Tamara Daly

Liminality in Ontario’s long-term care facilities: Private companions’ care work in the space ‘betwixt and between’

Nursing, personal care, food and cleaning are publicly funded in Ontario’s long-term care facilities, but under-staffing usually renders all but the most basic of personal preferences superfluous. This individualization of responsibility for more personalized care has resulted in more families providing more care and opting to hire private, private companion care. With direct payment of companions becoming a growing but largely invisible facet of care, exploring companion’s roles is important. Using a six site rapid ethnographic study in long-term care facilities (i.e. observations, documents and key informant interviews (n = 167)), this paper argues that private companions occupy a liminal space between policy, family and market, and their role within institutions and in private homes may be the missing link in the care work chain in the sense that it can at once be classified as formal and informal and draws on their own and others paid and unpaid labour.

Dancing The Two-Step in Ontario’s Long-Term Care Sector: Deterrence Regulation = Consolidation

Abstract This paper explores shifts in public and private care delivery over time through an analysis of Ontario’s approach to long-term care funding and regulation in relation to other jurisdictions in Canada and abroad. The case of the evolution of Ontario’s long-term care policy—from the 1940s until early 2013—shows how moving from compliance-to deterrence-oriented regulation can support the consolidation of commercial providers’ ownership and increase the likelihood of nonprofit and public providers outsourcing their management.

Non–Symptom-Related Factors Contributing to Delay in Seeking Medical Care by Patients With Heart Failure: A Narrative Review

BACKGROUND Delay in seeking timely medical care by patients with acute coronary syndrome and stroke has been well established in the literature, but less is known about delay in care-seeking behavior by patients with heart failure (HF). The purpose of this narrative review was to synthesize the literature regarding non-symptom-related factors that contribute to delay in seeking medical care for HF symptoms. METHODS AND RESULTS A literature search of Scopus, Medline, and Pubmed was conducted for published articles from database inception to July 2009. Available evidence has shown that non-symptom-related factors, such as HF severity, HF history, age, and ethnocultural background, were related to delay in certain studies; however, null results have also been reported. Other non-symptom-related factors, such as male gender, initial contact with a primary care physician, arriving in the emergency department by means other than ambulance, and patient responses such as self-care, low anxiety, and hopelessness, may play a role in longer delay. CONCLUSIONS Although this review identified several non-symptom-related factors that may be implicated in care-seeking delay, health care professionals should be vigilant in identifying all high-risk individuals and educating them about warning signs of HF. Moreover, access to outpatient chronic disease management programs that may have potential to reduce care-seeking delay behavior should be explored.

Liminal and invisible long-term care labour: Precarity in the face of austerity

Using feminist political economy, this article argues that companions hired privately by families to care for residents in publicly funded long-term care facilities (nursing homes) are a liminal and invisible labour force. A care gap, created by public sector austerity, has resulted in insufficient staff to meet residents’ health and social care needs. Families pay to fill this care gap in public funding with companion care, which limits demands on the state to collectively bear the costs of care for older adults. We assess companions’ work in light of Vosko’s (2015) and Rodgers and Rodgers’ (1989) dimensions for precariousness. We discuss how to classify paid care work that overlaps with paid formal and unpaid informal care. Our findings illuminate how companions’ labour is simultaneously autonomous and precarious; it fills a care gap and creates one, and can be relational compared with staffs’ task-oriented work.

Resisting Regulatory Rigidities: Lessons From Front-Line Care Work

Abstract In order to advance an argument addressing whether or not ethical and empowering care work is possible within the context of neoliberalism and managerialism, this article draws on international comparative, qualitative case-study data to ask whether processes and practices of radical care and emancipation already exist in nonprofit long-term care and social service work. If so, what do they look like, and what factors hinder or nurture social justice-based care practices? Given that paid and unpaid care continues to be a highly gendered and increasingly racialized realm of feminized struggle, it warrants further theorization and greater centrality within emancipatory projects and strategies.

Scarcity discourses and their impacts on renal care policy, practices, and everyday experiences in rural British Columbia

Drawing from a qualitative case study in rural British Columbia, Canada, this paper examines the discourse of kidney scarcity and its impact on renal care policies and practices. Our findings suggest that at different levels of care, there are different discourses and treatment foci. We have identified three distinct scarcity discourses at work. At the macro policy level, the scarcity of transplantable kidneys is the dominant discourse. At the meso health care institution level, we witnessed a discourse regarding the scarcity of health care and human resources. At the micro community level, there was a discourse of the scarcity of health and life-sustaining resources. For each form of scarcity, particular responses are encouraged. At the macro level, renal care and transplant organizations emphasize the benefits of kidney transplantation and procuring more donors. At the meso level, participants from the regional health care system increasingly encourage home hemodialysis and patient-led care. At the micro level, community health care professionals push for rural renal patients to attend dialysis and maintain their care plans. This work contributes to critical, interdisciplinary organ transfer discourse by contextualizing kidney scarcity. It reveals the tension between these discourses and the implications of pursuing kidney donations without addressing the conditions in which individuals experience kidney failure.

