Skip to main content
SpringerLink
Log in

Chapter Twelve: The Marketisation of Aged Care: The Impact of Aged Care Reform in Australia

  • Chapter
  • First Online:
Navigating Private and Public Healthcare

Abstract

Australia, in common with a number of Western countries, is opening the provision of aged care to market forces. The marketisation of aged care has been associated with increased service provision by private, (often) for-profit service providers, consumer choice and greater financial contribution by users. Older people are constructed as the consumers of these services. Underpinning this strategy is the belief that the creation of a market for aged care will ensure quality care through consumer choice between competing services and greater consumer control of these services. This chapter critically examines recent changes in policy and legislation which have enabled greater private for-profit ownership of residential aged care facilities, and consumer contributions to the cost of residential aged care through interest from a refundable accommodation deposit. It examines the impact of these changes on the ownership of residential aged care facilities, identifying increasing private for-profit ownership. These changes are rationalised by consumer-directed care (CDC). We critically examine CDC through exploring the assumptions underpinning it and evidence for capacity for consumer choice. The chapter concludes with a discussion of regulatory changes, noting that current standards provide limited capacity to address poor quality care arising from poor staffing of facilities.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Aged Care Act. (1997). [Commonwealth]. Available at: https://www.legislation.gov.au/Series/C2004A05206 [Accessed 17 Aug. 2018].

  • Aged Care Amendment (Red Tape Reduction in Places Management) Act. (2016). [Commonwealth].

    Google Scholar 

  • Akinci, F. and Krolikowski, D. (2005). Nurse staffing levels and quality of care in Northeastern Pennsylvania nursing homes. Applied Nursing Research, 18, pp. 130–137.

    Article  Google Scholar 

  • Angus, J. and Nay, R. (2003). The paradox of the Aged Care Act 1997: marginalization of nursing discourse. Nursing Inquiry, 10(2), pp. 130–138.

    Article  Google Scholar 

  • Antonnen, A. and Haikio, L. (2011). Care ‘going market’: Finnish elderly-care policies in transition. Nordic Journal of Social Research, pp. 70–90.

    Google Scholar 

  • Australian Aged Care Quality Agency [AACQA]. (n.d.). Accreditation standards factsheet. Available at: https://www.aacqa.gov.au/for-providers/residential-aged-care/resources/copy_of_BROCAH0011AccreditationStandardsfactsheetEnglishv14.1.pdf [Accessed 5 Apr. 2016].

  • Australian Government. (2014). Extra Services Principles, Federal Register of Legislative Instruments F2014L00809.

    Google Scholar 

  • Australian Government. (2014). Quality of Care Principles, Federal Register of Legislative Instruments F2014L00830.

    Google Scholar 

  • Australian Government, and Consumer-directed Care. (2017). My Aged Care Home Page. Available at: https://www.myagedcare.gov.au/help-home/home-care-packages/consumer-directed-care-cdc:.

  • Australian Institute of Health and Welfare. (2017). Health Workforce Data. 2017. Available at: www.health.gov.au.

  • Baldwin, R., Stephen, M., Sharp, D. and Kelly, J. (2013). The Financial Viability And Sustainability of the Aged Care Sector. Available at: https://opus.lib.uts.edu.au/bitstream/10453/36460/1/ACSAViabilityWhitePaper291113.pdf.

  • Baldwin, R., Chenoweth, L. and de la Rama, M. (2015a). Residential aged care policy in Australia–are we learning from evidence? Australian Journal of Public Administration, 74(2), pp. 128–141.

    Article  Google Scholar 

  • Baldwin, R., Chenoweth, L., de laRama, M. and Liu, Z. (2015b). Quality failures in residential aged care in Australia: the relationship between structural factors and regulation imposed sanctions. Australasian Journal on Ageing, 34, pp. E7–E12.

    Article  Google Scholar 

  • Barron, D. and West, E. (2017). The quasi-market for aged care in the UK: do for-profit, not-for-profit or public sector residential care and nursing homes provide better quality care?Social Science and Medicine, 179, pp. 137–146.

    Google Scholar 

  • Bergman,M., Johansson, P., Lundberg, S. and Spagnolo, G. (2016). Privatisation and quality: evidence from elderly care in Sweden. Journal of Health Economics, 49, pp. 109–199.

    Article  Google Scholar 

  • Brennan, D., Cass, B., Himelweit, S. and Szebehely, M. (2012). The marketisation of care: rationales and consequences in Nordic and liberal care regimes. Journal of European Social Policy, 22, pp. 377–391.

    Article  Google Scholar 

  • Bulamu, N., Billingsley, K., Gill, L., Cameron, I., McKechnie, S., Fiebig, J., Grady, R. and Ratcliffe, J. (2016). Impact of consumer-directed care on quality of life in the community aged care sector. Geriatrics Gerontology International, 17, pp. 1339–1405.

