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Out of Place: Mediating Health and Social Care in Ontario's Long-Term Care Sector*

Published online by Cambridge University Press:  31 March 2010

Tamara Daly
Tamara Daly*
Affiliation:
York University
*
Requests for offprints should be sent to:/Les demandes de tirés-à-part doivent être adressées à : Tamara Daly, Ph.D., School of Health Policy and Management, Faculty of Health, 411 Health, Nursing and Environmental Studies Building, York University, 4700 Keele Street, Toronto, ON M3J 1P3. ([email protected])
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Abstract

The paper discusses two reforms in Ontario's long-term care. The first is the commercialization of home care as a result of the implementation of a “managed competition” delivery model. The second is the Ministry of Health and Long-Term Care's privileging of “health care” over “social care” through changes to which types of home care and home support services receive public funding. It addresses the effects of these reforms on the state–non-profit relationship, and the shifting balance between public funding of health and social care. At a program level, and with few exceptions, homemaking services have been cut from home care, and home support services are more medicalized. With these changes, growing numbers of people no longer eligible to receive publicly funded home care services look for other alternatives: they draw available resources from home support, they draw on family and friend networks, they hire privately and pay out of pocket, they leave home and enter an institution, or they do without.

Résumé

l'article porte sur deux réformes dans le secteur des soins de longue durée en Ontario. d'abord, la commercialisation du secteur des soins à domicile à la suite de la mise en œuvre du modèle de prestation concurrentielle gérée. Puis, la primauté des «soins de santé» sur les «soins sociaux» sous la houlette du ministère de la Santé et des Soins de longue durée, par des changements selon lesquels des types de soins à domicile et de services de soutien à domicile sont financés par le secteur public. l'article examine l'effet de ces réformes sur les rapports entre l'État et les organismes à but non lucratif, et l'équilibre changeant du financement public des soins de santé et des soins sociaux. À l'échelon des programmes, à quelques exceptions près, les services d'aide domestique ne font plus partie des soins à domicile et les services de soutien à domicile sont essentiellement des services médicaux. Par suite de ce remaniement, de plus en plus de personnes ne sont plus admissibles à des services à domicile subventionnés par les deniers publics et elles sont à la recherche de solutions de rechange : elles puisent dans les ressources de soutien à domicile disponibles, elles s'en remettent au réseau familial et au réseau amical, elles retiennent les services d'aidants et assument les menues dépenses, elles quittent la maison pour élire domicile dans un établissement d'hébergement et de soins, ou elles s'en passent.

Keywords

aginghome carehome supportsocial carenon-profitmanaged competitioncommercializationvieillissementsoins à domicilesoutien à domicilesoins sociauxsans but lucratifconcurrence géréecommercialisation
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 26 , Issue S1: Hidden Costs/Invisible Contributions of Caregiving / Coûts cachés et contributions invisibles des soins , Winter/Hiver 2007 , pp. 63 - 75
Copyright
Copyright © Canadian Association on Gerontology 2007

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Footnotes

*

I collected data for this paper during my doctorate, which was funded by a CHSRF/CIHR Doctoral Research Fellowship. A CHSRF/CIHR Postdoctoral Award Fellowship enabled me the time to complete this manuscript. Over the course of preparing this work I am grateful for helpful comments from Pat Armstrong, Raisa Deber, Rhonda Cockerill, Marcia Rioux, Mark Rosenberg, and James Struthers. All omissions remain my responsibility.

