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“We Only Own the Hours”: Discontinuity of Care in the British Columbia Home Support System*

Published online by Cambridge University Press:  31 March 2010

Zena Sharman ,
Arlene Tigar McLaren ,
Marcy Cohen  and
Aleck Ostry
Zena Sharman*
Affiliation:
Department of Health Care and Epidemiology, Faculty of Medicine, University of British Columbia
Arlene Tigar McLaren
Affiliation:
Department of Sociology and Anthropology, Simon Fraser University
Marcy Cohen
Affiliation:
Hospital Employees' Union, Burnaby, B.C.
Aleck Ostry
Affiliation:
Faculty of Human and Social Development, University of Victoria
*
Requests for offprints should be sent to:/Les demandes de tirés-à-part doivent être adressées à: Department of Health Care and Epidemiology, Faculty of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC V6T 1Z3, (zsharman@interchange.ubc.ca)
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Abstract

This article uses the concept of continuity of care to examine the implications of health-system restructuring for workers and staff in the BC home support system. Home support primarily serves frail seniors living in poverty and has the potential to provide assistance with tasks like bathing, dressing, and toileting, as well as offer social support and relational care to isolated clients. Through presentation of qualitative data from focus groups and interviews with home support workers and clients in the Greater Vancouver area, we demonstrate how the casualization and intensification of work in a context of increasing client acuity levels has diminished both continuity and quality of care. This article discusses how restructuring in the home support sector in BC has reduced the overall number of persons under care in the system, disrupted continuity of care, and compromised quality.

Résumé

Le présent article utilise le concept de continuité des soins pour examiner les effets de la structuration du système de santé sur les travailleurs et le personnel du programme de soutien à domicile de la Colombie-Britannique (C.-B.). Ce programme dessert principalement les personnes âgée fragiles vivant dans la pauvreté, et il permet d'obtenir de l'aide pour des tâches comme le bain, l'habillement, et la toilette, et offre aussi un soutien social et relationnel spécial aux clients isolés. En présentant des données qualitatives tirées de groupes de discussion et d'entrevues avec des personnes assignées au soutien à domicile et des clients de la région métropolitaine de Vancouver, nous indiquons comment la précarisation et l'intensification du travail, dans un contexte d'un niveau accru d'acuité et de complexité des besoins des clients, ont réduit la continuité et la qualité des soins. Le présent article parle de la façon dont la restructuration du secteur du soutien à domicile en Colombie-Britannique a réduit le nombre total de personnes bénéficiant de soins dans le cadre du système, perturbé la continuité des soins, et compromis la qualité.

Keywords

vieillissementsoutien à domicilesoins à domicilecontinuité des soinspersonnes âgées fragilesrestructurationColombie-Britanniqueaginghome supporthome carecontinuity of carefrail seniorsrestructuringBritish Columbia
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 27 , Issue 1 , Spring/Printemps 2008 , pp. 89 - 99
Copyright
Copyright © Canadian Association on Gerontology 2008

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Footnotes

*

The authors would like to thank all the study participants and those who facilitated recruitment, interpretation, and transcription. In particular, we are very grateful to Lou Black for her careful research, to Ann Chambers, Anne-Marie DeLorey, and Darlene Thorburn for their assistance, and to the BC Health Coalition, the Hospital Employees' Union, and the BC Government and Service Employees' Union for resource support. Thanks to the several reviewers of the report of the larger study upon which this article is based. This article is part of the Economic Security Project, a SSHRC-funded research alliance led by the Canadian Centre for Policy Alternatives (BC Office) and Simon Fraser University. Ms. Sharman is supported by doctoral awards from the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research. Dr. Ostry is supported by a Senior Scholar award from the Michael Smith Foundation for Health Research.

