Home and Away: Reflections on Long-term Care in the UK and Australia
The challenges posed by an ageing population are major preoccupations of governments throughout the developed world. There are many dimensions to such challenges, and this paper focuses on issues relating to long-term care in old age. The debate around such matters has been similar in the UK and in Australia. In both countries, a history of incrementalism and poorly presented policy reform has contributed to widespread public mistrust, and a sense of injustice at the extension of means-testing or user pays principles. This paper examines the analysis and conclusions of a Royal Commission in the UK, set up to explore options for the finance and structure of long-term care. A fundamental principle advanced by the Commission is that the risk of needing long-term care should be shared by all citizens, rather than borne by those who have the misfortune to need such care. A separation of the personal care costs of long-term care from the living and housing costs components has been proposed as the most equitable way of sharing costs between individuals and the state. Major reforms to the structure community care in the early 1990s in the UK (and similar developments in Australia) were concerned largely with improving management and accountability of local services and with promoting community rather than residential-based models of care. These failed to address the larger underlying question about the balance of responsibilities between individuals and the state and how to achieve a sustainable model for funding long-term care. The proposals by the Royal Commission in the UK can be seen to offer one such model. It is not without flaws and a cautious initial political response is evident. Nonetheless, the model has an immediate appeal in the simplicity of its argument, and in the prospect of offering improved individual security and enhanced social cohesion.
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