Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-26T05:02:43.808Z Has data issue: false hasContentIssue false
  • English
  • Français

Reconciling Tensions: Needing Formal and Family/Friend Care but Feeling like a Burden

Published online by Cambridge University Press:  05 January 2017

Rachel Barken
Rachel Barken*
Affiliation:
Department of Sociology, York University
*
†La correspondance et les demandes de tire-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Rachel Barken, Ph.D. SSHRC Postdoctoral Fellow Department of Sociology, York University 359A York Lanes, 4700 Keele St. Toronto, ON M3J 1P3 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Within a neoliberal policy context that shifts responsibility for health and well-being from the state to families and individuals, Canadian home care strategies tend to present family members as “partners in care”. Drawing on an interpretive grounded theory study that involved 34 qualitative interviews, this article examines older people’s experiences at the intersections of formal home care and family/friend care arrangements, against the backdrop of policies that emphasize partnerships with family. The core concept derived from the interviews was reconciling tensions between care needs and concerns about burdening others, in the context of available home and community care. Four processes are identified, which illustrate how access to financial and social resources may lead to opportunities and constraints in experiences of care. Findings underscore the emotional and practical challenges that older people may encounter vis-à-vis policy discourses that encourage family responsibility for care. Implications for policy and practice are discussed.

Résumé

Dans le cadre d’une politique néolibérale qui transfère la responsabilité pour la santé et le bien-être de l’État aux familles et aux individus, les stratégies canadiennes pour soins à domicile ont tendance à présenter les membres de la famille comme « partners in care ». En s’appuyant sur une étude interprétative fondée sur une théorie qui comprenait 34 entrevues qualitatives, cet article examine les expériences des personnes âgées aux intersections des soins à domicile formels et arrangements pour les soins dispensés par la famille et les amis, dans le contexte de politiques mettant l’accent sur les partenariats avec les familles. Le concept fondamental tiré des entrevues était de concilier les tensions entre le besoin de soins et le souci de surcharger les autres, dans le contexte des soins à domicile et communautaires disponibles. Quatre processus sont identifiés, qui illustrent la façon dont l’accès aux ressources financières et sociales peut conduire à des opportunités et des contraintes dans l’expérience de soins. Les résultats mettent en évidence les défis émotionnels et pratiques que les personnes âgées peuvent rencontrer vis-à-vis le discours encourageant les familles à assumer la responsabilité des soins. Les implications pour la politique et la pratique sont discutées.

Keywords

aginghome careinformal careneoliberalismsocial policyCanadavieillissementsoins à domicilesoins informelsnéoliberalismepolitique socialeCanada
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 36 , Issue 1 , March 2017 , pp. 81 - 96
Check for updates
Copyright
Copyright © Canadian Association on Gerontology 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

* I thank Margaret Denton, Amanda Grenier, and Lori Campbell for their support with this research. I am indebted to the participants who took part in interviews as well as the various agencies and individuals who assisted with recruitment. This research was supported by a Bombardier Canada Graduate Scholarship from the Social Sciences and Humanities Research Council (award # 767-2012-2017), as well as an Award for Home Care Research from Saint Elizabeth Health Care.

