Skip to main content
×
×
Home

Reconciling Tensions: Needing Formal and Family/Friend Care but Feeling like a Burden

  • Rachel Barken (a1)
Abstract

Within a neoliberal policy context that shifts responsibility for health and well-being from the state to families and individuals, Canadian home care strategies tend to present family members as “partners in care”. Drawing on an interpretive grounded theory study that involved 34 qualitative interviews, this article examines older people’s experiences at the intersections of formal home care and family/friend care arrangements, against the backdrop of policies that emphasize partnerships with family. The core concept derived from the interviews was reconciling tensions between care needs and concerns about burdening others, in the context of available home and community care. Four processes are identified, which illustrate how access to financial and social resources may lead to opportunities and constraints in experiences of care. Findings underscore the emotional and practical challenges that older people may encounter vis-à-vis policy discourses that encourage family responsibility for care. Implications for policy and practice are discussed.

Dans le cadre d’une politique néolibérale qui transfère la responsabilité pour la santé et le bien-être de l’État aux familles et aux individus, les stratégies canadiennes pour soins à domicile ont tendance à présenter les membres de la famille comme « partners in care ». En s’appuyant sur une étude interprétative fondée sur une théorie qui comprenait 34 entrevues qualitatives, cet article examine les expériences des personnes âgées aux intersections des soins à domicile formels et arrangements pour les soins dispensés par la famille et les amis, dans le contexte de politiques mettant l’accent sur les partenariats avec les familles. Le concept fondamental tiré des entrevues était de concilier les tensions entre le besoin de soins et le souci de surcharger les autres, dans le contexte des soins à domicile et communautaires disponibles. Quatre processus sont identifiés, qui illustrent la façon dont l’accès aux ressources financières et sociales peut conduire à des opportunités et des contraintes dans l’expérience de soins. Les résultats mettent en évidence les défis émotionnels et pratiques que les personnes âgées peuvent rencontrer vis-à-vis le discours encourageant les familles à assumer la responsabilité des soins. Les implications pour la politique et la pratique sont discutées.

