Melbourne's earliest institutions, the Benevolent Asylum (1848) and the Immigrants' Aid Society (1853), began as multipurpose facilities, but progressively focused on aged care, with the opening of specialist hospitals, orphanages and disability services, and the ageing of gold rush immigrants. Anxious to save the more genteel from the indignities of such large institutions, community organisations like the Old Colonists Association established cottages for their elderly members. The Catholic Church moved into the field with the arrival of the Little Sisters of the Poor in 1883.
The introduction of the aged pension in 1900 temporarily relieved the demand, but a concern for the plight of widows left childless in the wake of World War I and couples left destitute as a result of the Depression saw more church homes opened. In 1945 the Brotherhood of St Laurence began moving aged couples into its Carrum Downs settlement, establishing the village pattern which would be adopted more widely after Commonwealth Government funding became available in 1955.
The Brotherhood also established the Coolibah Club (1946; see Coolibah Day Centre), the forerunner of Elderly Citizens Clubs which hosted the range of domiciliary services developed in the postwar years. Beginning with Meals on Wheels (South Melbourne, 1947), these services, designed to decrease the demand for institutional care, are administered by municipal councils through the Home and Community Services scheme (1970). Day hospitals auspiced by some of the established institutions provide medical and ancillary services for those with limited mobility and regular respite for their carers while Do-Care (1977), under the auspices of the Wesley Central Mission, provides contact for the housebound.
While, with the ageing of the population, there has been increasing pressure on private and charitable aged care facilities, most older Melburnians remain independently at home. Less than 15% of the elderly use any aged care services, with rates of institutionalisation the lowest in Australia.