References

Armstrong, P., Armstrong, H. (2002). Women, privatization and health care reform. In Armstrong, P., Amaratunga, C., Bernier, J., Grant, K., Pederson, A., & Willson, K. (Eds.), Exposing privatization. Aurora: Garamond.Google Scholar
Armstrong, P., & Kits, O. (2001). One hundred years of caregiving. Ottawa: Law Commission of Canada.Google Scholar
Aronson, J. (2004). “Just fed and watered”: Women's experiences of the gutting of home care in Ontario. In Grant, K., Amaratunga, C., Armstrong, P., Boscoe, M., Pederson, A., & Willson, K. (Eds.), Caring for/caring about: Women home care, and unpaid caregiving (pp. 167–183). Aurora: Garamond.Google Scholar
Aronson, J., & Neysmith, S. (2001). Manufacturing social exclusion in the home care market. Canadian Public Policy, 27(2), 151–165.Google Scholar
Baranek, P.M. (2000). Long term care reform in Ontario: The influence of ideas, institutions and interests on the public/private mix. Unpublished doctoral dissertation, University of Toronto, ON.Google Scholar
Baranek, P.M., Deber, R.B., & Williams, A.P. (1999). Policy trade-offs in ‘home care’: The Ontario example. Canadian Public Administration, 42(1), 69–92.CrossRefGoogle Scholar
Browne, P.L. (2000). Unsafe practices. Ottawa: Canadian Centre for Policy Alternatives.Google Scholar
Browne, (Ed.) (2003). The commodity of care. Ottawa: Canada Centre for Policy Alternatives.Google Scholar
Canadian Red Cross (1998/1999). Regional annual review. Ottawa: Author.Google Scholar
Caplan, E. (2005). Realizing the potential of home care. Toronto: Ministry of Health and Long Term Care.Google Scholar
Coburn, D. (2001). Introduction: The political economy of health and care. In Unhealthy times: Political economy perspectives on health and care in Canada (pp. vii–x). Don Mills: University of Toronto Press.Google Scholar
Coyte, P.C., Hall, R., & Croxford, R. (1999). Inter-provincial variation in home care funding. Toronto: Home Care Evaluation and Research Centre.Google Scholar
Cranswick, K. (2002). General social survey cycle 16: Caring for an aging society. Ottawa: Statistics Canada.Google Scholar
Daly, T. (2003a). <Was 2003b>. The grassroots ceiling: The impact of state policy change on home support nonprofits in Ontario and in Waterloo Region – Wellington-Dufferin (1958–2001). Toronto: University of Toronto Press.Google Scholar
Daly, T. (2003b). <Was 2003a> Responding to state retrenchment: An historical perspective on non-profit home health and social care in Ontario. In Browne, P.L. (Eds.), The commodity of care: Home care reform in Ontario (pp. 65–120). Ottawa: Canadian Centre for Policy Alternatives.Google Scholar
Grant, K., Amaratunga, C., Armstrong, P., Boscoe, M., Pederson, A., & Wilson, K. (2004). Caring for/caring about: Women home care, and unpaid caregiving. Aurora: Garamond.CrossRefGoogle Scholar
Hirdes, J., Dalby, D., & Poss, J. (2001). The use of homemaking and personal support services in the CCAC of Waterloo Region. Waterloo: RAI Health Informatics Project (RAI-HIP), Department of Health Studies & Gerontology, University of Waterloo.Google Scholar
Hollander, M., & Tessaro, A. (2001). Evaluation of the maintenance and preventive model of home care. Ottawa: Home Care/Pharmaceuticals Division, Policy and Communications Branch, Health Canada.Google Scholar
Jenson, J., & Phillips, S. (2000). Distinctive trajectories: Homecare and the voluntary sector in Quebec and Ontario. In Banting, K. (Eds.), The nonprofit sector in Canada (pp. 28–67). Kingston: School of Policy Studies.Google Scholar
Kelly, A.. (2002, February 6). VON loses contract, 60 jobs. Kitchener-Waterloo Record, p. B1.Google Scholar
Mahoney, J. (2000). Path dependence in historical sociology. Theory and Society, 29, 507–548.CrossRefGoogle Scholar
Ministry of Community and Social Services, Ministry of Health, & Ministry of Citizenship. (1991). Redirection of long-term care and support services in Ontario. Toronto: Queen's Printer.Google Scholar
Ministry of Health, Ministry of Community and Social Services, & Ministry of Citizenship. (1993a). Building partnerships in long-term care: A new way to plan, manage and deliver services and community support; A local planning framework. Toronto: Queen's Printer.Google Scholar
Ministry of Health, Ministry of Community and Social Services, & Ministry of Citizenship. (1993b). Partnerships in long-term care: A new way to plan, manage and deliver services and community support: A policy framework. Toronto: Queen's Printer.Google Scholar
Morris, M. (2004). What research reveals about gender, home care and caregiving: Overview and the case for gender analysis. In Grant, K., Amaratunga, C., Armstrong, P., Boscoe, M., Pederson, A., & Willson, K. (Eds.), Caring for/caring about: Women home care, and unpaid caregiving (pp. 000–000). Aurora: Garamond.Google Scholar
Neysmith, S.M. (2001). From home care to social care: The value of a vision. In Neysmith, S.M. (Ed.), Ontario Association for Community Care Access Centres. (2001). RFP Survey of CCACs.Google Scholar
Ontario Association for Community Care Access Centres. (2001). RFP Survey of CCACs. Toronto: Author.Google Scholar
Romanow, R. (2002). Building on values: The future of health care in Canada – final report. Ottawa: Library and Archives Canada.Google Scholar
Soo, K.. (2001, April 5). Red Cross workers in limbo. Toronto Star, p. B2.Google Scholar
Stein, J.G. (2001). The cult of efficiency. Etobicoke: Anansi.Google Scholar
Struthers, J. (2004). Comfort, security, dignity: The Veterans Independence Program – a policy history. Peterborough: Trent University Press.Google Scholar
Van Horne, R. (1986). A New Agenda. Toronto: Minister for Senior Citizens Affairs.Google Scholar
VON Canada (2003). VON Waterloo-Wellington-Dufferin Branch to close. Retrieved 1 June 2007 from http://www.von.ca/english/News/WWD2003.htm.Google Scholar
Waterloo Region District Health Council. (1996). Update on Waterloo Region's multi-year plan for long-term care services: A report on the status of 56 recommendations made in the strategic plans for supportive housing, palliative care, and community long-term care services. Waterloo: Waterloo Region District Health Council.Google Scholar
Waterloo Region – Wellington-Dufferin District Health Council. (2001). Volunteers in service to long term care agencies: A precious resource under pressure. Guelph: Waterloo Region-Wellington-Dufferin District Health Council.Google Scholar
Waterloo Region Working Group on Community-Based Long Term Care Services. (1995). Balance, quality, equity, sustainability: Report of the Working Group on Community-Based Long-term Care Services. Waterloo Region: Waterloo Region District Health Council.Google Scholar
Wellington-Dufferin, CCAC (2002). Nursing services contracts awarded: Community Care Access Centre of Wellington-Dufferin. Wellington-Dufferin, ON: Author.Google Scholar
Wiles, J. (2002). Informal caregivers' experiences of formal support in a changing context. Health and Social Care in the Community, 11(3), 189–207.Google Scholar
Williams, A.M. (1996). The development of Ontario's Home Care Program: A critical geographical analysis. Social Science and Medicine, 42(6), 937–948.CrossRefGoogle Scholar
Williams, A.P., Barnsley, J., Leggat, S., Deber, R.B., & Baranek, P. (1999). Long term care goes to market: Managed competition and Ontario's reform of community-based services. Canadian Journal of Aging, 18(2), 125–151.Google Scholar
Yin, R. (1994). Case study research: Design and methods: Vol. 5. London: Sage.Google Scholar