Introduction

Periodically, in most developed countries there are scandals reported in the press regarding poor treatment of frail elders living in residential care settings purportedly supervised by governmental authorities. While far more prevalent in the aggressive and adversarial legal environment in the US, scandals have been documented in England, Switzerland, Japan, Korea and China (Xinhua, 2005, 2007, 2008; Ferguson, 2012; Association TP, 2012). These instances represent an indictment of the regulatory bodies charged with insuring that adequate standards of care are maintained but also reflect the public outrage associated with authorities’ ‘allowing’ such scandalous situations. Indeed, the outrage is as strong in countries where the regulation of elder care services is new as it is in societies where it is more established.

Such scandals violate social norms of filial piety, which are strong in most societies, but they also violate our expectations that the social institutions and arrangements we have come to trust have let us down, with significant consequences for the lives of the frail elderly who depend upon society for their care. Whether these expectations are warranted or not is not the point. However, they call into question our assumptions about how society should be meeting the needs of the frail and the elderly. Social commentaries on these scandals tend to have a particularly parochial perspective, assuming that the structure of regulation, oversight and financing of long-term care services that exist within a country are necessarily unique. Since failures to adequately care for the most vulnerable among us often are used as an excuse to make political or ideological points, the resulting discussions are often superficial without any real analysis of the fundamental assumptions underlying regulatory structures that govern long-term care service providers. However, demography and the different approaches that countries have adopted vis-à-vis financing long-term care have conspired to bring the issue of how societies assure the quality of those services to the forefront.