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This chapter describes the policy and social settings of aged care and palliative care in Australia. This includes understanding the funding frameworks and mechanisms for the health and social systems in Australia which contextualize aged care support, service delivery, and support of caregivers. As with many similar health systems, there is an increasing emphasis on ageing in the setting of choice, with institutional care being an option only for people with complex needs. National policies and programmes that inform the structure and processes to support palliative care and care of the elderly include: the National Palliative Care Strategy (including the Palliative Care Outcomes Collaborative and The National (Palliative Care) Standards Assessment Program); the legislatively-backed Australian Aged Care Standards; and the ‘Living Longer–Living Better’ aged care reforms. Much of this work has been underpinned by evidence-based, nationally endorsed guidelines for palliative care in aged care and needs-based assessment tools.

What it means to be old is among the most pressing questions of our time. International organizations describe population aging as one of the most significant social transformations of this century with potentially dire effects. Yet there has been debate over measurements of population aging since it first became a topic of concern in the 1930s. Since then, the British state has established collective markers of old age such as retirement and residential care, but individuals experienced aging before, after, and independently of these apparent parameters of late life. Older people raised their voices in diverse fields of twentieth-century life and they spoke with particular authority at midcentury. In so doing, older Britons asked to be understood through the course of their own lives.

In 1958–1959 Peter Townsend interviewed almost 500 residents of old age homes for his project The Last Refuge. Townsend investigated what had changed since the Labour Government introduced new legislation for residential care in 1948. Old age homes had become symbolic of continuous state support from cradle to grave. Yet the delivery of residential care was uneven, and it divided the aged by social class and health. Meanwhile researchers, workers, and elderly people often disagreed about the ethics of aged care. Townsend drove change within these institutions. During interviews, for example, researchers and residents enacted the ideal of respect for the inner lives of the old, even if midcentury research methods sometimes recreated the disempowering conditions of institutional life.

This chapter provides an overview of the practice of palliative care volunteering and volunteer management in Australia. The history of volunteering in Australia is briefly considered as are the formative influences that have shaped volunteer services within the palliative care system. The chapter outlines the federated model of health funding, and the various service models within which volunteers are supported. Data from recent research is used to illustrate models of volunteer support in the state of New South Wales. The chapter considers the way in which volunteering is changing in Australia, the shifting demographics of volunteers, the effect of risk management on volunteer satisfaction, and the revival of interest in hospices. Factors that contribute to success are also considered including the positive effect of organizational support for the work of the volunteers, the skills of the volunteer manager, and the importance of acknowledging and including volunteers in aspects of service management.

Advance care planning enables health professionals to know and respect the wishes of the elderly when they approach the end of their lives. Respecting Patient Choices, a successful Australian model of advance care planning, has been implemented in hospitals and the community, particularly aged care homes. It improves end-of-life care for the elderly and those with chronic disease, raises satisfaction amongst patients and family regarding the quality of care, and reduces the incidence of symptoms of anxiety, depression, and post-traumatic stress in the surviving relatives of those who have died. It works effectively with competent English-speaking people and also those from culturally and linguistically diverse backgrounds and with dementia. It can ensure that aged care home residents‘ preferences, in the event of deterioration, are known and complied with, and can diminish the risk that the resident, against his or her wishes, will be transferred to hospital to die.

This chapter deals with how old people made a living, and how other people could make a living by taking care of the old. It discusses various forms of provision for the old in Sweden, from the wealthy farmers who could purchase care by selling their landed property, to the most destitute who had no other options but cohabitation in poverty. The chapter shows that source descriptions of care for the elderly are rarer than descriptions of childcare, and old women are more often described as poor than are old men. Wages fluctuated widely from year to year in early modern economies, and people who worked for daily wages were more vulnerable to these swings in purchasing power than people with landholdings. The chapter uses these insights to engage in a discussion about entitlement, well-being, and quality of life, particularly for those whose main asset was their labor power.