Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-01T20:09:11.809Z Has data issue: false hasContentIssue false
  • English
  • Français

Do Assessment Tools Shape Policy Preferences? Analysing Policy Framing Effects on Older Adults’ Conceptualisation of Autonomy

Published online by Cambridge University Press:  25 January 2021

DANIEL DICKSON Open the ORCID record for DANIEL DICKSON [Opens in a new window] ,
PATRIK MARIER Open the ORCID record for PATRIK MARIER [Opens in a new window]  and
ANNE-SOPHIE DUBÉ
DANIEL DICKSON
Affiliation:
Department of Political Science, Concordia University, 1455 Blvd. de Maisonneuve West Montreal, Quebec, CanadaH3G 1M8 email: daniel.dickson@mail.concordia.ca
PATRIK MARIER
Affiliation:
Department of Political Science, Concordia University, 1455 Blvd. de Maisonneuve West Montreal, Quebec, CanadaH3G 1M8 email: daniel.dickson@mail.concordia.ca
ANNE-SOPHIE DUBÉ
Affiliation:
Centre de recherche et d’expertise en gérontologie sociale, 5800 Cavendish Blvd, Côte Saint-Luc, Quebec, CanadaH4W 2T5
Get access Rights & Permissions [Opens in a new window]

Abstract

The concept of autonomy is essential in the practice and study of gerontology and in long-term care policies. For older adults with expanding care needs, scores from tightly specified assessment instruments, which aim to measure the autonomy of service users, usually determine access to social services. These instruments emphasise functional independence in the performance of activities of daily living. In an effort to broaden the understanding of autonomy into needs assessment practice, the province of Québec (Canada) added social and relational elements into the assessment tool. In the wake of these changes, this article studies the interaction between the use of assessment instruments and the extent to which they alter how older adults define their autonomy as service users. This matters since the conceptualisation of autonomy shapes the formulation of long-term care policy problems, influencing both the demand and supply of services and the types of services that ought to be prioritised by governments. Relying on focus groups, this study shows that the functional autonomy frame dominates problem definitions, while social/relational framings are marginal. This reflects the more authoritative weight of functional autonomy within the assessment tool and contributes to the biomedicalisation of aging.

