Long-term care restructuring in rural Ontario: retrieving community service user and provider narratives

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 .