Manufacturing Social Exclusion in the Home Care Market

Abstract

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.

Treatment Decision Making and Its Discontents

“…Especially relevant to this study: a third of Canadian women aged 65 and over live alone (Statistics Canada, 2001) and most older people are reluctant to turn to family, particularly for personal rather than practical help (Daatland, 1994). Importantly, over the past fifteen years public provision of formal home care has dwindled as the sector is reorganized along market-modeled lines (Aronson & Neysmith, 2001). Adequately managing and recovering from many kinds of cancer treatment thus increasingly requires private social and/or financial resources.…”

Managing under managed community care: the experiences of clients, providers and managers in Ontario’s competitive home care sector

“…If clients are to be used as information sources in the contract monitoring process in the home care sector, effort needs to be given to overcoming the numerous barriers that exist to obtaining the views of home care clients and caregivers which include fear of complaining due to fear of service loss; the biases inherent in formal complaints processes that favour those who are well enough to complain; and the tendency for home care clients, as they become socially isolated, to be excluded from active political participation in the decisions that directly affect them [26].…”

‘The Elephant on the Table’: Religious and Ethnic Diversity in Home Health Services

“…Financial pressures associated with global economies and rising healthcare costs, combined with improved medical technologies, have resulted in the global de-institutionalization movement and the glorification of home and community-based care, marked by the philosophy that home is a better site for care (Aronson & Neysmith, 2001;Bryant, 2017). Neoliberal ideologies shape this shift toward home and community-based care, whereby market economies with profit motivation, the mobilization of capital and workforces across borders, and the decline of the welfare state and government investment in social and health services are put forward as common sense and inevitable (Bryant, 2017).…”