Keywords

Policy FramingSocial ServicesAging PolicyAutonomyNeeds AssessmentBiomedicalisation of Aging
Type
Article
Information
Journal of Social Policy , Volume 51 , Issue 1 , January 2022 , pp. 114 - 131
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agich, G. (2003), Dependence and Autonomy in Old Age: An Ethical Framework for Long-Term Care, New York: Cambridge University Press.CrossRefGoogle Scholar
Anttonen, A. (2002), ‘Universalism and social policy: a Nordic-feminist revaluation’, NORA: Nordic Journal of Women’s Studies, 10, 2, 71–80.Google Scholar
Bacchi, C.L. (1999), Women, Policy and Politics: The Construction of Policy Problems, London: Sage.Google Scholar
Bernabei, R., Landi, F., Onder, G., Liperoti, R. and Gambassi, G. (2008), ‘Second and Third Generation Assessment Instruments: The Birth of Standardization in Geriatric Care’, Journal of Gerontology - Series A Biological Sciences and Medical Sciences, 63, 3, 308–313.CrossRefGoogle ScholarPubMed
Bharucha, A.J., Pandav, R., Shen, C., Dodge, H.H. and Ganguli, M. (2004), ‘Predictors of Nursing Facility Admission: A 12-Year Epidemiological Study in the United States’, Journal of the American Geriatrics Society, 52, 3, 434–39.CrossRefGoogle ScholarPubMed
Bosso, C.J. (1994), ‘The contextual bases of problem definition.’ in Rochefort, D.A. and Cobb, R.W. (eds), The Politics of Problem Definition, Lawrence: University Press of Kansas. 182–203.Google Scholar
Boudiny, K. (2013), “Active ageing’: from empty rhetoric to effective policy tool’, Ageing & Society, 33, 6, 1077–1098.CrossRefGoogle Scholar
Bowling, A. (2007), ‘Aspirations for Older Age in the 21st Century: What is Successful Aging?’, The International Journal of Aging and Human Development, 64, 3, 263–297.CrossRefGoogle ScholarPubMed
Carpenter, I. and Hirdes, J.P. (2013), ‘Using interRAI assessment systems to measure and maintain quality of long-term care’ in OECD/ European Commission (ed.), A Good Life in Old Age? Monitoring and Improving Quality in Long-Term Care, Paris: OECD Publishing. 93–139 Google Scholar
Chappell, N. L. and Hollander, M. J. (2013), Aging in Canada, Toronto: Oxford University Press.Google Scholar
Collopy, B.J. (1988), ‘Autonomy in Long Term Care: Some Crucial Distinctions’, The Gerontologist, 28, (Suppl), 10–17.CrossRefGoogle ScholarPubMed
Dekker, R. (2017), ‘Frame ambiguity in policy controversies: critical frame analysis of migrant integration policies in Antwerp and Rotterdam’, Critical Policy Studies, 11, 2, 127–145.CrossRefGoogle Scholar
Delli-Colli, N., Dubuc, N., Hébert, R., Lestage, C. and Dubois, M-F. (2013), ‘Identifying Psychosocial Variables for Home Care Services and How to Measure Them’, Home Health Care Services Quarterly, 32, 4, 197–217.Google Scholar
Dobson, R. (2015), ‘Power, agency, relationality and welfare practice’, Journal of Social Policy, 44, 4, 687–705.CrossRefGoogle Scholar
Estes, C.L. and Binney, E.A. (1989), ‘The Biomedicalization of Aging: Dangers and Dilemmas’, The Gerontologist, 29, 5, 587–596.CrossRefGoogle ScholarPubMed
Gilbert, N., Leibing, A. and Marier, P. (2018), ‘Mythe d’un soutien à domicile adéquatement assure par l’État aux personnes âgées en perte d’autonomie: quelles attentes peut-on juger réalistes?’, in Billette, V., Marier, P. and Séguin, A.M. (eds.), Le vieillissement sous la loupe: Mythes et réalités, Québec: Presses de l’Université Laval. 249–256.Google Scholar
Grootegoed, E. and Van Dijk, D. (2012), ‘The return of the family? Welfare state retrenchment and client autonomy in long-term care’, Journal of Social policy, 41, 4, 677–694.CrossRefGoogle Scholar
Guberman, N., Lavoie, J-P., Blein, L. and Olazabal, I. (2012), ‘Baby Boom Caregivers: Care in the Age of Individualization’, The Gerontologist, 52, 2, 210–218.CrossRefGoogle ScholarPubMed
Ho, A. (2008), ‘Relational Autonomy or Undue Pressure? Family’s Role in Medical Decision-Making’, Scandinavian Journal of Caring Sciences, 22, 1, 128–135.CrossRefGoogle ScholarPubMed
Hwang, H-L., Lin, H-S., Tung, Y-L. and Wu, H-C. (2006), ‘Correlates of perceived autonomy among elders in a senior citizen home: a cross-sectional survey’. International Journal Nursing Studies, 43, 4, 429–37.CrossRefGoogle Scholar
Katz, S., Ford, A.B., Moskowitz, R.W., Jackson, B.A. and Jaffe, M.W. (1963), ‘Studies of Illness in the Aged: The Index of ADL: A Standardized Measure of Biological and Psychosocial Function’, Journal of the American Medical Association, 185, 12, 914–919.CrossRefGoogle ScholarPubMed
