Sheila M. Neysmith

“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.

Women's caring : feminist perspectives on social welfare

Preface ONE: PERSPECTIVES ON CARING 1. Womens Caring: Work Expanding, State Contracting 2. Womens Professions and an Ethic of Care 3. Gender, Poverty, and Womens Caring 4. Caring and Women of Colour: Living the Intersecting Oppressions of Race, Class, and Gender TWO: LIVING THE REALITIES OF CARE 5. Still Girls Learn to Care: Girls Policed to Care 6. Dutiful Daughters and Undemanding Mothers: Constraining Images of Giving and Receiving Care in Middle and Later Life 7. Caught in Tangled Webs of Care: Women Abused in Intimate Relationships 8. Contradictions in Child Welfare: Neglect and Responsibility THREE: POLICY DIRECTIONS AND CARING EXPECTATIONS 9. The Child-Care Debate: Fading Hopes and Shifting Sands 10. Enter the Filipina Nanny: An Examination of Canadas Live-In Caregiver Policy 11. From Home Care to Social Care: The Value of a Vision Index

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.

Revealing the shape of knowledge using an intersectionality lens: results of a scoping review on the health and health care of ethnocultural minority older adults

ABSTRACT This paper uses an intersectionality theoretical lens to interrogate selected findings of a scoping review of published and grey literature on the health and health-care access of ethnocultural minority older adults. Our focus was on Canada and countries with similar immigrant populations and health-care systems. Approximately 3,300 source documents were reviewed covering the period 1980–2010: 816 met the eligibility criteria; 183 were Canadian. Summarised findings were presented to groups of older adults and care providers for critical review and discussion. Here we discuss the extent to which the literature accounts for the complexity of categories such as culture and ethnicity, recognises the compounding effects of multiple intersections of inequity that include social determinants of health as well as the specificities of immigration, and places the experience of those inequities within the context of systemic oppression. We found that Canadas two largest immigrant groups – Chinese and South Asians – had the highest representation in Canadian literature but, even for these groups, many topics remain unexplored and the heterogeneity within them is inadequately captured. Some qualitative literature, particularly in the health promotion and cultural competency domains, essentialises culture at the expense of other determinants and barriers, whereas the quantitative literature suffers from oversimplification of variables and their effects often due to the absence of proportionally representative data that captures the complexity of experience in minority groups.

Feminist Methodologies: A Consideration of Principles and Practice for Research in Gerontology

Feminist methodologies address the purpose and process of the research enterprise. They are not a particular set of techniques or procedures for gathering data. Rather they stem from the realization that it was the experiences of a very particular group of men, as both subject and object of enquiry, that defined social reality and the theories developed to explain our social worlds. This paper discusses some of the principles and approaches used by feminist researchers to explore the realities of womens lives. The authors research on home care workers, along with selected research in the field of aging, are used to illustrate the analysis and explore the implications of feminist methodologies for our understanding of aging in Canadian society.

Economic Dependency in the 1980s: Its impact on Third World Elderly

The purpose of this paper is to explore an alternative perspective for understanding individual and societal ageing within the context of global economic and social relations. The dependent status of Third World nations as a result of the process of capital accumulation is examined. It is argued that the manner in which Third World nations respond to the human needs of their old is subject to the relationship that entwines Third World and capitalist industralised nations. Moreover, it is argued that social policy and human service models are nurtured by the ideology underlying these economic relations. The assumptions behind two policy areas are examined. When diffused to Third World nations such social policies function to maintain national elites at the expense of the majority. In conclusion, questions are raised about the relevance of western models of ageing to the needs of old people in the Third World.

Understanding how globalisation and restructuring affect women’s lives: implications for comparative policy analysis

Globalisation and neo–liberal restructuring have transformed social policy and social services in many countries over the past two decades. Among the various impacts on different societies, one commonality is that many of the costs of restructuring are being picked up by women. In the last decade, feminist scholars have developed a critique of the effects of restructuring on the public and private lives of women, effects which are conspicuously absent from many discussions of restructuring. This article presents several conceptual ingredients for a framework that can facilitate a comparative understanding of restructuring and its effects on women at both global and local levels. Canada and China are used to illustrate the utility of such an approach to comparative policy analysis. The article contributes to a growing body of feminist literature on changing regimes of citizenship. It adds to the scholarship on comparative policy analysis by developing a research approach that is grounded in the experiences of women and is attentive to global and local politics. We argue that understanding just how restructuring affects different groups of women is essential for developing analyses that can cross national boundaries and challenge policies that reproduce conditions that oppress women.

Balancing Formal and Informal Care for Older Persons: How Case Managers Respond

Cette étude a examiné la façon dont les gestionnaires de cas de soins à domicile et en milieu communautaire dans la première ligne de la profession voir le rôle des aidants naturels et les facteurs qui contribuent aux décisions de ces gestionnaires en ce qui concerne l’allocation des ressources. La recherche pour l’étude a utilisé deux méthodes de collecte de données: (a) l’analyse secondaire des résultats de simulations de la balance de soins, réalisées dans neuf régions de l’Ontario, et (b) des entretiens en profondeur de suivi avec les différents gestionnaires de la B de S. Les résultats indiquent que les gestionnaires de cas sont d’accord à l’unanimité que l’unité des soins dans le secteur SDMC ne se limite pas à l’individu, tel qu’en soins aigus, mais englobe à la fois l’individu et le soignant. Nous avons constaté, cependant, des variations considérables dans l’assortiment et le volume des services SDMC recommandés par les gestionnaires de cas. Nous concluons que la variabilité de la prise de décision peut refléter la manque de réglementation, de meilleures pratiques, et de lignes directrices pour la responsabilité dans le secteur SDMC.This study examined how front-line home and community-care (H&CC) case managers view the role of informal caregivers, and the factors that contribute to H&CC managers’ resource allocation decisions. The study research used two methods of data collection: (a) secondary analysis of the results from balance of care (BoC) simulations conducted in nine regions of Ontario, and (b) in-depth follow-up interviews with participating BoC case managers. Results suggest that case managers unanimously agree that the unit of care in the H&CC sector is not confined to the individual, as in acute care, but encompasses both the individual and the caregiver. We found, however, considerable variation in the mix and volume of H&CC services recommended by case managers. We conclude that variability in decision making may reflect the lack of regulations, best practices, and accountability guidelines in the H&CC sector.