In response to ageing populations there are similar patterns of change in the organisation of community care for elderly people in many different countries. These changes may be characterised as firstly, a move away from institutional provision, secondly, the strengthening of home based care and thirdly, coordination and case management. Within care providing organisations issues of cost and allocation of service according to need have traditionally tended to be separate concerns. The development of case management with devolved budgets in community care offers one way in which the resolution of the tension between scarcity and choice, need and costs may be achieved. On the basis of previous studies of this approach some of the factors associated with more or less effective resolution of this tension within service organisations are considered.

Community care of elderly people: bringing together scarcity and choice, needs and costs

Providing alternatives to long-stay hospital care for frail elderly patients: Is it cost-effective?

Case management in community aged care: mapping the landscape in NSW

The process of adjustment to the changing demographic balance in Australia over recent years has resulted infrequent and complex changes in Australia's retirement income arrangements. Many people have found great difficulty in understanding how these new arrangements are supposed to work. This article describes some of these recent changes and the factors that triggered them. It also examines what the elderly's reactions to these changes indicate about the nature of the “politics of ageing”. Beginning with an overview of population ageing in Australia, it then briefly outlines the major features of the country's retirement income system. This is followed by an examination of the factors that triggered the recent changes in retirement income arrangements. The last section describes the political response of Australia's elderly to these changes.

The economics and politics of retirement incomes policy in Australia

As the population of Australia ages, social policy and human service practice in the field of aged care is increasingly important and relevant. The Home and community Care (H.A.C.C.) Program was established in 1985 by the Labor Government as a response to a demand for more community services for the frail aged and was designed to reduce the incidence of institutionalisation by increasing home care services. In this way the Home and Community Care Program is seen as linchpin in the Federal Government's initiative to create an efficient and cost-effective aged care policy to contend with the future growth of Australia's ageing population. This thesis argues that there are several assumptions intrinsic to the H.AC.C. Program that are potentially jeopardising and undermining its usefulness. These assumptions are based on familial ideology and nostalgic conceptualizations of 'the community’ and 'the family'. In addition, these assumptions also involve stereotypic attitudes to women as primary carers and nurturers that ignore, to a great degree, the needs of women themselves. These assumptions, combined with an increasingly neo-conservative view about a reduction in the role of the State and a corresponding increase in family responsibility in welfare, have major implications for Australian women. This socialist-feminist analysis argues that women who are providing care for aged spouses or relatives are doing essential, hard and stressful work, work which is unpaid and often unacknowledged, and that the Australian welfare system is now structured around the invisible labour of such women. Consequentially, the assumption that a social policy program such as H.A.C.C. makes, that is, that there will always be women who care, requires further analysis. This research has revealed that such assumptions have implications for the future development of social policy for the aged in Australia and on the future roles of women in this country. Particular questions which this thesis addresses include, firstly, who actually provides care? Empirical research indicates that the majority of care is provided by one individual, usually the spouse, daughter or daughter-in law. Secondly, what are the assumptions underlying the development and implementation of Home and Community Care social policy in relation to the social construction of caring? Such assumptions are found to include, that the H.A.C.C. Program is premised upon an erroneous concept of the 'community' and consequentially 'community care' and that traditional 'family' and familial values are a precondition to H.A.C.C. service delivery. A socialist-feminist critique offers a deeper analysis of such assumptions by disclosing that the Home and Community Care policies assume that service delivery can be best undertaken by extending the traditional domestic role of women, thus utilising them as an unpaid, or poorly paid, labour force. This analysis also discloses the explicit rejection of the informal service system as having any real economic significance but rather being viewed as…

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Making the invisible visable : an analysis of the Home and Community Care Program : a socialist-feminist perspective

This paper draws attention to a pilot programme sponsored by Aged Cottage Homes Inc. in South Australia with the aim of reducing the movement into residential care of elderly people assessed as urgently needing and eligible to enter such forms of care. The programme focuses directly on those factors precipitating movement into residential care. By negotiating with existing service providers, advocating on behalf of users of the programme, establishing new services which are specific to user needs, the Community Options programme has demonstrated that many users of aged accommodation services can be supported to live in their own homes. The benefits of the programme include enhanced lifestyles for elderly people, individuality of specific programs for users, close and continuing contact with users, and the process is cost effective in terms of government outlays.

Michael Rungie

Papers

Community options: a new approach in assessment and the delivery of services in the aged care field.