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Out of Place: Mediating Health and Social Care in Ontario's Long-Term Care Sector*

Published online by Cambridge University Press:  31 March 2010

Tamara Daly
Tamara Daly*
Affiliation:
York University
*
Requests for offprints should be sent to:/Les demandes de tirés-à-part doivent être adressées à : Tamara Daly, Ph.D., School of Health Policy and Management, Faculty of Health, 411 Health, Nursing and Environmental Studies Building, York University, 4700 Keele Street, Toronto, ON M3J 1P3. (dalyt@yorku.ca)
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Abstract

The paper discusses two reforms in Ontario's long-term care. The first is the commercialization of home care as a result of the implementation of a “managed competition” delivery model. The second is the Ministry of Health and Long-Term Care's privileging of “health care” over “social care” through changes to which types of home care and home support services receive public funding. It addresses the effects of these reforms on the state–non-profit relationship, and the shifting balance between public funding of health and social care. At a program level, and with few exceptions, homemaking services have been cut from home care, and home support services are more medicalized. With these changes, growing numbers of people no longer eligible to receive publicly funded home care services look for other alternatives: they draw available resources from home support, they draw on family and friend networks, they hire privately and pay out of pocket, they leave home and enter an institution, or they do without.

Résumé

l'article porte sur deux réformes dans le secteur des soins de longue durée en Ontario. d'abord, la commercialisation du secteur des soins à domicile à la suite de la mise en œuvre du modèle de prestation concurrentielle gérée. Puis, la primauté des «soins de santé» sur les «soins sociaux» sous la houlette du ministère de la Santé et des Soins de longue durée, par des changements selon lesquels des types de soins à domicile et de services de soutien à domicile sont financés par le secteur public. l'article examine l'effet de ces réformes sur les rapports entre l'État et les organismes à but non lucratif, et l'équilibre changeant du financement public des soins de santé et des soins sociaux. À l'échelon des programmes, à quelques exceptions près, les services d'aide domestique ne font plus partie des soins à domicile et les services de soutien à domicile sont essentiellement des services médicaux. Par suite de ce remaniement, de plus en plus de personnes ne sont plus admissibles à des services à domicile subventionnés par les deniers publics et elles sont à la recherche de solutions de rechange : elles puisent dans les ressources de soutien à domicile disponibles, elles s'en remettent au réseau familial et au réseau amical, elles retiennent les services d'aidants et assument les menues dépenses, elles quittent la maison pour élire domicile dans un établissement d'hébergement et de soins, ou elles s'en passent.

Keywords

aginghome carehome supportsocial carenon-profitmanaged competitioncommercializationvieillissementsoins à domicilesoutien à domicilesoins sociauxsans but lucratifconcurrence géréecommercialisation
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 26 , Issue S1: Hidden Costs/Invisible Contributions of Caregiving / Coûts cachés et contributions invisibles des soins , Winter/Hiver 2007 , pp. 63 - 75
Copyright
Copyright © Canadian Association on Gerontology 2007

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Footnotes

*

I collected data for this paper during my doctorate, which was funded by a CHSRF/CIHR Doctoral Research Fellowship. A CHSRF/CIHR Postdoctoral Award Fellowship enabled me the time to complete this manuscript. Over the course of preparing this work I am grateful for helpful comments from Pat Armstrong, Raisa Deber, Rhonda Cockerill, Marcia Rioux, Mark Rosenberg, and James Struthers. All omissions remain my responsibility.

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