Balancing Flexibility and Administrative Burden: Experiences of Family Managers Using Directly Funded Home Care in Manitoba, Canada

Abstract

Directly funded (DF) home care provides funding to home care recipients to coordinate their own care and supports, and is available across all Canadian provinces. Current research on DF home care focuses on the experiences of adults with disabilities self-directing their own care, but less is known about the experiences of family members managing services for adults 55 years of age and older. This article presents findings from a qualitative analysis of 24 semi-structured interviews with older adults and caregivers using the DF program in Manitoba, Canada, focusing on family manager experiences. We identify three themes in the interview data: (1) DF home care enhances choice and flexibility for older people and their caregivers, (2) choice and flexibility reduce caregiver strain, and (3) agency services reduce administrative burden. We discuss the importance of care relationships and the role of family managers. We recommend that traditional home care systems learn from DF, and that increased administrative support would reduce caregiver strain.

Participatory Evaluation of a Direct Payment Program for Equity in Dementia Care in Nova Scotia, Canada: A Study Protocol

“…Less is known about the experiences of PLWD who participate in these programs, as direct payment programs for older adults and PLWD are relatively new (Dansereau et al, 2022; Fitzgerald Murphy & Kelly, 2019; Kelly, Jamal, et al, 2021). Emerging research provides some evidence that this funding model can enhance choice and flexibility for older people and their caregivers while reducing caregiver strain, with a caution that it can also add administrative burden on the caregiver, who effectively becomes the ‘family care manager’ responsible for finding, hiring, and supervising home care workers (Dansereau et al, 2022; Fitzgerald Murphy & Kelly, 2019). There is also a lack of recognition for home care workers’ choices and preferences compared to recipients, and underexamined tensions between clients’ and workers’ choices in home care provision (Cranford, 2020).…”

“…An assumed benefit of directly funded care is that it can increase the flexibility and choice of recipients (Cranford, 2020; Fleming et al, 2019; van Toorn, 2021). Less is known about the experiences of PLWD who participate in these programs, as direct payment programs for older adults and PLWD are relatively new (Dansereau et al, 2022; Fitzgerald Murphy & Kelly, 2019; Kelly, Jamal, et al, 2021). Emerging research provides some evidence that this funding model can enhance choice and flexibility for older people and their caregivers while reducing caregiver strain, with a caution that it can also add administrative burden on the caregiver, who effectively becomes the ‘family care manager’ responsible for finding, hiring, and supervising home care workers (Dansereau et al, 2022; Fitzgerald Murphy & Kelly, 2019).…”