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York University Centre for Health Studies
In a study called Elderly Women and Women with Disabilities in Ontario's Home Care Marketplace: Living on the Edge, author and McMaster University Social Work Professor Jane Aronson describes the instability and deterioration in home-care service over the past 20 months, particularly for those who can't afford to buy more assistance. The three-year study is funded by the National Network on Environments and Women's Health (NNEWH), a Health Canada Centre of Excellence based at York University, and by the Social Sciences and Humanities Research Council. Aronson will present her findings Thursday, March 9, 2 p.m. at York University as part of the Women and Health Speaker Series, sponsored by the York Centre for Health Studies and NNEWH.
Aronson's research, undertaken after the provincial government's move in 1996 to a competitive bidding system and to private-sector service providers, has revealed thus far a pattern of declining services and cumulative harmful effects on home-care recipients.
Aronson says the competitive bidding process has led to frequent changes in nursing staff and home-care workers, disrupting the continuity of care so essential to long-term recipients. The refrain -- "I never know who is coming through the door"-- was one she often heard from patients who had lost their familiar home-care provider in the bidding process. And the Community Care Access Centres (CCACs), which award bids and monitor service, have faced budget restrictions from the provincial Ministry of Health at the same time as shorter hospital stays have increased demand for their services.
"The CCACs have had to ration their resources rigidly and have given higher priority to the acutely ill than to those who need small amounts of long-term practical help to remain at home," says Aronson.
Her study tracks a sample of 25 women in Ontario who receive ongoing home care. They are between the ages of 35 and 96 and live with a range of chronic conditions and disabilities. The length of time they have been receiving home care varies, as does their marital, family and cultural situation. Almost half are poor. Aronson says her research so far sheds light on the impact of instability on these and other home-care users, especially those without family members or private resources to help compensate for the inadequate or insufficient public provision of an increasingly important service. She also finds that the CCACs' approach to standardizing service ignores individual needs and further depersonalizes the assistance upon which these women depend.
Aronson describes the experience of one young woman with a neurological condition whose involuntary hand movements caused her to scratch herself. In the past, her care giver trimmed her nails once a week to keep injury to a minimum. Now, with home care visits reduced, she can no longer have her nails trimmed as frequently as she needs. Aronson says that many study participants have been warned by their case managers that they cannot count on the same level of service. "Such messages serve to reduce their expectations so that they are reluctant to ask for assistance, even if they are desperately in need."
She recalls the plight of another woman, an elderly one with poor mobility who had received such a warning and assumed it was pointless to ask for additional help after suffering a hairline fracture in a fall. "Instead, she struggled to manage alone and at some risk," says Aronson. Other efforts to standardize service include upper limits on monthly home-making support and a limit of one bath per week unless the patient is incontinent.
"There are issues of rights and human dignity here," says Aronson. She adds that the small amounts of preventive home help that have been taken away by many CCACs forced to limit and standardize services have eroded the confidence of many elderly, causing them to doubt their ability to remain at home. "The provincial government has said it wants to assist the elderly to live independently at home for as long as possible, but its system of "managed competition" in home care is actually pushing many into nursing homes prematurely," said Aronson.
Previous research sponsored by the NNEWH has shown that two-thirds of home care recipients are women, and in 1994-95 more than half of those who needed help with personal care received no formal care. The percentage was even greater for those who needed help with everyday living activities. According to 1998 provincial government guidelines, one must have first exhausted the care-giving and support capacities of friends, relatives and other community members to qualify for home care. Meanwhile, professional care providers, most of whom are women, are being replaced by lesser-skilled, non-unionized workers stripped of job security, benefits and adequate pay.
York Prof. Gina Feldberg, NNEWH Academic Director and Director of the York Centre for Health Studies, has pointed out that those who argue that Canada's health care system has been losing hundreds of millions of dollars through abuse fail to see that the abuse is more on the supply side in private markets than on the consumer side in a public system. In fact, a Yale University study published in Health Reform: Public Success, Private Failure (Routledge, 1999) shows that the United States pays 40 per cent more per capita for its uneven, privatized system than Canada pays for its public system.
"Canadians have imported the language of consumerism from the United States, transforming the patient into a consumer for the ostensible purpose of redressing health care abuse and contributing to a uniquely American conception of citizenship based upon unequal buying power, not equal democratic standards," said Feldberg.
The presentation, part of the Women and Health Speaker Series sponsored by the York Centre for Health Studies (YCHS) and the NNEWH, will be held on Thursday, March 9, 2 p.m., Room 305 York Lanes, York University, Keele Campus, 4700 Keele St.
For further information, please contact:
Prof. Jane Aronson
Gina Feldberg
Susan Bigelow |
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