Copyright
Corresponding author
La correspondance et les demandes de tire-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Rachel Barken, Ph.D. SSHRC Postdoctoral Fellow Department of Sociology, York University 359A York Lanes, 4700 Keele St. Toronto, ON M3J 1P3 (rbarken@yorku.ca)
Footnotes
Hide All
* I thank Margaret Denton, Amanda Grenier, and Lori Campbell for their support with this research. I am indebted to the participants who took part in interviews as well as the various agencies and individuals who assisted with recruitment. This research was supported by a Bombardier Canada Graduate Scholarship from the Social Sciences and Humanities Research Council (award # 767-2012-2017), as well as an Award for Home Care Research from Saint Elizabeth Health Care.
Footnotes
References
Hide All
Allen, S. M., & Ciambrone, D. (2003). Community care for people with disability: Blurring boundaries between formal and informal caregivers. Qualitative Health Research, 13(2), 207226.
Allen, R. E. S., & Wiles, J. L. (2014). Receiving support when older: What makes it OK? The Gerontologist, 54(4), 670682.
Armstrong, P. (2010). Neoliberalism in action: Canadian perspectives. In Braedley, S. & Luxton, M. (Eds.), Neoliberalism and everyday life (pp. 184201). Montreal, QC: McGill-Queen’s University Press.
Aronson, J., Denton, M. A., & Zeytinoglu, I. U. (2004). Market-modeled home care in Ontario: Deteriorating working conditions and dwindling community capacity. Canadian Public Policy, 30(1), 111125.
Barken, R. (2015). Age relations and care: Older people’s experiences of self-care, family/friend caregiving, and formal home care (Unpublished doctoral dissertation). McMaster University, Hamilton, ON.
Beach, M. C., Inui, T., Frankel, R., Hall, J., Haidet, P., Roter, D., … Williamson, P. (2006). Relationship-centered care: A constructive reframing. Journal of General Internal Medicine, 21(Suppl. 1), S38.
Breheny, M., & Stephens, C. (2012). Negotiating a moral identity in the context of later life care. Journal of Aging Studies, 26(4), 438447.
Brookman, C., Holyoke, P., Toscan, J., Bender, D., & Tapping, E. (2011). Promising practices and indicators for caregiver education and support programs. Markham, ON: Saint Elizabeth. Retrieved from https://www.saintelizabeth.com/getmedia/ec3bb66f-6ec9-4f53-b0b8-c3030361d1e7/Promising-Practices-and-Indicators-for-Caregiver-Education-and-Support.pdf.aspx?ext=.pdf.
Brookman, C., Jakob, L., DeCicco, J., & Bender, D. (2011). Client-centred care in the Canadian home and community sector: A review of key concepts. Final report. Markham, ON: Saint Elizabeth. Retrieved from https://www.saintelizabeth.com/getmedia/4aba6e8e-0303-4b9c-9117-a8c22a43f8bd/Client-Centred-Care-in-the-Canadian-Home-and-Community-Sector.pdf.aspx.
Canadian Home Care Association (2013). Portraits of home care in Canada. Executive précis. Retrieved from http://www.cdnhomecare.ca/content.php?doc=274. Mississauga, ON: Author.
Cantor, M. (1979). Neighbors and friends. Research on Aging, 1(4), 434463.
Cantor, M. (1991). Family and community: Changing roles in an aging society. The Gerontologist, 31(3), 337346.
Chappell, N. L., & Blandford, A. (1991). Informal and formal care: Exploring the complementarity. Ageing and Society, 11, 299317.
Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. Los Angeles, CA: Sage.
Claims Conference (2012). Worldbook: A guide to claims conference programs worldwide. Retrieved from http://forms.claimscon.org/worldbook12.pdf. New York, NY: Author.
Corbin, J. M., & Strauss, A. L. (2008). Basics of qualitative research: Techniques and procedures for developing grounded theory. Los Angeles, CA: Sage.
Creswell, J. W. (2013). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). Thousand Oaks, CA: Sage.
Davey, A., & Patsios, D. (1999). Formal and informal community care to older adults: Comparative analysis of the United States and Great Britain. Journal of Family and Economic Issues, 20(3), 271299.
Denton, M. A. (1997). The linkages between formal and informal care for the elderly. Canadian Journal on Aging, 16(1), 3050.
Denton, M. A., & Boos, L. (2007). The gender gap in wealth: Structural and material constraints. Journal of Women and Aging, 19(3-3), 105120.
Erlandson, D. A., Harris, E. L., Skipper, B. L., & Allen, S. D. (1993). Doing naturalistic inquiry: A guide to methods. Newbury Park, CA: Sage.
Funk, L. M. (2013). Home healthcare and family responsibility: A critical discourse analysis of talk and text. Healthcare Policy, 9, 8797.
Gee, E. M. T. (2000). Population and politics: Voodoo demography, population aging, and social policy. In Gee, E. M. T. & Gutman, G. M. (Eds.), The overselling of population aging: Apocalyptic demography, intergenerational challenges, and social policy (pp. 525). Don Mills, ON: Oxford University Press.
Glaser, B. G. (1978). Theoretical sensitivity: Advances in the methodology of grounded theory. Mill Valley, CA: Sociology Press.
Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. New York, NY: Aldine de Gruyter.
Greene, V. L. (1983). Substitution between formally and informally provided care for the impaired elderly in the community. Medical Care, 21(6), 609619.
Health Quality Ontario (2016). The reality of caring: Distress among the caregivers of home care patients. Toronto, ON: Queen’s Printer for Ontario.
Hoover, M., & Rotermann, M. (2012). Seniors’ use of and unmet needs for home care, 2009. Health Reports, 23(4), 38.
