A critique of the marketisation of long-term residential and nursing home care

Long-term care systems across countries within the Organisation for Economic Co-operation and Development have undergone a progressive marketisation and financialisation in recent decades, characterised by the embedding of neoliberal market values such as competition, consumer choice, and the profit motive. In this Personal View, we argue that these make poor guiding principles for the care sector, identifying the dysfunctional dynamics that arise as a result, and reflecting on the clinical implications of each, with a focus on facility-based care. We outline why providers can scarcely respond to competitive forces without compromising care quality. We explain why the promotion of consumer choice cannot effectively motivate improvements to quality of care. And we explore how privatisation opens the door to predatory financial practices. We conclude by considering how far proposals for reform can take us, ultimately arguing for a rejection of neoliberal market ideology, and calling for sector-wide discussions about what principles would be more fitting for a caring economy.