D. Cloutier-fisher et Ae. Joseph, Long-term care restructuring in rural Ontario: retrieving community service user and provider narratives, SOCIAL SC M, 50(7-8), 2000, pp. 1037-1045
This paper examines the extensive restructuring of community-based long-ter
m care that was initiated in Ontario, Canada in 1996, and does so with part
icular reference to longstanding problems of provision in rural communities
. Specifically, it draws on a case study focussed on two small rural towns
to develop a 'situated understanding' of service-user and service-provider
perspectives on service coordination issues and on service cuts, particular
ly as they affect the ability of elderly people reliant on publicly-funded
community services to stay in their homes, to continue to 'age in place'. T
he general and specific antecedents of long-term care reform are considered
prior to the presentation of the case study. General antecedents include t
he rapid aging of Canada's population and aggressive strategies to reduce g
overnment deficits, while specific antecedents flow from a decade df failed
attempts to address longstanding issues of service co ordination and from
the ideologically-driven, free market stance of the provincial government e
lected in 1995. The analysis of interviews conducted with 14 community-serv
ice users and 17 providers suggests that the managed competition system int
roduced as the centerpiece of long-term care reform has resulted in increas
ing diversity and uncertainty on both sides of the service provision equati
on. Despite continued attempts by rural elderly people and their families t
o 'cut and paste' support packages, it seems that the restructuring of publ
icly-funded community services, combined with a substantial re-investment i
n long-term care facilities, will make some elderly people more vulnerable
to institutionalization. (C) 2000 Elsevier Science Ltd. All rights reserved
.