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Frail and Disabled Users of Home Care: Confident Consumers or Disentitled Citizens?

Published online by Cambridge University Press:  31 March 2010

Jane Aronson
Jane Aronson*
Affiliation:
McMaster University
*
Requests etc.: Jane Aronson, School of Social Work, McMaster University, Hamilton, ON L8S 4M4
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Abstract

Health care cuts and restructuring are shifting the site of acute care from hospitals to homes and prompting provincial governments to introduce varying forms of mixed economies in home care. Typically, such arrangements seek to drive down public costs and to reposition service users as “consumers” of market-modelled care. Drawing on an ongoing study of frail elderly women and women with disabilities receiving home care in Ontario, this paper explores the significance for service users of these economic and political objectives. Rather than feeling like consumers free to exercise choice and demand quality in the mixed economy of home care, they experienced their positioning within it as insecure and subordinate and its supply as unpredictable and meagre. The implications of these findings for fashioning secure and equitable public responses to elderly and disabled citizens who need assistance at home over the long term are discussed.

Résumé

Les coupures budgétaires et la restructuration des services de Santé aboutissent progressivement à un déplacement des soins d'urgence du site hospitalier au domicile du bénéficiaire, et incitent les gouvernements provinciaux à offrir différentes formules de soins à domicile. Généralement, ces mesures visent à réduire les dépenses publiques et à répondre aux besoins d'un marché où les clients sont des « consommateurs ». Résumé d'une étude en cours sur les femmes âgées de santé fragile et handicapées qui reçoivent des soins à domicile en Ontario, ce document étudie l'importance de ces objectifs économiques et politiques pour les utilisateurs de ces services. Au lieu de consommatrices libres d'exercer leur choix et d'exiger la qualité dans une économie de services, ces femmes vivent une situation d'insécurité et de dépendance vis-à-vis de services de soins à domicile de qualité médiocre et peu fiables. Ce document examine les résultats dans le but d'établir une formule pouvant offrir sécurité et fiabilité aux citoyen(ne)s âgé(e)s et aux handicapés qui ont besoin de services de soins à domicile à long terme.

Keywords

Home CareCitizenshipConsumerismMixed EconomyWomenSoins à DomicileCitoyennetéConsommateurismeÉconomie MixteFemmes
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 21 , Issue 1 , Spring/Printemps 2002 , pp. 11 - 25
Copyright
Copyright © Canadian Association on Gerontology 2002

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Footnotes

*Thanks are due to the participants in the study: for their generosity and thoughtfulness in sharing their knowledge and time. A number of community groups were helpful in linking me with them and have been supportive of the project in an ongoing way; their input is much appreciated. The work reported here is supported by research grants from the Social Sciences and Humanities Research Council (Women and Change #816-98-0042) and the National Network on Environments and Women's Health (a Centre of Excellence in Women's Health funded by the Women's Health Bureau of Health Canada). For their comments on an earlier draft, I am grateful to Roy Cain, Mae Harman, Lynn Kearney and Ethel Meade.

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