Based on a qualitative study of home care workers, this paper aims to understand elder abuse of Chinese Canadians. The findings show disrespect is the key form elder abuse takes in the Chinese community. As a culturally specific form of abuse, disrespect remains invisible under categories of elder abuse derived from a Western cultural perspective. Applying a social exclusion framework to understand the dynamic of elder abuse, we argue that as a marginalized racial minority immigrant, an elderly Chinese person's vulnerability to abuse is increased under conditions of social isolation.

ABSTRACTThis paper uses an intersectionality theoretical lens to interrogate selected findings of a scoping review of published and grey literature on the health and health-care access of ethnocultural minority older adults. Our focus was on Canada and countries with similar immigrant populations and health-care systems. Approximately 3,300 source documents were reviewed covering the period 1980–2010: 816 met the eligibility criteria; 183 were Canadian. Summarised findings were presented to groups of older adults and care providers for critical review and discussion. Here we discuss the extent to which the literature accounts for the complexity of categories such as culture and ethnicity, recognises the compounding effects of multiple intersections of inequity that include social determinants of health as well as the specificities of immigration, and places the experience of those inequities within the context of systemic oppression. We found that Canada's two largest immigrant groups – Chinese and South Asians – had the highest representation in Canadian literature but, even for these groups, many topics remain unexplored and the heterogeneity within them is inadequately captured. Some qualitative literature, particularly in the health promotion and cultural competency domains, essentialises culture at the expense of other determinants and barriers, whereas the quantitative literature suffers from oversimplification of variables and their effects often due to the absence of proportionally representative data that captures the complexity of experience in minority groups.

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This study of displaced home care workers reveals how managed competition serves to produce a flexible and atomized work force. Laid off when their nonprofit employer could not compete in the local home care market, workers blamed their employer and their union for their jeopardy. Obscured from local view was the role of government policy in offloading services to the market, benefiting privileged participants in the hospital, professional and market health care sectors. Workers’ indignation at their own and their elderly clients’ unfair treatment dissipated: they had to attend to the practical imperatives in their lives, and were unable to locate a target for their protest. Resolving to be flexible and self-sufficient in the future, they struggled to rework identities as committed carers. The study illuminates how particular organizational and political processes render services more meagre and labour more flexible, and suggests particular possibilities for both accommodating and disrupting those trends.

Home care work in metropolitan areas is a source of employment for immigrant women of color. Service work of this type intertwines domestic and caring labor in ways that reinforce the historically gendered and racialized nature of the work. Such macro level economic and political issues are played out at the micro level of daily service provided within elderly clients' homes. A study of these processes in home care work was carried out in urban southern Ontario in two nonprofit home care agencies. In-depth interviews and focus groups held with visible minority home care workers suggested that workers deal daily with racist attitudes and behaviors from clients and their families; agencies recognize these oppressive processes but usually handle them on a case-by-case basis through supervisors; and home care workers handle racism on the job as they do in their off-work hours-by avoidance, situating incidents within an analysis of the circumstances of elderly clients, setting boundaries on discussions, and occasionally, confrontation.

Increasingly, interprofessional teams are responsible for providing integrated health care services. Effective teams, however, are not the result of chance but require careful planning and ongoing attention to team processes. Based on a case study involving interviews, participant observation, and a survey, we identified key attributes for effective interprofessional working (IPW) within a home-based primary care (HBPC) setting. Recognizing the importance of a theoretical model that reflects the multidimensional nature of team effectiveness research, we employed the integrated team effectiveness model to analyze our findings. The results indicated that a shared vision, common goals, respect, and trust among team members – as well as processes for ongoing communication, effective leadership, and mechanisms for conflict resolution – are vital in the development of a high-functioning IPW team. The ambiguity and uncertainty surrounding the context of service provision (clients' homes), as well the negotiation of external relationships in the HBPC field, require further investigation.

Cet article examine comment la perspective des services de santé qui englobe les soins à domicile obscurcit l'ampleur des processus d'exclusion sociale qui se manifestent dans cette arène des politiques publiques. Une étude de femmes âgées et de femmes handicapées recevant des soins à domicile en Ontario révèle que les soins organisés dans la communauté génèrent et renforcent l'isolement social des usagers de ces services ainsi que leur exclusion spatiale, institutionnelle et politique. L'analyse des expériences des sujets participant à cette étude met en évidence les défis à relever pour s'éloigner d'un discours de marché et d'une structure établie et pour développer une politique de soins à domicile qui parvienne à l'inclusion et à la participation des citoyens âgés et des handicapés ayant besoin d'une aide à domicile. This paper examines how the health care perspective which dominates home care obscures the broader processes of social exclusion that play out in this arena of public policy. A study of elderly women and women with disabilities receiving home care in Ontario reveals how managed community care generates and reinforces service users' social isolation and their spatial, institutional, and political exclusion. Analysis of study participants' experiences points to the challenges of moving away from a market discourse and a health framework to develop home care policy which achieves the inclusion and participation of elderly citizens and citizens with disabilities in need of assistance at home.

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