Aging in place operates in multiple interacting ways, which need to be taken into account in both policy and research. The meanings of aging in place for older people have pragmatic implications beyond internal "feel good" aspects and operate interactively far beyond the "home" or housing.

This study was based on in-depth qualitative interviews with 40 francophone Québécois family caregivers of frail elderly or mentally ill relatives and focused on the caregiving relation rather than on the specificities of aging and mental illness. Fourteen factors (love, guilt and duty, women's social identity built around caring, absence of appropriate public or private care alternatives, women's socioeconomic dependence, etc.) emerged from an analysis of informants' accounts of how they came to be the primary caregiver. Data indicate that analyses attempting to understand women's caregiving must take into account the sexual division of labor, its reinforcement through social policy, and how women internalize ideas and norms regarding appropriate gender-role behavior.

The research community is showing increasing interest in the analysis of the care trajectory of people with chronic health problems, especially dementias such as Alzheimer's disease. However, despite this interest, there is little research on the initial phases of the care trajectory. The fact that the first symptoms of dementia are generally noticed by those surrounding the elderly person suggests that the recognition of the disease is intimately linked to interactions not only amongst family members but also amongst friends, neighbours and health professionals. This study focuses on the period beginning with the first manifestations of cognitive difficulties and ending with the diagnosis of Alzheimer-type dementia. Interviews with 60 caregivers in Montreal, Canada were used to reconstruct how older people with Alzheimer-type dementia enter into the care trajectory. Our methods consisted of the analysis of social networks, social dynamics and action sequences. Our findings are presented in the form of a typology comprised of 5 pathways of entries into the care trajectory that are structured around the following four principles of the Life Course Perspective: family history, linked lives, human agency and organisational effects. We believe that analyses of the initial phases of the care trajectory, such as this one, are essential for the application of effective early detection and intervention policies. They are also central to informing future studies that seek to understand the care experience in its entirety.

The new conception of caregiving as work that can and should be shared with services is in direct opposition to public policy that is based on the assumption of family care as the cornerstone of long-term care. Can the healthcare system adapt to the new expectations of the Baby Boom generation or will these caregivers be forced to take on elements of caregiving they no longer consider legitimate?

Daphne Nahmiash McGill Center for Studies in AgingCaregivers to family and friends are increasingly recognized as essential players in the continued shift of care of dependent populations to the community. Currently, Canadian provincial home care programs have neither a comprehensive policy nor an assessment regarding caregivers' needs. This article describes an assessment tool that takes into account caregivers' reality and conditions and that situates them as essential partners with the formal system and reports on the validation and reliability testing of this tool. Seven sites in Quebec and Nova Scotia involving 40 assessors tested the tool with 168 caregivers. Results suggest that this comprehensive tool enables practitioners to understand caregivers' needs and situations. Focus groups with assessors and interviews with home care administrators revealed that the tool increased worker understanding and awareness of what it means to be a caregiver, ascertained the key caregiver concerns, and identified these needs in rapid succession.Caregivers are increasingly identified by health and social service practitioners as having specific and often unmet needs (Beeson, 2003;Soothill et al.,

The formal sector's increasing recourse to families poses questions concerning the type and degree of participation that is expected of family caregivers and the conceptions that exist regarding them. This article examines different conceptions and their implications for practice, based on reflexions emanating from the authors' 15 years of empirical research on caregiving. A typology of practice approaches based on the various conceptions is presented including: the dependent adult approach, the caregiver as joint-client, the caregiver as resource and the caregiver as partner approach. Each of these approaches is based on a framework of beliefs, values and principles which shape policy and practice and have implications for how caregivers are perceived and served. The authors propose an alternative community-oriented approach which addresses the limitations of those which currently dominate homecare policy and practice.

Researchers and practitioners in several Western countries have recently developed tools for assessing the situation of the carers of adults who are ill, elderly or have disabilities. The present article describes the impact of three such assessment tools, from Canada, the UK and Sweden, on the professional practice of assessors. All tools were tested in agency-based studies. Focus groups, workshops and interviews with assessors were employed to understand the impact on professionals and their practice. An Australian researcher and case manager comments on these experiences from her unique perspective. The results reveal that the use of carer assessments can lead to changes in the appropriateness of intervention by informing practitioners of issues which are given little attention, but which impact on the adequacy of interventions to the service user. Across the projects, most workers found that the tools facilitated a more comprehensive, in-depth and carer-focused assessment. Experience across all the projects suggests that, used sensitively, such tools and approaches can play a key role in transforming the relationship between carers, and the health and social care system. Giving carers a legitimate voice, acknowledging their perspective and expertise, and making them central to assessment processes accords them status both as active partners, and as individuals with their own needs and aspirations, rather than seeing them primarily as resources. As a result of their experiences, many workers and administrators concluded that home-care programmes must change their mandate to include carers among their clients, raising the issue of available monetary and human resources to meet the needs of this group. In addition, as our Australian colleague points out, time, efficiency, relevance, benefit and minimal intrusiveness are important factors for practitioners which influence their use of assessment tools.

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