References

Allen, S. M., & Ciambrone, D. (2003). Community care for people with disability: Blurring boundaries between formal and informal caregivers. Qualitative Health Research, 13(2), 207–226.Google Scholar
Allen, R. E. S., & Wiles, J. L. (2014). Receiving support when older: What makes it OK? The Gerontologist, 54(4), 670–682.Google Scholar
Armstrong, P. (2010). Neoliberalism in action: Canadian perspectives. In Braedley, S. & Luxton, M. (Eds.), Neoliberalism and everyday life (pp. 184–201). Montreal, QC: McGill-Queen’s University Press.Google Scholar
Aronson, J., Denton, M. A., & Zeytinoglu, I. U. (2004). Market-modeled home care in Ontario: Deteriorating working conditions and dwindling community capacity. Canadian Public Policy, 30(1), 111–125.CrossRefGoogle Scholar
Barken, R. (2015). Age relations and care: Older people’s experiences of self-care, family/friend caregiving, and formal home care (Unpublished doctoral dissertation). McMaster University, Hamilton, ON.Google Scholar
Beach, M. C., Inui, T., Frankel, R., Hall, J., Haidet, P., Roter, D., … Williamson, P. (2006). Relationship-centered care: A constructive reframing. Journal of General Internal Medicine, 21(Suppl. 1), S3–8.CrossRefGoogle Scholar
Breheny, M., & Stephens, C. (2012). Negotiating a moral identity in the context of later life care. Journal of Aging Studies, 26(4), 438–447.Google Scholar
Brookman, C., Holyoke, P., Toscan, J., Bender, D., & Tapping, E. (2011). Promising practices and indicators for caregiver education and support programs. Markham, ON: Saint Elizabeth. Retrieved from https://www.saintelizabeth.com/getmedia/ec3bb66f-6ec9-4f53-b0b8-c3030361d1e7/Promising-Practices-and-Indicators-for-Caregiver-Education-and-Support.pdf.aspx?ext=.pdf.Google Scholar
Brookman, C., Jakob, L., DeCicco, J., & Bender, D. (2011). Client-centred care in the Canadian home and community sector: A review of key concepts. Final report. Markham, ON: Saint Elizabeth. Retrieved from https://www.saintelizabeth.com/getmedia/4aba6e8e-0303-4b9c-9117-a8c22a43f8bd/Client-Centred-Care-in-the-Canadian-Home-and-Community-Sector.pdf.aspx.Google Scholar
Canadian Home Care Association (2013). Portraits of home care in Canada. Executive précis. Retrieved from http://www.cdnhomecare.ca/content.php?doc=274. Mississauga, ON: Author.Google Scholar
Cantor, M. (1979). Neighbors and friends. Research on Aging, 1(4), 434–463.Google Scholar
Cantor, M. (1991). Family and community: Changing roles in an aging society. The Gerontologist, 31(3), 337–346.CrossRefGoogle Scholar
Chappell, N. L., & Blandford, A. (1991). Informal and formal care: Exploring the complementarity. Ageing and Society, 11, 299–317.Google Scholar
Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. Los Angeles, CA: Sage.Google Scholar
Claims Conference (2012). Worldbook: A guide to claims conference programs worldwide. Retrieved from http://forms.claimscon.org/worldbook12.pdf. New York, NY: Author.Google Scholar
Corbin, J. M., & Strauss, A. L. (2008). Basics of qualitative research: Techniques and procedures for developing grounded theory. Los Angeles, CA: Sage.Google Scholar
Creswell, J. W. (2013). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). Thousand Oaks, CA: Sage.Google Scholar
Davey, A., & Patsios, D. (1999). Formal and informal community care to older adults: Comparative analysis of the United States and Great Britain. Journal of Family and Economic Issues, 20(3), 271–299.Google Scholar
Denton, M. A. (1997). The linkages between formal and informal care for the elderly. Canadian Journal on Aging, 16(1), 30–50.Google Scholar
Denton, M. A., & Boos, L. (2007). The gender gap in wealth: Structural and material constraints. Journal of Women and Aging, 19(3-3), 105–120.Google Scholar
Erlandson, D. A., Harris, E. L., Skipper, B. L., & Allen, S. D. (1993). Doing naturalistic inquiry: A guide to methods. Newbury Park, CA: Sage.Google Scholar
Funk, L. M. (2013). Home healthcare and family responsibility: A critical discourse analysis of talk and text. Healthcare Policy, 9, 87–97.Google Scholar
Gee, E. M. T. (2000). Population and politics: Voodoo demography, population aging, and social policy. In Gee, E. M. T. & Gutman, G. M. (Eds.), The overselling of population aging: Apocalyptic demography, intergenerational challenges, and social policy (pp. 5–25). Don Mills, ON: Oxford University Press.Google Scholar
Glaser, B. G. (1978). Theoretical sensitivity: Advances in the methodology of grounded theory. Mill Valley, CA: Sociology Press.Google Scholar
Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. New York, NY: Aldine de Gruyter.Google Scholar
Greene, V. L. (1983). Substitution between formally and informally provided care for the impaired elderly in the community. Medical Care, 21(6), 609–619.Google Scholar
Health Quality Ontario (2016). The reality of caring: Distress among the caregivers of home care patients. Toronto, ON: Queen’s Printer for Ontario.Google Scholar
Hoover, M., & Rotermann, M. (2012). Seniors’ use of and unmet needs for home care, 2009. Health Reports, 23(4), 3–8.Google Scholar
Hooyman, N., Browne, C. V., Ray, R., & Richardson, V. (2002). Feminist gerontology and the life course: Policy, research and teaching issues. Gerontology & Geriatrics Education, 22(4), 3–26.Google Scholar
Kahn, R. L., & Antonucci, T. C. (1980). Convoys over the life course: Attachment, roles, and social support. In Baltes, P. B. & Brim, O. (Eds.), Life span development and behavior (Vol. 3, pp. 254–283). New York, NY: Academic Press.Google Scholar
Keefe, J. (2011). Supporting caregivers and caregiving in an aging Canada. Montreal, QC: Institute for Research on Public Policy.Google Scholar
Kemp, C. L., Ball, M. M., & Perkins, M. M. (2013). Convoys of care: Theorizing intersections of formal and informal care. Journal of Aging Studies, 27(1), 15–29.Google Scholar
Kemp, C. L., & Denton, M. (2003). The allocation of responsibility for later life: Canadian reflections on the roles of individuals, government, employers and families. Ageing and Society, 23(6), 737–760.Google Scholar
King, N., & Calasanti, T. (2013). Men’s aging amidst intersecting relations of inequality. Sociology Compass, 7(9), 699–710.Google Scholar
Lero, D. S., Keating, N. C., Fast, J., Joseph, G., & Cook, L. (2007). The interplay of risk factors associated with negative outcomes among family caregivers: A synthesis of the literature (Centre for Families, Work & Well-Being, University of Guelph; & Research on Aging, Policies and Praxis, University of Alberta). Retrieved from http://www.worklifecanada.ca/cms/resources/files/718/The_interplay_of_risk_factors_associated_with_negative_outcomes_among_family_caregivers_2007.pdf.Google Scholar
Lewinter, M. (2003). Reciprocities in caregiving relationships in Danish elder care. Journal of Aging Studies, 17(3), 357–377.Google Scholar
Litwak, E. (1985). Helping the elderly: The complementary roles of informal networks and formal systems. New York, NY: Guilford Press.Google Scholar
Martin-Matthews, A. (2000). Intergenerational caregiving: How apocalyptic and dominant demographies frame the questions and shape the answers. In Gee, E. M. T. & Gutman, G. M. (Eds.), The overselling of population aging: Apocalyptic demography, intergenerational challenges, and social policy (pp. 64–79). Don Mills, ON: Oxford University Press.Google Scholar
Martin-Matthews, A., Sims-Gould, J., & Tong, C. E. (2013). Canada’s complex and fractionalized home care context: Perspectives of workers, elderly clients, family carers, and home care managers. Canadian Review of Social Policy, 68/69, 55–74.Google Scholar
McDonald, L., & Robb, L. (2004). The economic legacy of divorce and separation. Canadian Journal on Aging, 23(S1), S83–S98.Google Scholar
Neysmith, S. M. (2000). Networking across difference: Connecting restructuring and caring labour. In Neysmith, S. M. (Ed.), Restructuring caring labour: Discourse, state practice, and everyday life (pp. 1–28). Don Mills, ON: Oxford University Press.Google Scholar
Oleson, V. (2007). Feminist qualitative research and grounded theory: Complexities, criticisms, and opportunities. In Bryant, A. & Charmaz, K. (Eds.), The SAGE handbook of grounded theory (pp. 417–435). Thousand Oaks, CA: Sage.Google Scholar
Ontario Association of Community Care Access Centres (2014). Making way for change: Transforming home and community care for Ontarians. Retrieved from http://www.homecareontario.ca/home-care-reports/other-home-care-publications/home-and-community-care.Google Scholar
Ontario Home Care Association (2013). Private home care—A vital component of the health care continuum in Ontario. Retrieved from http://www.homecareontario.ca/docs/default-source/position-papers/position-papers/private-home-care–-a-vital-component–-oct-2013e81a79fdc99c68708e32ff0000f8dac8.pdf?sfvrsn=10.Google Scholar
Peckham, A., Williams, A. P., & Neysmith, S. M. (2014). Balancing formal and informal care for older persons: How case managers respond. Canadian Journal on Aging, 33(2), 123–136.Google Scholar
Penning, M. J. (2002). Hydra revisited: Substituting formal for self- and informal in-home care among older adults with disabilities. The Gerontologist, 42(1), 4–16.Google Scholar
Perkins, M. M., Ball, M. M., Kemp, C. L., & Hollingsworth, C. (2013). Social relations and resident health in assisted living: An application of the convoy model. The Gerontologist, 53(3), 495–507.Google Scholar
Peters, C. L., Hooker, K., & Zvonkovic, A. M. (2006). Older parents’ perceptions of ambivalence in relationships with their children. Family Relations, 55(5), 539–551.Google Scholar
Pinquart, M., & Sörensen, S. (2002). Older adults’ preferences for informal, formal, and mixed support for future care needs: A comparison of Germany and the United States. The International Journal of Aging & Human Development, 54(4), 291–314.Google Scholar
Porter, E. J., Ganong, L. H., Drew, N., & Lanes, T. I. (2004). A new typology of home-care helpers. The Gerontologist, 44(6), 750.Google Scholar
Rose, N. (2000). Government and control. British Journal of Criminology, 40, 321–339.Google Scholar
Sims-Gould, J., & Martin-Matthews, A. (2010). We share the care: Family caregivers’ experiences of their older relative receiving home support services. Health & Social Care in the Community, 18(4), 415–423.Google Scholar
Sinha, M., & Bleakney, A. (2014). Receiving care at home. Ottawa, ON: Statistics Canada, Ministry of Industry.Google Scholar
Ward-Griffin, C., & Marshall, V. W. (2003). Reconceptualizing the relationship between “public” and “private” eldercare. Journal of Aging Studies, 17(2), 189–208.CrossRefGoogle Scholar
Weicht, B. (2013). The making of “the elderly”: Constructing the subject of care. Journal of Aging Studies, 27(2), 188–197.Google Scholar