Regulating nursing homes: The challenge of regulating care for older people in Australia

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Abstract
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 were often cared for in buildings constructed to house convicts, although overcrowding in convict colonies was less serious than overcrowding among elderly people: convicts were sent into the community to work when there was a shortage of beds. In contrast, 19th century poorhouses burst at the seams, and their regimes became more totalitarian in response. The Melbourne Benevolent Asylum housed 1337 residents in 1891 and this grew to 3436 in 1897, and “the overspill population were incarcerated in Pentridge prison.”1 Summary points In Australia, privatisation of the nursing home industry occurred at the same time as deregulation This has caused a crisis in the quality of care and a crisis of political confidence Depending on market mechanisms to regulate care in nursing homes is inappropriate because older people often cannot exercise their rights as consumers by leaving or complaining All nursing homes should be inspected regularly, and sometimes without notice, and the results should be available to the public A regulatory process that empowers residents and focuses on them will repay public investment many times over The same phenomenon occurs today in many Western countries where policies aimed at moving people with mental illness out of institutions have had the unintended effect of turning prisons into the institutions that care for the largest number of people with mental illness. McCallum and Geiselhart considered that what changed this situation of care for poor older people in mid-20th century Australia was that “At some point in the development of countries, modern, high-quality aged care services emerge from these sometimes depressing beginnings. The key factor distinguishing the new from the old is the emergence of public funding for and public regulation of the aged care industry.”1 View larger version: In this window In a new window Reacting to the welfare state: Australian pensioners demonstrated in March in a bid for increased pensions (Credit: WILL BURGESS/REUTERS)

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