Oscar E. Firbank

Older Persons Relocating With a Family Caregiver: Processes, Stages, and Motives

In North America, a significant number of families who care for an elderly relative relocate in the same residence. However, research has paid little attention to the process that precedes such relocation. This article aims at studying this process by examining the experiences of a sample of Canadian elderly and their caregivers, born in Quebec and in Haiti. The article highlights that in spite of diversity, moving in together usually occurs in stages and follows a relatively lengthy process in which transitory living arrangements are not uncommon. In addition, a range of events, hospital stays in particular, act as markers between stages or shorten their duration. It appears that cohabitation trajectories differ according to origin and generational group. Noteworthy is that home-care services did not greatly influence the cohabitation decision of respondents from either group. Most respondents claim that the decision to relocate together was consensual but motivated by a variety of reasons.

Connecting the voices of users, caregivers and providers on service quality: A study of home‐care services

PURPOSE This article aims to discuss the relevancy of different instruments used to gather information on homecare service quality from multiple stakeholders and the challenges encountered when trying to blend their views for prioritizing areas needing improvement. DESIGN/METHODOLOGY/APPROACH The study centers on four homecare agencies: one public, one private for-profit and two not-for-profit services, implementing continuous quality improvement (CQI) programs. Various instruments were tested with random and convenience elderly service user, family caregiver and front-line worker samples. Instrument evaluation included operational effectiveness and agency manageability. FINDINGS A qualitative approach, centered on small stakeholder samples, is fairly effective at assessing service quality, yet demands a strong commitment from agencies in personnel time and resources, as well as the necessary skills. Small-size, private homecare providers seem less-well equipped to handle comprehensive assessments without external support More importantly, assessments have to be done strategically, such that timing and work needed does not undermine program viability. PRACTICAL IMPLICATIONS The approach and instruments tested have practical implications for decision makers and homecare organization managers interested in CQI. ORIGINALITY/VALUE The article systematically evaluates quality assessment and priority-setting instruments applied to various stakeholders and homecare settings.

Unpacking the Meaning of Quality in Quebec’s Health-care System: The Input of Commissions of Inquiry

The paper explores how several commissions of inquiry established in Quebec, Canada, have, over time, contributed in redefining the meaning of quality in health-care and its management. Adopting an interpretive analysis of commissions’ reports, the paper examines the particular ‘conceptual boxes’ used by their members to tackle quality and the embedded nature of their work. It is shown that although quality was always considered, this was generally done by bringing into focus specific quality domains and issues, some new, others not so new. In addition, the various management approaches to quality featured in the reports were informed by evolving templates; although this evolution was not as straight and unwavering as some retrospective studies of quality in health-care seem to indicate. A common thread to all commissions is the fact that, beyond the definition of general principles, responsibility for quality oversight was not clearly assigned and criteria on whether quality initiatives should be voluntary or compulsory were often left unspecified. Further, quality was never regarded by the commissions as a strategic aspect of health-care. It is speculated that these failings on the part of commissions may partly explain the unassertive course of action taken by the provincial government in the area.