In many developed contexts, home-care services have been overhauled with the intent of increasing control and flexibility for those using social and health services. This change is associated with providing funds directly to individuals, and sometimes their families and supports, to arrange at home-care assistance with the activities of daily living. Directly funded home-care programs, or "direct funding" (DF), are not value-neutral policy interventions, but complex and politicised tools for the enactment of care in contemporary times. In this qualitative metasynthesis, we consider 47 research articles published between 2009 and 2017 that explore various DF programs for older persons in the United Kingdom, Australia, and the United States to identify core concepts in the literature. We find that choice emerges as a central concern. We then assess the literature to explore the questions: How does the existing literature conceptualise choice, and the mechanisms through which choice is enhanced, in DF programs for older persons? How is choice, and the benefit of choice to older service users, understood in relevant studies? We argue that the concept of "choice" manifests as a normative goal with presumed benefits among the studies reviewed. Particularly when discussing DF for older people, however, it is essential to consider which mechanisms improve care outcomes, rather than focusing on which mechanisms increase choice writ large. In the case of DF, increased choice comes with increased legal responsibilities and often administrative tasks that many older people and their supports find burdensome. Furthermore, there is no evidence that choice over all elements of one's services is the mechanism that improves care experiences. We conclude by presenting alternative models of understanding care emerging from feminist and other critical scholarship to consider if we are, perhaps, asking the wrong questions about why DF is so often preferred over conventional home-care delivery.

The ethics of care has gained traction as a feminist normative lens from which to examine policies and policy issues. This thesis aims to contribute to this growing literature by employing a critical ethics of care lens to assess a new long-term care initiative in the province of Newfoundland and Labrador, Canada. This initiative, called the Newfoundland Paid Family Caregiver Program, allows eligible participants to pay family members for some care services. This analysis uncovers numerous tensions, both practical and theoretical, related to the way this program (re)organizes care. Specifically, the ways in which this program downloads caring responsibilities onto the family and monetizes caring relations is discussed. Finally, this analysis explores what care policies starting from the premises of a critical ethics of care might look like, and argues that such policies would have greater reach and positive consequences in terms of (re)producing healthy, flourishing lives for us all.iii

Daniel Engster's most recent book, Justice, Care, and the Welfare State, is a well-researched and compelling exploration of welfare-state reform and moral theory. Specifically, Engster aims to "bridge the gap" (2) between welfare-state policies and justice theories by employing a nonideal theory of justice--based largely on the ethics of care--to defend a variety of welfare-state supports and programs. Melding care ethics and detailed empirical research, Engster imagines and justifies welfare-state provisions and reforms related to health care and poverty alleviation, as well as specific programs for the elderly, people with disability, and children. In this way, Engster provides a robust vision for the welfare state that is explicitly normative and that focuses on numerous sectors of social support and the interstices among these.

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