Jane Aronson

“YOU'RE NOT JUST IN THERE TO DO THE WORK” Depersonalizing Policies and the Exploitation of Home Care Workers' Labor

Community care for frail elderly people rests heavily on the work of low-status, paraprofessional home care workers. Home care workers describe their work as highly personalized caring labor that often seeps out of its formal boundaries into informal, unpaid activities. Although these activities are valued by workers, their supervisors, elderly clients, and family members, they represent uncompensated and exploited labor. Cost-cutting trends in home care management that seek to depersonalize home care labor are likely to increase its exploitative potential for paid care workers and, simultaneously, to disadvantage and jeopardize elderly home care clients and their unpaid family caregivers.

Elderly people's accounts of home care rationing: missing voices in long-term care policy debates.

Fundamental shifts in state intervention in recent years have resulted in steady curtailment in public provision of community and social care. A longitudinal study of elderly women receiving home care in Ontario explored the reverberations of these shifts in the texture of frail elderly peoples lives. Three distinct accounts of negotiating unstable and rationed home care were discernible. Taking charge was an active account of women successfully impressing their particular needs and identities on home care provision. Pushed over the edge was a vulnerable account of insufficient and depersonalised care in which participants felt themselves practically and emotionally out of control. In Restraining expectations, women adjusted silently to the shortcomings of home care, stoically making themselves smaller as they found their previous orbits and identities unsupported. Home cares front line emerged as a complex site of struggle for identity and agency – a struggle in which elderly people engage with inventiveness and determination but also with dwindling support, few witnesses and in mounting isolation.

Exposing failures, unsettling accommodations: tensions in interview practice

This article aims to augment collective understandings of the ethical complexities of qualitative research, and to encourage more attention to the actual practices of interviewing than has usually been paid in discussions in this area. Drawing on interview transcripts, we offer an analysis of the ways vulnerability may be produced for research participants by the intersection of interview factors (an interview strategy, the interviewer’s presence, a line of questioning) with particular discursive and political surrounds. This conceptualization of the conditions of interviewee vulnerability prompts a revisioning of the power that researchers bring to, and exercise in, interviews. In reflecting on interactions with research participants we describe our efforts to use our power wittingly and responsibly.

The Retreat of the State and Long-Term Care Provision: Implications for Frail Elderly People, Unpaid Family Carers and Paid Home Care Workers

Over the last twenty years, public policy and debate about health and social services for elderly people (long-term care/LTC) have stressed the importance of moving from institutionally-based provision to community-based care.

Home care workers discuss their work: The skills required to “use your common sense”

Abstract Home care services, a major component of long-term care policy, depend upon the availability of a labor pool of women hired as paraprofessional home care workers. In this article we argue that home care is a site for competing interpretations of the needs of frail elderly persons and, thus, of the character of home care work. The dominant discourse on, and powerful interests in, health and social policy making construe the work as inexpensive, semi-skilled, practical labor. Critics seeking to revalue caring labor by articulating its complexity challenge this construction. Using in depth interviews with a sample of home care workers, this study probed various aspects of home care work. Two themes critical to revaluing this work are elaborated: (1) the skills required for negotiating the content and organization of the care provided; (2) the ways in which the setting of the work hides the degree of responsibility and decision making in the job. The implications of these findings for womens caring labor, both formal and informal, are considered.

Obscuring the costs of home care: restructuring at work

This study of displaced home care workers reveals how managed competition serves to produce a flexible and atomized work force. Laid off when their nonprofit employer could not compete in the local home care market, workers blamed their employer and their union for their jeopardy. Obscured from local view was the role of government policy in offloading services to the market, benefiting privileged participants in the hospital, professional and market health care sectors. Workers’ indignation at their own and their elderly clients’ unfair treatment dissipated: they had to attend to the practical imperatives in their lives, and were unable to locate a target for their protest. Resolving to be flexible and self-sufficient in the future, they struggled to rework identities as committed carers. The study illuminates how particular organizational and political processes render services more meagre and labour more flexible, and suggests particular possibilities for both accommodating and disrupting those trends.

Market-Modelled Home Care in Ontario: Deteriorating Working Conditions and Dwindling Community Capacity

The closure of a non-profit, unionized home support agency in Hamilton in 2002 offers an illuminating case study of the local impacts of Ontarios contractual approach to home care. A survey of the 317 support workers who were laid off revealed that only 38 percent stayed in the home-care sector; most were absorbed by for-profit, non-unionized agencies where their employment conditions deteriorated. These findings are at odds with the long-established connection between quality of home-care employment and quality of home-care service. They have implications for developing criteria for dispersing public funds in mixed economies of community care, and for conceptualizing the capacity-building responsibilities of governments in their coordination.

Giving Consumers a Say in Policy Development: Influencing Policy or Just Being Heard?*

This paper focuses on the trend to involve consumers in public policy-making and implementation. The development of long-term care policies for elderly people in Ontario is examined as an illustrative case to explore the purposes and accomplishments of such initiatives. Building upon analysis of policy documents, observation of a community consultation process and debates in the literature on consumer participation and on the politics of needs interpretation, it is suggested that government-initiated participatory strategies elicit only particular kinds of information from consumers and do not live up to their democratizing promise.

Wife Assault in Old Age: Coming out of Obscurity

A review of gerontological literature on elder abuse and feminist literature on wife assault points to the conceptual and practice divisions that have separated attention to age and gender and, thus, obscured older womens experiences of abuse by their male partners. The first person account of a woman who left her abusive husband in her 70s and the supporting observations of a group of concerned service providers are introduced to bridge these conceptual divisions and to call attention to the social processes that hide and perpetuate wife assault in old age. With a view to developing methodologies and practices that make visible and challenge the conditions that sustain abuse of older women, directions for future approaches to research and service are considered.

'You need them to know your ways': service users' views about valued dimensions of home care.

ABSTRACT Dominant approaches to evaluating supportive home care tend to be ‘top-down,’ undertaken from the vantage points of funding bodies and professionals, rather than from the perspectives of service users. A longitudinal, qualitative study of women receiving home care in Ontario, Canada explored their accounts of what constitutes good and responsive care. Participants identified four dimensions of care that they particularly valued: Minimized exposure, being known, staying in charge, and being able to speak. The implications of their perspectives for home care practice, evaluation and organization are discussed.