References

Adams, K.B., Sanders, S., & Auth, E.A. (2004). Loneliness and depression in independent living retirement communities: Risk and resilience factors. Aging and Mental Health, 8(6), 475–485.Google Scholar
Aronson, J. (2003). “You need them to know your ways”: Service users' views about valued dimensions of home care. Home Health Care Services Quarterly, 22(4), 85–98.Google Scholar
Aronson, J., Denton, M., & Zeytinoglu, I. (2004). Market modeled home care in Ontario: Deteriorating working conditions and dwindling community capacity. Canadian Public Policy, 30(1), 111–125.CrossRefGoogle Scholar
Aronson, J., & Neysmith, S.M. (2006). Obscuring the costs of home care: Restructuring at work. Work, Employment and Society, 20(1), 27–45.CrossRefGoogle Scholar
British Columbia Ministry of Health (2005). Better care for seniors—Health authority redesign accomplishments: A four year picture. Victoria, BC: Author.Google Scholar
Cabana, M.D., & Jee, S.H. (2004). Does continuity of care improve patient outcomes? Journal of Family Practice, 53(12), 974–980.Google Scholar
Canadian Council on Social Development (1971). Visiting homemaker services in Canada: Report of a survey with recommendations. Ottawa: Author.Google Scholar
Chichin, E.R. (1992). Home care is where the heart is: The role of interpersonal relationships in paraprofessional home care. Home Health Care Services Quarterly, 13(1/2), 161–177.Google Scholar
Cohen, M., McLaren, A., Sharman, Z., Murray, S., Hughes, M., & Ostry, A. (2006). From support to isolation: The high cost of BC's declining home support services. Vancouver, BC: Canadian Centre for Policy Alternatives.Google Scholar
Dewolfe, J., & Millan, K. (2003). Dietary intake of older adults in the Kingston area. Canadian Journal of Dietetic Practice and Research, 64(1), 16–24.Google Scholar
Elkan, R., Kendrick, D., Dewey, M., Hewitt, M., Robinson, J., Blair, M., et al. (2001). Effectiveness of home based support for older people: Systematic review and meta-analysis. British Medical Journal, 323, 1–9.CrossRefGoogle ScholarPubMed
Finch, J., & Groves, D. (Eds.), (1983). A labour of love: Women, work and caring. London, UK: Routledge and Kegan Paul.Google Scholar
Haggerty, J., Reid, R.J., Freeman, G.K., Starfield, B.H., Adair, C.E., & McKendry, R. (2003). Continuity of care: A multidisciplinary review. British Medical Journal, 327, 1219–1221.CrossRefGoogle ScholarPubMed
Hollander, M., & Tessaro, A. (2001). Evaluation of the maintenance and preventive function of home care. Victoria, BC: Hollander Analytical Services.Google Scholar
Locher, J.L., Ritchie, C.S., Roth, D.L., Baker, P.S., Bodner, E.V., & Allman, R.M. (2005). Social isolation, support, and capital and nutritional risk in an older sample: Ethnic and gender differences. Social Science and Medicine, 60, 747–761.CrossRefGoogle Scholar
Neysmith, S.M., & Aronson, J. (1996). Home care workers discuss their work: The skills required to “use your common sense.”. Journal of Aging Studies, 10(1), 1–14.CrossRefGoogle Scholar
Ostry, A. (2006). Change and continuity in Canada's health care system. Ottawa: CHA Press.Google Scholar
Penning, M.J., Brackley, M.E., & Allan, D.E. (2006). Home care and health reform: Changes in home care utilization in one Canadian province, 1990–2000. Gerontologist, 46(6), 744–758.Google Scholar
Piercy, K.W., & Woolley, D.N. (1999). Negotiating worker–client relationships: A necessary step to providing quality home health care. Home Health Care Services Quarterly, 18(1), 1–24.CrossRefGoogle ScholarPubMed
Porter, E.J., & Ganong, L.H. (2005). Filling in the helper-gap: The intentions of frail older widows. Holistic Nursing Practice, 19(5), 228–>223.Google Scholar
Saultz, J.W., & Lochner, J. (2005). Interpersonal continuity of care and care outcomes: A critical review. Annals of Family Medicine, 3(2), 159–166.CrossRefGoogle ScholarPubMed
Seeman, T.E., Crimmins, E. (2001). Social environmental effects on health and aging: Integrating epidemiologic and demographic approaches and perspectives. In Weinstein, M., Hermalin, A.I., & Soto, M.A. (Eds.), Population health and aging: Strengthening the dialogue between epidemiology and demography (pp. 88–117). New York: New York Academy of Sciences.Google Scholar
Shye, D., Mullooly, J.P., Freeborn, D.K., & Pope, C.R. (1995). Gender differences in the relationship between social network support and mortality: A longitudinal study of an elderly cohort. Social Science and Medicine, 41(7), 935–947.CrossRefGoogle ScholarPubMed
Szebehely, M. (2005). The woman-friendly welfare state? Scandinavian elder care in transition. Paper presented at Imagining Public Policy to Meet Women's Economic Security Needs, Vancouver, BC.Google Scholar
Statistics Canada (2006). Table 202-0411: Median total income, by economic family type, 2005 constant dollars, annual (1080 series). Retrieved 22 Feb. 2008 from http://cansim2.statcan.ca/cgi-win/CNSMCGI.EXE?&Lang=E&ArrayId=202-0411&Array_Pick=1&Detail=1&ResultTemplate=CII/CII___&RootDir=CII/.Google Scholar
Temkin-Greener, H., Bajorska, A., Peterson, D.R., Kunitz, S.J., Gross, D., Williams, T.F., et al. (2004). Social support and risk-adjusted mortality in a frail older population. Medical Care, 42(8), 779–788.Google Scholar
Twigg, J. (2000). Carework as a form of bodywork. Aging and Society, 20, 389–411.Google Scholar
Williams, A.M. (2006). Restructuring home care in the 1990s: Geographical differentiation in Ontario, Canada. Health and Place, 12, 222–238.CrossRefGoogle ScholarPubMed
Woodward, C.A., Abelson, J., Tedford, S., & Hutchison, B. (2004). What is important to continuity in home care? Perspectives of key stakeholders. Social Science and Medicine, 58, 177–192.Google Scholar
Vogel, D., Rachlis, M., & Pollak, N. (2000). Without foundation: How medicare is undermined by gaps and privatization in community and continuing care. Vancouver, BC: Canadian Centre for Policy Alternatives.Google Scholar