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The Limits of Consumer Directed Care as Public Policy in an Aging Society*

  • Sharon M. Keigher (a1)

Abstract

This paper overviews the emergence of a philosophy of “consumer-direction” in personal, home, and community care for the disabled elderly in North America and Europe. Consumer direction is associated with direct payment schemes and other mechanisms that support user choices in the purchase of care, user empowerment and independence. To illustrate the strengths and limitations of consumer direction in practice, the paper analyses interview data collected from users and providers of existing care arrangements where elders and families choose and/or hire, supervise, and manage their “own” homecare workers who are self-employed. Interviews conducted separately with care users and providers illustrate how structural and interpersonal power related to financial, social and geographic proximity affect the way independent care arrangements are established, and maintained. Power issues embedded in marketized arrangements suggest the need for caution against wholesale adoption of market principles in social provisions for serving elders.

Cette communication porte sur l'émergence d'une philosophie «d'orientation du consommateur» dans les soins personnels, à domicile et communautaires offerts aux personnes âgées dépendantes en Amérique du Nord et en Europe. L'orientation du consommateur est associée au paiement direct et autres mécanismes qui appuient l'usager dans ses choix d'achat de soins, de prise en charge personnelle et d'indépendance. Pour illustrer les forces et les faiblesses de l'orientation du consommateur dans la pratique, les auteurs analysent des données d'entrevues menées auprès d'utilisateurs et de fournisseurs de soins dans lesquels les aîné(e)s et leurs familles ont choisi et/ou retenu, supervisé et géré leurs «propres» soignants à domicile, qui sont des travailleurs autonomes. Les entrevues, menées séparément avec les bénéficiaires et les fournisseurs de soins illustrent l'effet des pouvoirs structurels et interpersonnels reliés aux facteurs financiers, sociaux et géographiques sur la façon dont les arrangements de soins indépendants sont négociés et gérés. Les questions de pouvoir incluses dans les arrangements proposés suggèrent qu'il faut faire preuve de prudence devant l'adoption globale des principes du marché dans la provision de services de soins aux aînés.

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References

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The Limits of Consumer Directed Care as Public Policy in an Aging Society*

  • Sharon M. Keigher (a1)

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