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Welfare Reform on the Web (September 2008): Care of the elderly - overseas

Assessing experts' views of the future of long-term care

E.A. Miller, M. Booth and V. Mor

Research on Aging, vol. 30, 2008, p. 450-473

The authors report results from in-depth interviews with a range of experts regarding the current state of long-term care in the United States, the attributes of an ideal long-term care system, and potential areas and strategies for reform. The findings highlight the problem of maintaining an adequate workforce despite changing demographics. They also identify commonly agreed upon attributes of an ideal system, that it should be person centred, professionally rewarding, integrated, affordable, accountable, community based and consumer directed. Areas for reform include workforce recruitment and retention, financing and insurance, quality improvement and regulation, health information technology, and organisational change and innovation. The challenges facing long-term care must be addressed by both citizens and government if recipients' lives are to improve and the increased demand for services is to be met.

Economic and financial themes in Australian aged care: regulatory restraint and its consequences

W.P. Hogan

International Journal of Behavioural and Healthcare Research, vol. 1, 2008, p. 1-21

This paper is based on work for a review of elder care policies and services in Australia. It presents a survey of the economic and financial performance of elder care services, focusing on labour costs in relation to total costs and earnings before interest and taxes. Cross-sectional analyses are based on institutional differences between providers of services. Locational differences are also examined. It is concluded that the elder care industry is bound by a set of regulatory restraints that foster stagnation in management performance, stifle competition between providers, limit access to services by rationing the provision of beds in residential facilities and care packages in the community, and handicap any quest for service quality improvement by restricting user choice and not allowing management any flexibility in investment and pricing decisions. This centrally-planned and rigidly administered industry shows strong evidence of shortcomings in efficiency. There is no incentive to improve because competition between providers is restricted.

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