Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-10T16:01:20.543Z Has data issue: false hasContentIssue false
  • English
  • Français

The Limits of Consumer Directed Care as Public Policy in an Aging Society*

Published online by Cambridge University Press:  29 November 2010

Sharon M. Keigher
Sharon M. Keigher
Affiliation:
University of Wisconsin-Milwaukee
Get access Rights & Permissions [Opens in a new window]

Abstract

This paper overviews the emergence of a philosophy of “consumer-direction” in personal, home, and community care for the disabled elderly in North America and Europe. Consumer direction is associated with direct payment schemes and other mechanisms that support user choices in the purchase of care, user empowerment and independence. To illustrate the strengths and limitations of consumer direction in practice, the paper analyses interview data collected from users and providers of existing care arrangements where elders and families choose and/or hire, supervise, and manage their “own” homecare workers who are self-employed. Interviews conducted separately with care users and providers illustrate how structural and interpersonal power related to financial, social and geographic proximity affect the way independent care arrangements are established, and maintained. Power issues embedded in marketized arrangements suggest the need for caution against wholesale adoption of market principles in social provisions for serving elders.

Résumé

Cette communication porte sur l'émergence d'une philosophie «d'orientation du consommateur» dans les soins personnels, à domicile et communautaires offerts aux personnes âgées dépendantes en Amérique du Nord et en Europe. L'orientation du consommateur est associée au paiement direct et autres mécanismes qui appuient l'usager dans ses choix d'achat de soins, de prise en charge personnelle et d'indépendance. Pour illustrer les forces et les faiblesses de l'orientation du consommateur dans la pratique, les auteurs analysent des données d'entrevues menées auprès d'utilisateurs et de fournisseurs de soins dans lesquels les aîné(e)s et leurs familles ont choisi et/ou retenu, supervisé et géré leurs «propres» soignants à domicile, qui sont des travailleurs autonomes. Les entrevues, menées séparément avec les bénéficiaires et les fournisseurs de soins illustrent l'effet des pouvoirs structurels et interpersonnels reliés aux facteurs financiers, sociaux et géographiques sur la façon dont les arrangements de soins indépendants sont négociés et gérés. Les questions de pouvoir incluses dans les arrangements proposés suggèrent qu'il faut faire preuve de prudence devant l'adoption globale des principes du marché dans la provision de services de soins aux aînés.

