Caregiver Experiences with Publicly Funded and Privately Financed Home Care in Ontario

Home care is an integral aspect of Ontarios health care system. Services provided to individuals may allow them to live with independence within the comfort of their own residence. Over the last decade the demand for home care has risen substantially due to a number of factors including: the growing population, the rising share of individuals over the age of 65, the increasing rates of complex and chronic conditions, trends to faster hospital discharge, and advances in treatments/technologies. Simultaneously, the rise in neoliberalism has led to the restructuring of financing and delivery of health care through market-based models. While ostensibly an attempt to reduce public spending, it is more likely a result of an ideological shift away from state-provided care towards market-oriented service provision. In light of this, in the home care area, the state has been able to reduce its financial obligations by enabling privatization in the sector. The significance of policy change in the home care system and the decisions regarding the balance of the public/private scheme, therefore, have had serious implication for the experiences of those who provide the care the unpaid Informal Family Caregivers (IFC). At present, public funding and provision of care have not kept up with the demand for services, thereby, encouraging individuals to turn to the private market if they find inadequacies in the delivery of publicly funded local home care services (McGregor, 2001). In light of this, the purpose of this study is to examine the lived experiences of IFC who seek services for their relatives from the public home care system as well as from the private marketplace. In doing so, the goal is to understand the circumstances and challenges faced by these caregivers in accessing care in each of these two systems and obtaining respite from their duties. This knowledge is fundamental to the health care system which seeks to prevent the institutionalization of individuals as well as to minimize health care costs associated with the physical and psychological outcomes of caregiving which may differ in quality. This study is influenced by the work of FP economists to explain inequities in health as stemming in part from the unequal division of labour in society by which women must both gain paid employment and carry out household work (cleaning, cooking, laundry, gardening, taking care of children and the elderly etc.). FPE further draws on the Social Determinants of Health (SDOH) concept, which considers how the organization, and distribution of resources such as income and health services interact with the social location of gender to impact health outcomes. The qualitative research approach of descriptive phenomenology is employed to convey and understand the lived experiences of IFC with both the publicly funded and privately financed home care systems in and around the Greater Toronto Area. Quantitative analysis is further used to complement the voices of the participants. By illuminating micro-level individual experiences in relation to broader political and economic context, the development of new theories can take place and lead to further investigations pertaining to the phenomenon of interest. By generating knowledge and creating awareness, the ultimate goal is to influence policies of care and service provision to address issues concerning equity and health.