    Google Scholar 

  • Carey, G., Riley, T. and Cramming, B. (2012). The Australian Governments’ ‘social inclusion agenda’: the intersection between public health and social policy. Critical Public Health, 22(1), pp. 47–59.

    Google Scholar 

  • Chan, G., ChinC., McKitrick, D. and Warne, R. (2014). Does the Aged Care Funding Instrument provide increased funding in residential care? Comparisons with the Residential Classification Scale. Australasian Journal of Ageing, 33(2), pp. 121–123.

    Article  Google Scholar 

  • Dean, M. (1999). Governmentality: Power and Rule in Modern Society. London: Sage.

    Google Scholar 

  • Department of Health. (2017). Approved Provider Information. Available at: https://agedcarehealth.gov.au/aged-care-funding/approved-provider-information[Accessed 15May 2017].

  • Department of Social Services. (2015). Accommodation Payments. Available at: http://www.myagedcare.gov.au/aged-care-homes-costs-explained/accommodation-payments[Accessed 5 Nov. 2015]

  • Fournier, V. (2000). Boundary work and the (un)making of the professions, In: N. Malin (ed.) Professionalism, Boundaries and the Workplace. London: Routledge. pp. 67–86.

    Google Scholar 

  • Gibson, D. (1998). Aged Care: Old Policies New Problems. Melbourne: Cambridge University press.

    Google Scholar 

  • Gordon, C. (1991). Governmental rationality: an introduction. In: G. Burchell, C. Gordon and P. Miller (eds.) The Foucault Effect: Studies in Governmentality. Chicago: University of Chicago press. pp. 1–51.

    Google Scholar 

  • Harrington, C., Zimmerman, D., Karon, S., Robinson, J. and Beutel, P. (2000). Nursing home staffing and its relationship to deficiencies. Journal of Gerontology, 55B(5), pp. S278–S287.

    Article  Google Scholar 

  • Henderson, J., Blackman, I, Willis, E., Gibson, T., Price, K., Toffoli, L., Bonner, R., Hurley, J. and Currie, T. (2018). The impact of facility ownership on nurses’ and care workers’ perceptions of missed care in Australian residential aged care. Australian Journal of Social Issues. https://doi.org/10.1002/ajs4.50.

    Article  Google Scholar 

  • Horn, S., Buerhaus, P., Bergstrom, N. and Smout, R. (2005). RN staffing time and outcomes of long-stay nursing home residents. AJN, 10(11), pp. 58–70.

    Article  Google Scholar 

  • Howe, A. (2000). Rearranging the compartments: the financing and delivery of care for Australia’s elderly. Health Affairs, 19(3), pp. 57–71.

    Article  Google Scholar 

  • Hughes, M. (2011). The productivity commission inquiry into aged care: a critical review. Australian Social Work, 64, pp. 526–536.

    Article  Google Scholar 

  • Japara Healthcare. (2016). Overview of Residential Aged Care market in Australia. Available at: http://investor.japarahealthcare.com.au/FormBuilder/_Resource/_module/dYCDKYylV0umYHC7KDqmOw/documents/Presentation-Andrew-Sudholz-New-York-March-2016%2D%2D-FINAL.pdf [Accessed 6 Jan. 2018].

  • Kaine, S. and Ravenswood, K. (2014). Working in residential aged care: a trans-Tasman comparison. New Zealand Journal of Employment relations, 38(2), pp. 33–46.

    Google Scholar 

  • Kendig, H. and Duckett, S. (2001). Australian directions in aged care: the generation of policies for generations of older people. Sydney: The Australian Health Policy Institute at the University of Sydney.

    Google Scholar 

  • KPMG. (2015). Formative Evaluation of the Home Care Packages Program: Detailed Findings Report. Available at: https://agedcare.health.gov.au/sites/g/files/net1426/f/documents/09_2015/formative-evaluation-of-the-home-care-packages-programme-detailed-findings-report.pdf:

  • Macnicol, J. (2015). Neoliberalising Old Age. Cambridge: Cambridge University Press.

    Google Scholar 

  • Meagher, G. and Szebehely, M. (eds.) (2013). Marketisation in Nordic Eldercare: A Research Report on Legislation, Oversight, Extent and Consequences. Stockholm: Stockholm University.

    Google Scholar 

  • Meagher, G. and Wilson, S. (2015). The politics of market encroachment: policymaker rationales and voter responses. In: G. Meagher and S. Goodwin (eds.) Markets, Rights and Power in Australian Social Policy. Sydney: Sydney University Press. pp. 29–96.

    Google Scholar 

  • Meinow, B., Parker, M. and Thorslund, M. (2011). Consumers of eldercare in Sweden: the semblance of choice. Social Science and Medicine, 73, pp. 1285–1289.

    Article  Google Scholar 

  • Mojberg, L., Blomqvist, P. and Winblad, U, (2016). User choice in Swedish eldercare – conditions for informed choice and enhanced service quality. Journal of European social policy, 26(3), pp. 281–295.