Volunteers’ Experiences Delivering a Community-University Chronic Disease Health Awareness Program for South Asian Older Adults

Volunteers and voluntary organizations can connect preventative health care programs to communities and may play an important role in addressing the health needs of older adults. Despite this, tensions may exist in the structures that drive volunteers and voluntary organizations representing immigrant communities to provide unpaid labour to augment and supplement health care services. Furthermore, organizational challenges may exist for community agencies relying on volunteers to sustain a health screening and education program. The intervention program was led by one voluntary agency specifically for South Asian communities in partnership with the university and five local organizations. This paper draws on volunteer surveys (n = 22) and key informant interviews (n = 12) to detail volunteer experiences providing this intervention. Volunteers were university students and other community volunteers. A total of 810 adults participated in the intervention within the Greater Toronto Area, Ontario, Canada between October 2014 and June 2016. We found that volunteers often used their experience as a ‘stepping stone’ position to other education or work. They also gained from the knowledge and used it to educate themselves and their family members and friends. This paper provides a critical reflection on the role of volunteers in a preventative and educational healthcare intervention program for older adults from the South Asian community. Tensions exist when relying on volunteer labour for the implementation of preventative community health care programming and must be explored to ensure program sustainability as well as equity within the health care system.

Prescriptive or Interpretive Regulation at the Frontlines of Care Work in the “Three Worlds” of Canada, Germany and Norway

This paper examines the tension between macro level regulation and the rule breaking and rule following that happens at the workplace level. Using a comparative study of Canada, Norway, and Germany, the paper documents how long-term residential care work is regulated and organized differently depending on country, regional, and organizational contexts. We ask where each jurisdiction’s staffing regulations fall on a prescription-interpretation continuum; we define prescription as a regulatory tendency to identify what to do and when and how to do it, and interpretation as a tendency to delineate what to do but not when and how to do it. In examining frontline care workers’ strategies for accomplishing everyday social, health, and dining care tasks we explore how a policy-level prescriptive or interpretive regulatory approach affects the potential for promising practices to emerge on the frontlines of care work. Overall, we note the following associations: prescriptive regulatory environments tend to be accompanied by a lower ratio of professional to non-professional staff, a higher concentration of for-profit providers, a lower ratio of staff to residents and a sharper division of labour. Interpretive regulatory environments tend to have higher numbers of professionals relative to non-professionals, more limited for-profit provision, a higher ratio of staff to residents, and a more relational division of labour that enables the work to be more fluid and responsive. The implication of a prescriptive environment, such as is found in Ontario, Canada, is that frontline care workers possess less autonomy to be creative in meeting residents’ needs, a tendency towards more task-oriented care and less job autonomy. The paper reveals that what matters is the type of regulation as well as the regulatory tendency towards controlling frontline care workers decision-making and decision-latitude.

Underpaid, unpaid, unseen, unheard and unhappy? Care work in the context of constraint:

Care work – in its paid and unpaid forms – spans the private, public and non-profit sectors in addition to being an essential underpinning of home and community life (Duffy et al., 2015). Due to its close association with gendered expectations of elastic, uncomplaining work undertaken by women across the continuum of home, community and residential places, care work continues to be undervalued in numerous ways (Baines, 2004; England, 2005; Folbre, 2008). Indeed, care workers often work in conditions in which they are underpaid, unpaid, unseen, unheard and unhappy (Daly and Szebehely, 2012; Palmer and Eveline, 2012). These conditions are related to government austerity models; how care work is regulated within employment relations; state, market and private roles providing and funding care; and how care work organisation is shifting in the context of austerity strategies, policies of constraint, continued high demand, decreased union density and increasing standardisation. These conditions and the women who work within them and around them are the focus of this Special Issue: Care Work in the Context of Constraint. The Special Issue draws together international researchers and scholars in a close investigation of the complexity of care work in the era of austerity policies. Government bodies that fund care work have been under increasing pressure to cut costs, expand accountability and contribute to austerity agendas (Brennan et al., 2012; Cunningham et al., 2014; Grimshaw and Rubery, 2012). This impacts

“Leisurely Dining”: Exploring How Work Organization, Informal Care, and Dining Spaces Shape Residents’ Experiences of Eating in Long-Term Residential Care:

Mealtimes are among the busiest times in nursing homes. Austerity measures resulting in insufficient staff with heavy workloads limit the amount of time available to assist residents with eating. Within a feminist political economy framework, rapid team-based ethnography was used for an international study involving six countries exploring promising practices and also for a study conducted in one Canadian province in which interrelationships between formal and informal care were investigated. Data collection methods included interviews and observations. In addition, dining maps were completed providing a cross-jurisdictional comparison of mealtime work organization, and illustrating the time spent assisting residents with meals. Dining maps highlight the reliance on unpaid care as well as how low staffing levels leave care providers rushing around, preventing a pleasurable resident dining experience, which is central to overall health and well-being.