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Reconciling Tensions: Needing Formal and Family/Friend Care but Feeling like a Burden

Published online by Cambridge University Press:  05 January 2017

Rachel Barken*
Department of Sociology, York University
La correspondance et les demandes de tire-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Rachel Barken, Ph.D. SSHRC Postdoctoral Fellow Department of Sociology, York University 359A York Lanes, 4700 Keele St. Toronto, ON M3J 1P3 (


Within a neoliberal policy context that shifts responsibility for health and well-being from the state to families and individuals, Canadian home care strategies tend to present family members as “partners in care”. Drawing on an interpretive grounded theory study that involved 34 qualitative interviews, this article examines older people’s experiences at the intersections of formal home care and family/friend care arrangements, against the backdrop of policies that emphasize partnerships with family. The core concept derived from the interviews was reconciling tensions between care needs and concerns about burdening others, in the context of available home and community care. Four processes are identified, which illustrate how access to financial and social resources may lead to opportunities and constraints in experiences of care. Findings underscore the emotional and practical challenges that older people may encounter vis-à-vis policy discourses that encourage family responsibility for care. Implications for policy and practice are discussed.


Dans le cadre d’une politique néolibérale qui transfère la responsabilité pour la santé et le bien-être de l’État aux familles et aux individus, les stratégies canadiennes pour soins à domicile ont tendance à présenter les membres de la famille comme « partners in care ». En s’appuyant sur une étude interprétative fondée sur une théorie qui comprenait 34 entrevues qualitatives, cet article examine les expériences des personnes âgées aux intersections des soins à domicile formels et arrangements pour les soins dispensés par la famille et les amis, dans le contexte de politiques mettant l’accent sur les partenariats avec les familles. Le concept fondamental tiré des entrevues était de concilier les tensions entre le besoin de soins et le souci de surcharger les autres, dans le contexte des soins à domicile et communautaires disponibles. Quatre processus sont identifiés, qui illustrent la façon dont l’accès aux ressources financières et sociales peut conduire à des opportunités et des contraintes dans l’expérience de soins. Les résultats mettent en évidence les défis émotionnels et pratiques que les personnes âgées peuvent rencontrer vis-à-vis le discours encourageant les familles à assumer la responsabilité des soins. Les implications pour la politique et la pratique sont discutées.

Copyright © Canadian Association on Gerontology 2017 

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* I thank Margaret Denton, Amanda Grenier, and Lori Campbell for their support with this research. I am indebted to the participants who took part in interviews as well as the various agencies and individuals who assisted with recruitment. This research was supported by a Bombardier Canada Graduate Scholarship from the Social Sciences and Humanities Research Council (award # 767-2012-2017), as well as an Award for Home Care Research from Saint Elizabeth Health Care.


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