The bigger picture

The political question of who cares for the old is one of the oldest political questions in any society. Different traditions have answered it differently. In many pre-industrial societies, including Indigenous Australian, Pacific, East Asian, South Asian, and Mediterranean, the answer was an obligation of family, kin, or community, embedded in religious, cultural, or political frameworks that bound the generations. In other traditions, it became the obligation of religious institutions, the church, the temple, or the mosque. In yet others, it became a state obligation through the development of poor laws, alms-houses, and institutional care.

What changed in the modern era was who was answering it, with what political authority, and on whose labour. The question had always been asked; the political form the answer took shifted across centuries.

The American political scientist Joan Tronto has argued that care is one of the central political activities of any society, even when it is presented as a private or family matter. The political question of who does the work of caring for the very young, the very sick, the very old, and the very vulnerable shapes everything else about the society's political settlement. Aged care is one of the clearest places where her argument lands.

The colonial transfer

Australian aged care took its institutional shape through colonial transfer, primarily from Britain, and the political assumptions travelled with the buildings.

The poor law tradition of nineteenth-century Britain reached Australia in modified form. The aged poor who could not be cared for by family were placed in institutions that were political artefacts of British thinking about deserving and undeserving poverty. The benevolent asylum, the church-run home for the aged, and the public infirmary were all British forms with British political assumptions about who deserved care and on what terms.

What that political vision excluded is part of the history. First Nations elders had their own systems of care for older people, developed over thousands of years and embedded in Country, kinship, and obligation. Colonial-era aged care institutions were not built for First Nations elders, and the active political project of removing First Nations children from families, including elders' care responsibilities, broke kinship structures in ways that are still doing political work in aged care today.

The welfare state and the second half of the twentieth century

The post-war political settlement transformed aged care across the industrialised world. The Beveridge Report in Britain, the Marshall Plan in continental Europe, and the New Deal legacy in the United States all produced political frameworks that placed aged care within state responsibility, even where private and church providers continued to operate. Australia followed, with the development of aged-care subsidies, the Commonwealth-state agreements that funded residential care, and the gradual emergence of what would later become the modern aged care system.

The post-war settlement was a political achievement, won through union pressure, feminist organising, public health campaigns, and electoral contest, that recognised aged care as something a society owed its old. The political fact that residential aged care is funded with public money and operates under public licence is the legacy of that settlement.

The American philosopher Nancy Fraser has argued that the welfare-state settlement of the post-war period was always built on a quiet assumption: that women in the household would do the unpaid care work that the welfare state did not fund directly. When women's labour-force participation rose from the 1960s onward, the unpaid care assumption became politically untenable, and the political question of who would do the care work re-opened with new urgency. Aged care has been one of the central battlegrounds of that re-opened question ever since.

The neoliberal turn

From the 1980s, a different political settlement began to assert itself. The political idea that aged care should be increasingly marketised, that residents should be increasingly described as consumers, and that providers should compete in a quasi-market for funding tied to individual residents, was developed in policy think tanks in the United States, Britain, and Australia and rolled out through successive reforms.

The marketisation programme was contested at every stage, and the contest is still moving. The Royal Commission into Aged Care Quality and Safety, which reported in 2021, surfaced political conditions that had been building for forty years. The political legacy of the Royal Commission continues to reach providers, the workforce, and the funding settlement that the federal government is now trying to reset.

The neoliberalisation of aged care reached the workforce as well as the funding model. The political conditions of feminised care work, including casualisation, low wages, migrant worker dependency, and limited industrial protection, are the legacy of a political programme that treated aged care as a market problem rather than a public responsibility.

The present moment

Three political forces are reshaping aged care, and they reach providers in different ways.

The demographic shift is one. The political question of who cares for the rapidly growing older population is becoming politically central in every industrialised country, and the Australian conversation is part of a global political conversation that includes Japan, Germany, Italy, Korea, and others.

Migrant labour politics is another. The aged care workforce depends on federal migration policy, qualification recognition, and visa frameworks that reach the aged care floor faster than most industries. The political settlement on migration is a political settlement on aged care, even when it is not labelled that way.

The political backlash against feminist, queer, trans, racial-justice, and First Nations recognition is the third. Aged care is one of the places where that backlash reaches resident lives directly. Older LGBTQ+ residents, multicultural residents, and First Nations residents are politically exposed in ways the design of the system did not adequately anticipate.