Canada’s Complex and Fractionalized Home Care Context: Perspectives of Workers, Elderly Clients, Family Carers, and Home Care Managers (original) (raw)

Canadian Review of Social Policy / Revue canadienne de politique sociale, 2012

Abstract

In Canada, home care provides health and social services to an estimated one million people, most of them older adults. In the absence of national policy directives, services vary considerably from one jurisdiction to the next, in what has been called a “checkerboard” of policy and practice. This paper examines policy-relevant issues in the provision of home care services, focusing specifically on “home support” services delivered by unregulated workers. We examine findings from our six-year program of research, and highlight three policy issues that emerged from our study of workers, older clients, family carers, and managers. These are: scope of services, scheduling of services, and the presumption of availability of family/friend carers. For each issue, we give examples of policy or practice initiatives being undertaken and current challenges. We then examine these issues in relation to guiding principles for services, as identified by the Canadian Home Care Association. Au Canada, des services de sante et des services sociaux a domicile sont fournis a environ un million de personnes, pour la plupart des personnes âgees. En l'absence de directives politiques nationales, les services varient considerablement d'un territoire a l'autre, dans ce qui a ete appele une « mosaique » de politiques et de pratiques. Ce document examine les questions liees aux orientations politiques en matiere de prestation de services de soins a domicile, et plus particulierement les services de « soutien a domicile » proposes par des travailleurs non reglementes. Nous analysons les conclusions de notre programme de recherche mene a bien sur six annees, et mettons en avant trois problemes de politique qui ont emerge de notre etude sur les travailleurs, les clients âges, les aidants familiaux et les gestionnaires. Ces trois problemes sont : la portee des services, les horaires des services et la disponibilite presumee des aidants familiaux ou amicaux. Pour chaque point, nous presentons des exemples d'initiatives entreprises en matiere d'orientation politique ou de pratiques, ainsi que les defis rencontres. Nous considerons ensuite ces questions a la lumiere des principes directeurs de ces services, identifies par l'Association canadienne de soins et services a domicile.

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