A hands-on hands-off approach: governance of managed long-term care services in a context of rapid policy change

Workforce Policy and Care Quality in English Long-term Elder Care

“…This mirrors arrangements in the United States, where around three quarters of long-term care services are funded by Medicaid and other public sources, though delivered by largely private providers (Nisbet, 2017). Similar policy approaches are evident in other neoliberal regimes, such as Australia (Harley, Allen, & Sargent, 2007), Canada (Cunningham, Baines, & Charlesworth, 2014), and Japan (Broadbent, 2014).…”

“…Similar policy approaches are evident in other neoliberal regimes, such as Australia (Harley, Allen, & Sargent, 2007), Canada (Cunningham, Baines, & Charlesworth, 2014), and Japan (Broadbent, 2014). However, there is growing recognition of NPM's failure to deliver high quality care, not least given budgetary constraints in austere times (Nisbet, 2017). In England, claims abound of a crisis in ASC, amid a number of high-profile scandals over care failures (e.g., Kingsmill, 2014).…”

“…The rapid growth in demand for elder care noted above has been accompanied by increased demand for care workers, termed "aides" in the United States (Nisbet, 2017). In a NPM regime, most are based in independent-sector organizations (Howes, 2014), where the state has limited control over employment practice-how workers are recruited, paid, trained, and otherwise managed, and its attempts to assure an adequate, skilled labor supply are at arm's length via policy interventions.…”

“…Demand for long-term elder care has, in tandem, grown exponentially, with many neoliberal market economies adopting new public management (NPM) approaches to its delivery (Nisbet, 2017). In essence, NPM promotes market-based mechanisms premised on private sector principles of efficiency and outcomes in delivery of public services (Goldfinch & Wallis, 2010).…”

“…In essence, NPM promotes market-based mechanisms premised on private sector principles of efficiency and outcomes in delivery of public services (Goldfinch & Wallis, 2010). Accordingly, governments purchase elder-care from the private or voluntary sectors using market mechanisms that emphasize cost-control, competition, and quality (Nisbet, 2017). In this article, we focus on long-term elder care in England, where it is termed "adult social care" (ASC) and describes the provision of personal care, protection, or social support to some of society's most vulnerable adults in either their own homes or residential facilities (Gray & Birrell, 2013).…”