Canada’s Complex and Fractionalized Home Care Context: Perspectives of Workers, Elderly Clients, Family Carers, and Home Care Managers
Mots-clés :
home care, home support, policy, stakeholder perspectivesRésumé
In Canada, home care provides health and social services to an estimated one million people, most of them older adults. In the absence of national policy directives, services vary considerably from one jurisdiction to the next, in what has been called a “checkerboard” of policy and practice. This paper examines policy-relevant issues in the provision of home care services, focusing specifically on “home support” services delivered by unregulated workers. We examine findings from our six-year program of research, and highlight three policy issues that emerged from our study of workers, older clients, family carers, and managers. These are: scope of services, scheduling of services, and the presumption of availability of family/friend carers. For each issue, we give examples of policy or practice initiatives being undertaken and current challenges. We then examine these issues in relation to guiding principles for services, as identified by the Canadian Home Care Association. Au Canada, des services de santé et des services sociaux à domicile sont fournis à environ un million de personnes, pour la plupart des personnes âgées. En l'absence de directives politiques nationales, les services varient considérablement d'un territoire à l'autre, dans ce qui a été appelé une « mosaïque » de politiques et de pratiques. Ce document examine les questions liées aux orientations politiques en matière de prestation de services de soins à domicile, et plus particulièrement les services de « soutien à domicile » proposés par des travailleurs non réglementés. Nous analysons les conclusions de notre programme de recherche mené à bien sur six années, et mettons en avant trois problèmes de politique qui ont émergé de notre étude sur les travailleurs, les clients âgés, les aidants familiaux et les gestionnaires. Ces trois problèmes sont : la portée des services, les horaires des services et la disponibilité présumée des aidants familiaux ou amicaux. Pour chaque point, nous présentons des exemples d'initiatives entreprises en matière d'orientation politique ou de pratiques, ainsi que les défis rencontrés. Nous considérons ensuite ces questions à la lumière des principes directeurs de ces services, identifiés par l'Association canadienne de soins et services à domicile.
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