Abstract

Home Care in Ontario in the 21st century: Medicalized? Retrenched?

Denise O'Connor

In the national policy discourse, home care is being broadly proclaimed as a key component of our health care system. However, both the idea of what constitutes the set of services referred to as home care and the group of citizens for whom these services are designed have changed dramatically over the last seven years in Ontario. The traditional notion of home care services, that is a set of services designed to enable the frail elderly or chronically disabled to avoid or delay institutionalization in support of their choice to live with dignity and independence in their own homes is being replaced by an idea of home care that presents it as an extension of the acute care medical system. Home care is now presented as a set of services that, when available, enable hospitals to discharge their patients "quicker and sicker". This erosion of the traditional idea of home care has been accompanied by a shift in the boundary between what is a public and what is a private responsibility. With extended families called upon to do more themselves or pay others to do it, home care is now a service of last resort. This paper will explain this phenomenon through an examination of politics, policy discourse and power resources.

Bio

Denise O'Connor is a Doctoral Candidate (Comparative Public Policy) at McMaster University doing a comparative study of home care in Ontario and England. She is particularly interested in the governance of the relationships among the organizational actors charged with developing and implementing health and social services policy. She examines the power relations among the actors and the linkage between the policy ideas and frames at the central government level and how these play out at the local level, including the agencies contracted to delivery these services. She pays particular attention to the political economy that underpins these systems. She has "on the ground experience" in home care, having served on the Board of Directors of Hamilton’s largest not-for-profit home care agency for six years, until it closed in August 2002.

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