Reforms to long-term care in Australia : a changing and challenging landscape

Long-term care (LTC) touches the daily lives of millions of Australians: older people, informal carers and paid care workers. Historically, the primary providers of LTC, referred to as ‘aged care’ in Australia, were informal carers, mostly families and not-for profit care providers, with governments making a relatively small contribution. However, from the 1980s, the national government started to take on greater responsibility for funding and regulation of LTC, investing particularly in the expansion of home care services. This expansion of LTC has occurred at a time when New Public Management (NPM) has had considerable influence on policy development, internationally and in Australia. The influence of NPM can be seen on the reforms to LTC since the 1980s, with progressive waves of reform moving towards greater national regulation and increasing marketization and competition. Throughout this period, there have been constant underlying tensions between providing high-quality support and services for older people and demonstrating quantifiable outcomes and balancing budgets (Sidoti et al., p. 8). This chapter provides an examination of the context and background to LTC in Australia, an overview of reforms from the mid-1980s, and a discussion of the current opportunities and challenges in accessing and providing LTC for older people and informal carers, for care workers and for care provider organizations.