Keywords

Community CareElderly ConsumersLong-Term CarePayment for CareWisconsin.Soins communautaireconsommateurs aînéssoins de longue duréepaiement des soinsWisconsin.
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 18 , Issue 2 , Été/Summer 1999 , pp. 182 - 210
Copyright
Copyright © Canadian Association on Gerontology 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adamek, M. (1991). Caregivers' views of disability allowances as a support for in-home care. Journal of Gerontological Social Work, 17(2/2), 121–137.CrossRefGoogle Scholar
Barnes, M. (1997). Care, communities, and citizens. Essex, England: Addison Wesley Longman Ltd.Google Scholar
Barnes, M., & Walker, A. (1996). Consumer vs. empowerment: a principled approach to the involvement of older service users. Policy & Politics, 24(4), 375–393.CrossRefGoogle Scholar
Barrows, R., & Loader, B. (Ed.) (1994). Towards a post-Fordist welfare state? London: Routledge.Google Scholar
Cranswick, K. (1997, winter). Canada's caregivers, Canadian Social Trends, #47.Google Scholar
Doty, P. (1986). Family care of the elderly: the role of public policy. The Milbank Quarterly, 64(64), 1–75.CrossRefGoogle ScholarPubMed
Doty, P., Kasper, J., & Litvak, S. (1996). Consumer-directed models of personal care: Lessons from Medicaid. Milbank Quarterly, 74(3), 377–409.CrossRefGoogle ScholarPubMed
Doty, P., Stone, R., & Jackson, B. (1997). Beyond alternatives to institutionaliza-tion: “Negotiated choices.” Home Care Research Initiative, Robert Wood Johnson Foundation (Author).Google Scholar
Estes, C. & Swan, J., & Assoc. (1993). The long-term care crisis: Elders trapped in the no-care zone. Newberry Park, CA: Sage.Google Scholar
Evers, A. (1998). The new long-term care insurance program in Germany. Journal of Aging and Social Policy, 10(1), 77–90.CrossRefGoogle ScholarPubMed
Evers, A., & Leichsenring, K. (1994). Paying for informal care: An issue of growing importance. Aging International, 21(1), 29–40.Google Scholar
Evers, A., Leichsenring, K., & Pruckner, B. (1994). Payments for care: the case of Austria. In Evers, A., Pijl, M., & Ungerson, C. (Eds.), Payment for care: A comparative overview (pp. 191–214).Google Scholar
Evers, A., Pijl, M., & Ungerson, C. (1994). Payment for care: A comparative overview. Aldershot, England: Avebury.Google Scholar
Glendinning, C. (1997). Personal correspondence.Google Scholar
Grana, J., & Yamashiro, S.M. (1987). An evaluation of the VA housebound and Aid and Attendance Allowance Program. Millwood, VA: Center for Health Affairs, Project HOPE.Google Scholar
Hoch, C., & Slayton, R.A. (1989). New homeless and old: Community and the skid row hotel. Philadelphia: Temple University Press.Google Scholar
Hooyman, N., & Gonyea, J. (1995). Feminist perspectives on caregiving: Policies forgender justice. Thousand Oaks, CA: Sage.Google Scholar
Keefe, J. (1993). Direct payments to family care in Nova Scotia. Paper presented at Canadian Association on Aging, November, Montreal.Google Scholar
Keefe, J., & Fancey, P. (1997). Financial compensation or home help services: Examining differences among program recipients. Canadian Journal on Aging, 16(2), 254–278.CrossRefGoogle Scholar
Keefe, J.M., & Fancey, P.J. (1998). Financial compensation vs. community supports: An analysis of effects on caregivers and care receivers. Final Report to the Director of Research & Knowledge Synthesis, March 31. Health Canada, Ottowa.Google Scholar
Keigher, S. (1997, November). Austria's new attendance allowance: Prototype for a consumer choice model of care for the frail and disabled. International Journal of Health Services, 27(4), 753–765.CrossRefGoogle ScholarPubMed
Keigher, S., & Luz, C. (1997). Common stakes in homecare of the elderly: A pilot study of Milwaukee's gray market in independent care. The Helen Bader Foundation and the University of Wisconsin-Milwaukee School of Social Welfare. November.Google Scholar
Keigher, S., & Murphy, C. (1992, summer). A consumer view of a family care compensation program. Social Service Review, 66(2), 256–277.Google Scholar
Keigher, S., Simon-Rusinowitz, L., Linsk, N., & Osterbusch. (1988). Payments to informal service providers: Policy divergence affecting the elderly and their families in Michigan and Illinois. Journal of Applied Gerontology, 7, 456–473.CrossRefGoogle Scholar
Linsk, N., Keigher, S., & Osterbusch, S. (1986) States policies regarding paid family caregiving. The Gerontologist, 28, 204–212.Google Scholar
Linsk, N., Keigher, S., Simon-Rusinowitz, L., & England, S. (1992) Wages for caring: Compensating family care of the elderly. New York: Praeger.Google Scholar
Morris, J. (1993). Independent lives'? Community care and disabled people. London: Macmillan.Google Scholar
Morris, J. (1997). Care or empowerment? A disability rights perspective. Social Policy and Administration, 31(1), 54–68.Google Scholar
National Center for Health Statistics (NCHS). (1994, June). Healthy people 2000 review 1993. Washington, DC: U.S. Department of Health & Human Services, Centers for Disease Control and Prevention.Google Scholar
NCOA. (1996, October). Survey of states shows consensus on consumer direction. Consumer Choice News, 1(3), 1, 6.Google Scholar
NCOA. (1997). California's public authorities: An emerging model from consumer-directed personal assistance services. Consumer Choice News, 2(2), 1, 6.Google Scholar
Ritzer, G. (1993). The McDonaldization of society. Thousand Oaks: Pine Forge Press.Google Scholar
Roeher Institute. (1997). Self-managed attendant services in Ontario: Direct funding pilot project. Final Evaluation Report, March. Toronto: Centre for Independent Living, Inc.Google Scholar
Stack, C. (1974). All our kin: Strategies for survival in a black community. New York: Harper & Row.Google Scholar
Statistics Canada. (1997, Aug. 19). Who cares? Caregiving in 1990s, 1996. The Daily, Statistics Canada, 5–6.Google Scholar
Stone, R., & Keigher, S. (1994). Toward an equitable, universal caregiver policy: The potential of financial supports for family caregivers. Journal of Aging and Social Policy, 6(1/2), 57–75.Google Scholar
Strychman, J., & Nahmiash, D. (1994). Payments for care: The case of Canada. In Evers, A., Pijl, M., & Ungerson, C. (Eds.), Payments for care: A comparative overview (pp. 207–319).Google Scholar
Twigg, J. (1997) Bathing and the politics of care. Social Policy and Administration, 31(1), 61–72.Google Scholar
Ungerson, C. (1997a). Social politics & the commodification of care. Social Politics, 4(4), 3–381.Google Scholar
Ungerson, C. (1997b). ‘Give them the money’: Is cash a route to empowerment? Social Policy and Administration, 31(1), 45–53.Google Scholar
Vinton, L., & Kim, Y. (1996). Paying family members to provide home care: an evaluation of one program. Journal of Case Management, 5(3), 99–105.Google ScholarPubMed