Abstract
Objective
Through close, critical readings of everyday practice of homecare case managers in Canada and Iceland, we demonstrate how contemporary neo-liberal policy that focuses on enhancing efficiency in the health care system has the effect of undermining forms of flexibility that previously enabled the delivery of home-based care and respected the unique needs of older adults.
Method
A case study method is used, drawing on a single case from Canada and another from Iceland to undertake an ethnomethodological analysis of how assessments of older adults’ needs for homecare support that is largely performed by women are accomplished.
Results
The interpretation of data illustrates both individual and collective strategies for the conduct of care in homes and communities. The effects of such strategies in terms of their effects in diminishing resistance to further shifts of responsibility for care over to individuals are demonstrated. Professional imperatives are shown to be effective in repairing and even extending the effects of responsibilization.
Discussion
This paper explores the effects of a variety of strategies employed by health care organizations as they both shape and respond to a changing care provision landscape. We illustrate how gendered organizational policies and professional practices support wider political interests in performance management and efficiency and, in so doing, further the effects of individualization in what could otherwise be mobilized collective responses to aging, poverty, illness and isolation.
Key words: Home care, neo-liberalism, gender, ethnography, Canada, Iceland
Résumé
Objectif
Au moyen d’une lecture critique et approfondie des pratiques quotidiennes des gestionnaires de soins à domiciles au Canada et en Islande, nous montrons que les politiques néolibérales contemporaines qui cherchent à améliorer l’efficience du système de santé portent atteinte à la souplesse qui permettait auparavant d’offrir des soins à domicile aux personnes âgées en respectant leurs besoins particuliers.
Méthode
Nous avons utilisé une étude de cas au Canada et une autre en Islande pour mener une analyse ethnométhodologique de l’exécution des évaluations des besoins des personnes âgées qui requièrent des soins à domicile, une tâche effectuée en grande partie par des femmes.
Résultats
L’interprétation des données montre qu’il existe à la fois des stratégies individuelles et collectives pour la prestation des soins à domicile et dans la communauté. Nous démontrons que ces stratégies ont pour effet de diminuer la résistance à de nouveaux transferts de responsabilité vers les particuliers en matière de soins. Les impératifs professionnels s’avèrent efficaces pour réparer, et même prolonger, les effets de la responsabilisation.
Discussion
Dans cet article, nous explorons les effets de diverses stratégies employées par les organismes de soins de santé pour orienter l’évolution de l’environnement de prestation des soins et pour s’y adapter. Nous montrons par des exemples que les politiques organisationnelles et les pratiques professionnelles sexospécifiques appuient des intérêts politiques plus vastes, axés sur la gestion du rendement et l’efficience, et que ce faisant, elles affermissent les effets de l’individualisation au détriment d’une riposte collective et mobilisée au vieillissement, à la pauvreté, à la maladie et à l’isolement.
Mots clés: soins à domicile, néolibéralisme, sexospécificité, ethnographie, Canada, Islande
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