Introduction

This chapter focuses on older people who need care in Australia and England, liberal democracies in which the state has long recognised some responsibility for older people's welfare, introducing ‘old age’ pensions (from 1908) and allocating some public funds to provide residential care, home care and local community services for sick, frail or disabled older people.

The limited public eldercare services developed in England after 1945 were initially delivered by public sector employees: social workers, residential care staff, ‘home helps’ and community health workers. Services for older people in Australia, developed from the colonial period onwards by voluntary societies and charitable and religious organisations, were later mainly funded by government (Murphy, 2011: 30; Productivity Commission, 2011a: 12–14). Although neither country made providing care or financial support to older relatives a legal obligation for family members, it was assumed in both countries that while they lived at home, older people's care needs would mainly be met by their families.

Australia's national (Commonwealth) government assumed greater responsibility for social services in the decade after 1945, creating what some consider a ‘social service’ rather than a European-style ‘welfare’ state (Phillips, 1976: 259; Roe, 1976). Public support for aged care developed at the intersection of pensions, housing and health care policy (Productivity Commission, 2011a: 12): the 1954 Aged Persons Homes Act made capital funding available for residential eldercare and nursing home benefits were introduced in 1963 (Dixon, 1977: 147). Residential care was subsequently expanded within a mixed economy of government-subsidised non-government and commercial providers (Fine, 2007a: 275). In 1985, responding to escalating expenditure on residential support and older consumers’ desire to stay at home, an Aged Care Reform Strategy shifted the emphasis from residential to home care (Howe, 1997: 306–8; Pfeffer and Green, 1997: 282). Since that date, the Home and Community Care (HACC) programme – delivered under the aegis of the states and jointly funded by the Commonwealth, State and Territory governments – has provided domestic assistance, personal care, meals, transport, home maintenance and nursing health care (AIHW, 2011: 187).