Background: Implementing elder-dedicated local health and social services (LHSS) is primary for older Canadian adults to age in place. However, there is currently no synthesis of the factors (barriers and facilitators) involved in LHSS implementation.Objective: This study aimed to synthesize current knowledge about the institutional factors involved in elder-dedicated LHSS implementation by describing them and their influence. Methods: A scoping review was conducted using eight databases and the grey literature. Data were analyzed thematically. Results: A total of 23 documents led to the identification of 15 inter-influencing factors (12 barriers and 11 facilitators). Indeed, 20 connections were noted among factors, mostly among barriers.
To respond to the needs of home healthcare (HHC) patients, HHC professionals must use strategies to navigate the influence of the institutional context, that is, laws and regulations, the administration, and the organization of HHC services. However, no synthesis of those strategies exists. This review aimed to synthesize the strategies used by HHC professionals working with older adults to navigate the institutional context. An integrative review was undertaken in 5 databases, from 2011 to January 2023. The quality of documents was assessed based on an adapted version of the Critical Review Form—Qualitative Studies (Version 2.0) in which a score was calculated out of 25, and data was analyzed through coding, data display and comparison. Thirteen documents were included. The quality of studies ranged from 13 to 21.75. Strategies are often used to overcome limited resources (e.g., time, funding). Six types of strategies were identified: Deviating (bypassing rules or processes), taking on more and more (taking additional work), offering one’s personal time (working without remuneration), reallocating resources (splitting HHC services between patients), limiting HHC visits (restricting interventions or actions) and relying on others (transferring responsibilities). The use of strategies could alleviate the discomfort felt by HHC professionals due to limited resources. However, as some strategies lead to a reduced scope of practice and to a loss of expertise, this could impede the quality of the care, resulting in non-responded needs for HHC patients.
As eldercare forefronts mainstream news media during the COVID-19 pandemic, these media accounts may draw on and/or further reshape public understandings of home care in Canada. A frame analysis informed by critical discourse theory was used to examine 56 English-language articles related to home care (March 2020–March 2021). Home care is often “tacked on” to discussions of long-term residential care and is constructed by what it is not, by what it is a preferred alternative to, and by what it might circumvent (i.e., neglect, contagion). Infused with taken-for-granted meanings and linked to population aging and system crisis, home care is positioned as the progressive future of Canadian eldercare. Although home care investment is a common call, at times the gravity of the problem is imbalanced against small-scale individualistic solutions. Inequities of home spaces and impacts on families are obscured, with homes characterized as idealized places of dignity and (relative) safety. Older adults are positioned as vulnerable, passive victims, in contrast to their benevolent helpers. The authors discuss how we can clarify and strengthen political advocacy and public discourse around eldercare without reinforcing compassionate ageism, apocalyptic demography, and fear of aging while recognizing the nuances around receiving care in either home or residential settings.
Considering that French is the dominant language in Quebec, that relatively few francophone providers of health and social services are able to speak English, and that English-speaking older adults (OAs) have low levels of bilingualism, anglophone OAs are more likely than their francophone peers to face language barriers when accessing health and social services. However, little is known about the strategies English-speaking OAs put into place to overcome the difficulties encountered due to language barriers when they access these services. We therefore aimed to document the strategies used by English-speaking OAs when, due to language barriers, they faced difficulties in accessing health and social services. We conducted a qualitative case study with ten English-speaking OAs in the Eastern Townships in Quebec. Through interviews and document reviews, we collected data which we then analyzed thematically. We identified seven strategies used by English-speaking OAs: investigating for health- and access-related information in English, creating their own services, entering the health and social services system offered in French, entering the health and social services system with help from others, putting the responsibility of overcoming the language barrier on the provider, splitting that responsibility, and taking on the responsibility. Our results highlight a potential burden associated with the involvement of the English-speaking community in enabling English-speaking OAs to access health and social services.
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