A shift in emphasis from institutions to community poses important challenges for providers and policy makers, key among them being the challenge of providing asufficient volume of high quality community-based services to meet consumer needs. This challenge is particularly evident in community-based long-term care (LTC) due to the complexity and diversity of the field, the vulnerability of the population served, and the current wave of demand for services generated by hospital downsizing. The most recent reform of long-term care in Ontario is of particular interest in this context because, as suggested by the provincial government's maxim “highest quality, best price,” it promises cost-efficiency while maintaining or improving quality. To do this it employs a “managed competition” model in which for-profit and not-for-profit providers compete for service contracts under the auspices of local Community Care Access Centres (CCACs) run by volunteer boards. In this paper we draw on the comments of senior government officials and representatives of provider organizations, as well as published documents, to highlight issues and problems posed by the province's latest reform. We argue that, particularly under conditions of capped budgets and increasing demands, the managed competition process may result in the subordination of service quality and consumer choice to pressures for cost-containment.

This paper extends an earlier analysis of the geography of caregiving to elderly relatives (Joseph & Hallman, 1996), by closely examining the implications of time-distance between family caregivers and their older relatives. We hypothesize that overlaying a highly gendered social behaviour (eldercare) onto the distinctive time-space geographies of men and women will translate into demonstrably different “eldercare geographies”. Analysis of data from two interrelated CARNET surveys suggests that female and male caregivers provide assistance within very different time-space contexts. Women demonstrate greater engagement with caregiving and more extensive commitments to travel in order to provide assistance. This “distance-defying” behaviour translates into the use of residential relocation as a means of modifying time-space in order to improve caregiving provision. In contrast, male caregivers are more sensitive to the limiting effects of time-distance, including the manipulation of their eldercare geographies. The paper concludes with a discussion, based on comments made by caregivers, of the negative impacts of eldercare involvement, focussing on perceived effects on personal time for other family relationships.

This study uses qualitative methods to explore subjective perceptions of independence and dependence for older adults with chronic musculoskeletal conditions. Twenty-seven in-depth interviews were conducted with community-dwelling older adults with osteoarthritis and/or osteoporosis in the greater Metropolitan Toronto area. Respondents shared similar overall perceptions of independence and dependence, but self-definitions as independent were related to domains of difficulty, coping skills used, assistive devices, and nature of the helping relationship. Three categories of respondents based on domains of difficulty (Community Mobility, Household Activities, and Personal Care) are used to illustrate how respondents negotiate their self-identities as independent in light of the other three factors.

This paper reviews the literature on the relation of coping and control processes to health outcomes in late adulthood and presents new data on relations between coping and control processes and health for 295 World War II veterans. The results for the veterans showed that health was positively associated with cognitive coping, and negatively associated with behavioural coping and avoidance. No association was found between perceived locus of control and health. These findings, together with those in the literature, were discussed in terms of their implications for future research on the role of coping and control in health maintenance and their significance for people working with older persons.

The purpose of this paper is to explore occupational health issues among employees of home care agencies. Results of a survey of 892 office and visiting employees of three not-for-profit home care agencies and focus group discussions show that employees of home care agencies experience high levels of stress, tiredness and exhaustion. This work-related stress is most acutely felt by those in managerial occupations, nurses and therapists. When compared to findings from the Canadian National Population Health Survey, employees of home care agencies are found to be significantly more likely than all working women to suffer from allergies, asthma, arthritis or rheumatism, back problems, high blood pressure, migraine headaches, and work-related injuries in the past year. Many employees of home care agencies suffer pain or discomfort in several body locations. Visiting employees of home care agencies suffer from sprains or strains, dislocations, fractures, and bruises as a result of lifting or moving clients, bending or straining, accidental falls, repetitive motion injuries, and motor vehicle accidents. Home care office staff suffer from repetitive strain injuries and respiratory illness. Implications for policy and research are discussed.

Based on data from a random sample of foreign-born Chinese elders (n = 708) interviewed in Vancouver and Victoria in 1995–96, this paper examines the extent, determinants, and consequences of ethnic identification. Of the respondents, who have a median age of 75 and a median age at immigration to Canada of 55, 49.3 per cent stated that they felt more Canadian than Chinese, 36.6 per cent felt more Chinese, and 14.1 per cent felt equally Chinese and Canadian. Logistic regression analysis is performed, in an attempt to discover the determinants of Chinese ethnic identity. Significant independent variables include: place of residence, age, years since immigration, English-speaking ability, and personal monthly income. Consequences of retention of Chinese ethnic identity are explored, in terms of religious affiliation, health-related behaviours, family variables, and well-being variables. Only well-being is affected by retention of Chinese identity, an effect that is negative and felt largely by women only.

Efforts to address the “paradox of autonomy in long-term care” attempt to salvage an ethic of autonomy by redefining the central concept, and then applying it to the long-term care environment. Such attempts are critiqued, and an alternative ethic of dignity for long-term care is developed. Autonomy, it is argued, is crucial to certain aspects of dignity, but should not be confused with the whole of it. Indeed, long after the capacity for autonomy has diminished or vanished, basic dignity continues to exert normative force.

Although the physical environment as a co-determinant of health could be approached in many ways, we chose to focus on an understudied area: how the immediate living environment can act as a persuasive force affecting physical activity level in older people, with physical activity in turn affecting health status. To explore this topic, the methods and findings of a literature search are described, the theoretical underpinnings of our thesis are presented, and an example is given of how a planned environment, which upon first glance seems supportive, may have unexpected and negative consequences on the activity level, and ultimately the health status, of the residents. Theory related to changes with aging in homeostatic capacity and reserve capacity of organ systems as well as Lawton's environmental press-competence model are applied to environmental characteristics (e.g., staircases) of continuing care retirement communities. We argue that physically challenging aspects of the environment, such as stairs, should be included in the design of living spaces for the elderly with the goal of encouraging greater daily physical activity and improved health status.