Health care cuts and restructuring are shifting the site of acute care from hospitals to homes and prompting provincial governments to introduce varying forms of mixed economies in home care. Typically, such arrangements seek to drive down public costs and to reposition service users as “consumers” of market-modelled care. Drawing on an ongoing study of frail elderly women and women with disabilities receiving home care in Ontario, this paper explores the significance for service users of these economic and political objectives. Rather than feeling like consumers free to exercise choice and demand quality in the mixed economy of home care, they experienced their positioning within it as insecure and subordinate and its supply as unpredictable and meagre. The implications of these findings for fashioning secure and equitable public responses to elderly and disabled citizens who need assistance at home over the long term are discussed.