    Article  Google Scholar 

  • Pradhan, R., Weech-Maldonado, R., Harman, J.S. and Hyer, K., (2014). Private equity ownership of nursing homes: Implications for quality. Journal of Health Care Finance, 42(2), pp. 1–14.

    Google Scholar 

  • Productivity Commission. (2011). Caring for Older Australians: Overview. Report No.53, Final Inquiry Report. Productivity Commission, Canberra.

    Google Scholar 

  • Rose, N. (1996) Governing “advanced” liberal democracies. In: A. Barry, T. Osborne and N. Rose (eds.) Foucault and Political Reason: Liberalism, Neo-liberalism and the Rationalities of Government. London: UCL Press. pp. 37–64.

    Google Scholar 

  • Ross, L. and Harrington, C. (2016). California Nursing Home Chains by Ownership Type: Facility and Resident Characteristics, Staffing, and Quality Outcomes in 2015. Available at: http://theconsumervoice.org/uploads/files/general/CA-Chains-Report_20AUG2016.pdf [Accessed 15May 2017].

  • Ryan, S. (2014). Implementing Consumer-Directed Care. Available at: https://www.humanrights.gov.au/news/speeches/implementing-consumer-directed-care:.

  • Stolt, R. and Winblad, U. (2009). Mechanisms behind privatization: a case study of private growth in Swedish elder care. Social Science and Medicine, 68, pp.903–911.

    Article  Google Scholar 

  • Thornton, G. (2015). Growing With Age: Deal Tracker for the Aged Care Sector. Available at: https://www.grantthornton.com.au/globalassets/1.-member-firms/australian-website/industry/hac/pdfs/gtal_2015_growing-with-age_-aged-care-dealtracker.pdf [Accessed 15May 2017].

  • Vamstad, J. (2016). Exit, voice and indifference - older people as consumers of Swedish home care services. Ageing and Society, 36, pp. 2163–2182.

    Article  Google Scholar 

  • Venturato, L., Kellet, U. and Windsor, C. (2007). Nurses’ experience of practice and political reform in long term aged care in Australia: implications for the retention of nursing personnel. Journal of Nursing Management, 15, pp.4–11.

    Article  Google Scholar 

  • Willis, E., Price, K., Bonner, R., Henderson, J., Gibson, T., Hurley, J.,Toffoli, L. and Currie, T. (2016). National Aged Care Staffing and Skills Mix Project Report: Meeting Residents’ Care Needs: A Study of the Requirements for NUrsing and Personal Care Staff. Available at: http://www.anmf.org.au/documents/reports/National_Aged_Care_Staffing_Skills_Mix_Project_Report_2016.pdf:.

  • Yeandle, S., Kröger, T. and Cass, B. (2012). Voice and choice for users and carers?Developments in patterns of care for older people in Australia, England and Finland. Journal of European Social Policy, 22, pp. 432–445.

    Article  Google Scholar 

  • Yeatman, A. (2009a). Introduction. In: A. Yeatman, G. Dowsett, M. Fine and D. Gursansky (eds.) Individualization and the Delivery of Welfare Services: Contestation and Complexity. London: Palgrave Macmillan.

    Google Scholar 

  • Yeatman, A. (2009b). The Will as the subject of welfare - The consumer model of service delivery. In: A. Yeatman, G. Dowsett, M. Fine and D. Gursansky (eds.) Individualization and the Delivery of Welfare Services: Contestation and Complexity. New York: Palgrave Macmillan. pp. 73–88.

    Chapter  Google Scholar 

  • Zhang, N., Unrah, L., Lui, R. and Wan, T. (2006). Minimum nurse staffing ratios for nursing homes. Nursing Economics, 24(2), pp. 78–85, 93.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Flinders University, Adelaide, Australia

    Julie Henderson & Eileen Willis

Authors
  1. Julie Henderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eileen Willis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julie Henderson .

Editor information

Editors and Affiliations

  1. Department of Sociology and Social Policy, University of Sydney, Sydney, NSW, Australia

    Fran Collyer

  2. School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia

    Karen Willis

Rights and permissions

Reprints and permissions

Copyright information

© 2020 The Author(s)

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Henderson, J., Willis, E. (2020). Chapter Twelve: The Marketisation of Aged Care: The Impact of Aged Care Reform in Australia. In: Collyer, F., Willis, K. (eds) Navigating Private and Public Healthcare. Palgrave Macmillan, Singapore. https://doi.org/10.1007/978-981-32-9208-6_12

Download citation

  • DOI: https://doi.org/10.1007/978-981-32-9208-6_12

  • Published:

  • Publisher Name: Palgrave Macmillan, Singapore

  • Print ISBN: 978-981-32-9207-9

  • Online ISBN: 978-981-32-9208-6

  • eBook Packages: Social SciencesSocial Sciences (R0)

Publish with us

Policies and ethics

Search

Navigation