A shift in emphasis from institutions to community poses important challenges for providers and policy makers, key among them being the challenge of providing asufficient volume of high quality community-based services to meet consumer needs. This challenge is particularly evident in community-based long-term care (LTC) due to the complexity and diversity of the field, the vulnerability of the population served, and the current wave of demand for services generated by hospital downsizing. The most recent reform of long-term care in Ontario is of particular interest in this context because, as suggested by the provincial government's maxim “highest quality, best price,” it promises cost-efficiency while maintaining or improving quality. To do this it employs a “managed competition” model in which for-profit and not-for-profit providers compete for service contracts under the auspices of local Community Care Access Centres (CCACs) run by volunteer boards. In this paper we draw on the comments of senior government officials and representatives of provider organizations, as well as published documents, to highlight issues and problems posed by the province's latest reform. We argue that, particularly under conditions of capped budgets and increasing demands, the managed competition process may result in the subordination of service quality and consumer choice to pressures for cost-containment.

The purpose of this paper is to explore occupational health issues among employees of home care agencies. Results of a survey of 892 office and visiting employees of three not-for-profit home care agencies and focus group discussions show that employees of home care agencies experience high levels of stress, tiredness and exhaustion. This work-related stress is most acutely felt by those in managerial occupations, nurses and therapists. When compared to findings from the Canadian National Population Health Survey, employees of home care agencies are found to be significantly more likely than all working women to suffer from allergies, asthma, arthritis or rheumatism, back problems, high blood pressure, migraine headaches, and work-related injuries in the past year. Many employees of home care agencies suffer pain or discomfort in several body locations. Visiting employees of home care agencies suffer from sprains or strains, dislocations, fractures, and bruises as a result of lifting or moving clients, bending or straining, accidental falls, repetitive motion injuries, and motor vehicle accidents. Home care office staff suffer from repetitive strain injuries and respiratory illness. Implications for policy and research are discussed.

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.

Spousal caregivers are the most vulnerable of all caregivers to the stresses associated with the caregiving role, yet they are the least likely of all caregivers to utilize formal support services. This low use of services is poorly understood. To develop insight into this issue, this qualitative study explored how spousal caregivers made sense of the personal experience of living with a memory-impaired partner. The goal was to better understand the interface between this personal experience and the use of formal support services. Information was gathered through the use of unstructured interviews with 14 spouses, most of whom had turned down available formal support services. Analysis of their transcripts revealed the availability of four discourses, or story-lines, for framing the experience. These included two competing story-lines which were used to structure individuals' caring activities and two other competing story-lines which provided the framework for judging one's personal competence within the experience. This paper examines these four discourses and highlights how each influences the meaning associated with the use of formal support services. This analysis makes visible the multiple and sometimes contradictory meanings that service use may have for spouses caring for a memory-impaired partner.

This study explored middle-aged, university educated women's views of their own future aging, using a combination of qualitative and quantitative techniques. Seventy-four university graduates, aged 45 to 65, were interviewed about their views of aging and their employment histories. They also completed questionnaires measuring personality, self-efficacy, well-being, depression and social support. Content analysis of interview responses revealed that most women were optimistic about their own old age and expected overall stability in themselves, their financial situation and their relationships, with an improvement in the area of leisure. Positive expectations of stability were associated with satisfaction with oneself and past accomplishments. A typology of accommodation to future aging, derived from the data on women's expectations and preparations, captured four patterns of cognitive, affective and behavioural dynamics. Women with different accommodation types differed primarily on well-being, neuroticism and employment histories.

In the past two decades the Supreme Court of Canada made apparently contradictory rulings on mandatory retirement. In 1982, the Court ruled that mandatory retirement for firefighters at age 60 violated provincial human rights laws; in 1990, it found that forced retirement for university faculty and others at age 65 was constitutional. An analysis of the decisions shows that the Court relied on the stereotype of older workers as being less competent than younger workers, and failed to provide older workers with protection against age-based discrimination. A number of the key mandatory retirement cases deal with university faculty and may yet have unanticipated consequences, such as strengthening the role of academic tenure. The unwillingness of the Supreme Court to eliminate mandatory retirement means that ad hoc arrangements driven by changing life cycles, employer needs, demographic changes and legislative actions will continue to arise.