Lawton, M.P. and Brody, E.M. (1969), ‘Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living’, The Gerontologist, 9 3, Part 1, 179–186.CrossRefGoogle ScholarPubMed
Le Bihan, B. and Martin, C. (2006), ‘A comparative case study of care systems for frail elderly people: Germany, Spain, France, Italy, United Kingdom and Sweden’, Social Policy & Administration, 40, 1, 26–46.CrossRefGoogle Scholar
Litosseliti, L. (2003), Using Focus Groups in Research, New York: Continuum.Google Scholar
Mackenzie, C. and Stoljar, N. (2000), ‘Introduction: Autonomy Reconfigured’, in Mackenzie, C. and Stoljar, N. (eds.), Relational autonomy: Feminist perspectives on autonomy, agency, and the social self, Oxford University Press. 3–32.Google Scholar
Marier, P., Dickson, D. and Dubé, A. S. (2020), ‘Using focus groups in comparative policy analysis’, in Peters, B. G. and Fontaine, G. (eds), Handbook of Research Methods and Applications in Comparative Policy Analysis, Edward Elgar Publishing.Google Scholar
Marier, P., Carrière, Y. and Purenne, J. (2018), ‘Riche comme Crésus? Le mythe des aînés riches’, in Billette, V., Marier, P. and Séguin, A.M. (eds), Le vieillissement sous la loupe: Mythes et réalités, Québec: University of Laval Press. 25–34.Google Scholar
Morgan, L. A. and Brazda, M. A. (2013), ‘Transferring Control to Others Process and Meaning for Older Adults in Assisted Living’, Journal of Applied Gerontology, 32, 6, 651–668.CrossRefGoogle ScholarPubMed
Morgan, D. L. (1996), ‘Focus groups’, Annual Review of Sociology, 22, 1, 129–152.CrossRefGoogle Scholar
Parsons, M., Senior, H., Chen, Mei-Hu, X., Jacobs, S., Parsons, J., Sheridan, N. and Kenealy, T. (2013), ‘Assessment without action; a randomised evaluation of the interRAI home care compared to a national assessment tool on identification of needs and service provision for older people in New Zealand’, Health & social care in the community, 21, 5, 536-544.CrossRefGoogle Scholar
Perkins, M. M., Ball, M. M., Whittington, F. J. and Hollingsworth, C. (2012), ‘Relational Autonomy in Assisted Living: A Focus on Diverse Care Settings for Older Adults’, Journal of Aging Studies, 26, 2, 214–225.CrossRefGoogle ScholarPubMed
Peters, G.B. (2005), ‘The Problem of Policy Problems’, Journal of Comparative Policy Analysis, 7, 4, 349–370.Google Scholar
Pinsonnault, E., Dubuc, N., Desrosiers, J., Delli-Colli, N. and Hébert, R. (2009), ‘Validation Study of a Social Functioning Scale: The social-SMAF (social-Functional Autonomy Measurement System)’, Archives of Gerontology and Geriatrics, 48, 1, 40–44.CrossRefGoogle Scholar
Pullman, D. (1999), ‘The Ethics of Autonomy and Dignity in Long-Term Care’, Canadian Journal on Aging, 18, 1, 26–46.Google ScholarPubMed
Rein, M. (2006), ‘Reframing problematic policies’, in Goodin, R.E., Moran, M. and Rein, M. (eds.), The Oxford Handbook of Public Policy, Oxford University Press. 389–405 Google Scholar
Rein, M. and Schön, D. (1993), ‘Reframing policy discourse’, in Fischer, F. and Forester, J. (eds), The Argumentative Turn in Policy Analysis and Planning, Durham: Duke University Press. 145-166Google Scholar
Simon-Rusinowitz, L. and Hofland, B.F. (1993), ‘Adopting a disability approach to home care services for older adults’, The Gerontologist, 33, 2, 159–167.CrossRefGoogle ScholarPubMed
Söderberg, M., Ståhl, A. and Emilsson, U.M. (2013), ‘Independence as a stigmatizing value for older people considering relocation to a residential home’, European Journal of Social Work, 16, 3, 391–406.CrossRefGoogle Scholar
Stone, D.A. (1997), Policy Paradox: The Art of Political Decision Making, New York: Norton.Google Scholar
Van Hulst, M. and Yanow, D. (2016), ‘From policy “frames” to “framing” theorizing a more dynamic, political approach’, The American Review of Public Administration, 46, 1, 92–112.CrossRefGoogle Scholar
Walker, A. and Maltby, T. (2012), ‘Active ageing: A strategic policy solution to demographic ageing in the European Union’, International Journal of Social Welfare, 21: S117–S130.CrossRefGoogle Scholar
Wood, B.D. and Vedlitz, A. (2007), ‘Issue Definition, Information Processing, and the Politics of Global Warming’, American Journal of Political Science, 51, 3, 552–568.CrossRefGoogle Scholar