrow range of health professionals and those members of the public directly concerned with their own or a relative's circumstances, is now a major topic of discussion in the media and the wider community. Undoubtedly the three major factors driving this change are, first, the occurrence of another phase in the community's awakening to the implications of Australia's changing demographic profile. Second, there have been consequential concerns, especially in government circles, over the budgetary impact of funding the future provision of aged care in the quantities likely to be needed. Third, the first and second factors have prompted a renewed questioning of when and how far community-based and home-delivered services can be substituted for full-time residential care, a question this chapter briefly returns to in closing.

Australia's changing demographic profile and the projected future costs of aged care provide our starting point. The chapter then briefly traces the confused course of residential care provision between about 1950 and 1980, a picture of abundant effort with little direction. We shall see how the ill-planned developments of that period caused problems necessitating successive waves of reforms culminating in the aged-care structural reforms of the mid-1980s and early 1990s, and the Aged Care Act 1997. The chapter closes by examining how far those reforms achieved their objectives and what problems can be expected to command our attention in the next ten or so years.