A critical policy analysis of an emerging agenda for home care in one Canadian province

Abstract

Amidst projections of the increased care demands and expectations for home care, policy in this area demands urgent attention. Home care is inherently complex as it challenges us to deliberate fundamental issues of responsibility for care, and the limits of care for people in their most immediate contexts and needs. This research takes the form of a critical policy analysis of the interaction of the context, process and content of policy proposals in home care in a regional health system in one Canadian province. The method of study includes thematic and comparative analyses of perspectives derived from policy documents, and interviews with policy actors (decision-makers, healthcare providers, public advocates) regarding their perspectives of policy problems and processes. The content and process of policy in home care interact in important ways with political, economic, social and historical contexts. This critical analysis revealed that the emerging policy agenda in regional home care is one of medicalisation, which stands in contrast to the principles of primary health care, and potentially leads to further marginalisation of the most vulnerable. This contrast is characterised by tensions between the fundamental values of equity and efficiency, choice and universality, and public vis-à-vis individual responsibility for the provision of care.

Creating and sustaining disadvantage: the relevance of a social exclusion framework

“…1998, Armstrong & Armstrong 1999, Bégin et al . 1999, Fuller 1999, Duncan & Reutter 2006). What is commonly understood as a mounting neoliberalist approach results in home‐care programmes delivered within the ‘mixed‐economy of care’ comprised of a combination of public, para‐public and private services, as seen in Québec.…”

Effective nursing leadership of older persons in the community – a systematic review

“…Two studies (Henriksen & Rosenqvist , Duncan & Reutter ) revealed that managers were aware of an attitude problem among their staff towards older persons. In the study by Henriksen and Rosenqvist () the managers described taking care of older persons in a traditional sense, i.e.…”

“…They complained about the emphasis on the medical paradigm and questioned who was responsible for the care of elderly people (Henriksen & Rosenqvist ). Duncan and Reutter () stated that managers need to develop a new value and meaning of caring for older persons when the shift to a medical model is widespread. The managers in their study expressed concern that older and socially isolated individuals were ‘falling through the cracks' (Duncan & Reutter ).…”

The Emotional Consequences of Organizational Change

“…Despite taking place in varied international contexts, the reforms similarly focus on altering the structure of programs and standardizing procedures across organizational or geographic boundaries (see Kettl, 2000). Criticisms of such reforms have focused on the political shift toward neoliberal priorities (Hornblow, 1997;Gross et al, 1998;Anell, 2005;Duncan & Reutter, 2006;Irvine et al, 2006;Wimbush et al, 2007), implementation of rational, technocratic and managerial procedures (see Neysmith & MacAdam, 1999;Grenier, 2007;Grenier & Guberman, 2009), and ageist attempts to justify the re-ordering of public services (see Gee & Gutman, 2000). Academics and professionals alike, particularly in the United Kingdom, have expressed scepticism about the new managerialism, and its claims for effi ciency, the feasibility of improving services while reducing costs, and the impact on persons providing and receiving care (see Hoggett, Mayo & Miller, 2006;Clarke & Newman, 1997;Beck & Young, 2005).…”