RE No. 13: Failed Market Approaches to Long-Term Care

Research Essay Description

In countries where responsibility for long-term care of a growing elderly population has shifted significantly to the private sector, expectations of quality of service and standards of care are not being realised. This essay draws on prior research, analyses and case studies from Australia, Canada, the United Kingdom, France and the United States. Employment in long-term care has been growing but its largely female, often migrant, workforce has been subject to severe exploitation. High turnover and chronic staff shortages are exacerbated by low wages and excessive workloads, undermining the quality of care. Rather than funding improvements, private operators of long-term care regularly extract excessive revenues from public funding and private fees. This pattern is common across ownership types: private equity, private business, public company and large-scale not-for-profit. In almost all cases, private operators put business interests—profits or expansion—ahead of quality of care.

Government regulation has been largely insufficient to maintain acceptable standards but some reform efforts are beginning to emerge. Greater worker participation and engagement with public-health systems and communities must be part of the solution, to ensure higher quality, address chronic staff shortages and build public support for adequate, fair and transparent public funding. Further reforms and future funding increases should prioritise direct public provision, to ensure adequate standards and reduce profit extraction by private operators.