Hooyman, N., Browne, C. V., Ray, R., & Richardson, V. (2002). Feminist gerontology and the life course: Policy, research and teaching issues. Gerontology & Geriatrics Education, 22(4), 326.
Kahn, R. L., & Antonucci, T. C. (1980). Convoys over the life course: Attachment, roles, and social support. In Baltes, P. B. & Brim, O. (Eds.), Life span development and behavior (Vol. 3, pp. 254283). New York, NY: Academic Press.
Keefe, J. (2011). Supporting caregivers and caregiving in an aging Canada. Montreal, QC: Institute for Research on Public Policy.
Kemp, C. L., Ball, M. M., & Perkins, M. M. (2013). Convoys of care: Theorizing intersections of formal and informal care. Journal of Aging Studies, 27(1), 1529.
Kemp, C. L., & Denton, M. (2003). The allocation of responsibility for later life: Canadian reflections on the roles of individuals, government, employers and families. Ageing and Society, 23(6), 737760.
King, N., & Calasanti, T. (2013). Men’s aging amidst intersecting relations of inequality. Sociology Compass, 7(9), 699710.
Lero, D. S., Keating, N. C., Fast, J., Joseph, G., & Cook, L. (2007). The interplay of risk factors associated with negative outcomes among family caregivers: A synthesis of the literature (Centre for Families, Work & Well-Being, University of Guelph; & Research on Aging, Policies and Praxis, University of Alberta). Retrieved from http://www.worklifecanada.ca/cms/resources/files/718/The_interplay_of_risk_factors_associated_with_negative_outcomes_among_family_caregivers_2007.pdf.
Lewinter, M. (2003). Reciprocities in caregiving relationships in Danish elder care. Journal of Aging Studies, 17(3), 357377.
Litwak, E. (1985). Helping the elderly: The complementary roles of informal networks and formal systems. New York, NY: Guilford Press.
Martin-Matthews, A. (2000). Intergenerational caregiving: How apocalyptic and dominant demographies frame the questions and shape the answers. In Gee, E. M. T. & Gutman, G. M. (Eds.), The overselling of population aging: Apocalyptic demography, intergenerational challenges, and social policy (pp. 6479). Don Mills, ON: Oxford University Press.
Martin-Matthews, A., Sims-Gould, J., & Tong, C. E. (2013). Canada’s complex and fractionalized home care context: Perspectives of workers, elderly clients, family carers, and home care managers. Canadian Review of Social Policy, 68/69, 5574.
McDonald, L., & Robb, L. (2004). The economic legacy of divorce and separation. Canadian Journal on Aging, 23(S1), S83S98.
Neysmith, S. M. (2000). Networking across difference: Connecting restructuring and caring labour. In Neysmith, S. M. (Ed.), Restructuring caring labour: Discourse, state practice, and everyday life (pp. 128). Don Mills, ON: Oxford University Press.
Oleson, V. (2007). Feminist qualitative research and grounded theory: Complexities, criticisms, and opportunities. In Bryant, A. & Charmaz, K. (Eds.), The SAGE handbook of grounded theory (pp. 417435). Thousand Oaks, CA: Sage.
Ontario Association of Community Care Access Centres (2014). Making way for change: Transforming home and community care for Ontarians. Retrieved from http://www.homecareontario.ca/home-care-reports/other-home-care-publications/home-and-community-care.
Ontario Home Care Association (2013). Private home care—A vital component of the health care continuum in Ontario. Retrieved from http://www.homecareontario.ca/docs/default-source/position-papers/position-papers/private-home-care–-a-vital-component–-oct-2013e81a79fdc99c68708e32ff0000f8dac8.pdf?sfvrsn=10.
Peckham, A., Williams, A. P., & Neysmith, S. M. (2014). Balancing formal and informal care for older persons: How case managers respond. Canadian Journal on Aging, 33(2), 123136.
Penning, M. J. (2002). Hydra revisited: Substituting formal for self- and informal in-home care among older adults with disabilities. The Gerontologist, 42(1), 416.
Perkins, M. M., Ball, M. M., Kemp, C. L., & Hollingsworth, C. (2013). Social relations and resident health in assisted living: An application of the convoy model. The Gerontologist, 53(3), 495507.
Peters, C. L., Hooker, K., & Zvonkovic, A. M. (2006). Older parents’ perceptions of ambivalence in relationships with their children. Family Relations, 55(5), 539551.
Pinquart, M., & Sörensen, S. (2002). Older adults’ preferences for informal, formal, and mixed support for future care needs: A comparison of Germany and the United States. The International Journal of Aging & Human Development, 54(4), 291314.
Porter, E. J., Ganong, L. H., Drew, N., & Lanes, T. I. (2004). A new typology of home-care helpers. The Gerontologist, 44(6), 750.
Rose, N. (2000). Government and control. British Journal of Criminology, 40, 321339.
Sims-Gould, J., & Martin-Matthews, A. (2010). We share the care: Family caregivers’ experiences of their older relative receiving home support services. Health & Social Care in the Community, 18(4), 415423.
Sinha, M., & Bleakney, A. (2014). Receiving care at home. Ottawa, ON: Statistics Canada, Ministry of Industry.
Ward-Griffin, C., & Marshall, V. W. (2003). Reconceptualizing the relationship between “public” and “private” eldercare. Journal of Aging Studies, 17(2), 189208.
Weicht, B. (2013). The making of “the elderly”: Constructing the subject of care. Journal of Aging Studies, 27(2), 188197.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Canadian Journal on Aging / La Revue canadienne du vieillissement
  • ISSN: 0714-9808
  • EISSN: 1710-1107
  • URL: /core/journals/canadian-journal-on-aging-la-revue-canadienne-du-vieillissement
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed