Elderly people require health care at all levels: primary, secondary and tertiary. Virtually all specialty areas are dealing with an increasing proportion of elderly people and the effectiveness of the specialty department in dealing with this component of its service often has a considerable effect on its overall function. The wellbeing of elderly people is not just dependent on the formal health care services. Informal support systems, and economic and work conditions have a major effect on health. An examination of health policies that relate to the elderly would therefore require an examination of total health and social policy. To make my task more manageable, I shall limit myself to discussion of those health policies that are concerned with specific services for the elderly. I shall also confine most of my discussion to an examination of one central health objective in the care of the elderly, namely the maintenance of the appropriate balance between institutional and community care.
In 1967 a report of the Board of Health Committee on Care of the Aged in New Zealand detailed the principles on which government had based its policy as it related to the more dependent elderly. These were stated as follows:
-(a) The family should retain the basic responsibility for the care of its older members. Wherever possible, old people should be cared for by their families, relatives and friends. -(b) Where there is no family or they are unable to assist, care of the elderly devolves on the community, working through religious, charitable, and various community organizations. -(c) In those situations where neither family nor community resources are in a position to make the necessary provision, responsibility falls on the state, through the medium of hospital boards.
It was indicated clearly by the Committee that this statement of responsibility was understood to apply principally to 'the frail and infirm aged' and was not to be seen as embracing the full range of services for elderly people.
It is an important statement and indicates clear levels of responsibility. When an elderly person requires assistance, that assistance in the first instance should be provided by family and friends. When that responsibility cannot be met by the immediate support network, the responsibility falls on the wider community and in particular on the religious and welfare (R&W) organizations. The R&W organizations or non-governmental organizations are seen to have a central and important role in the provision of care. If these services are unable to meet the