Choice, risk, and responsibility in Manitoba’s self and family managed home care program
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Enhancing choice in home care has become part of a national discourse that aligns with aging in place strategies. Choice in home care is best realized through the mechanism of direct funding (DF), where the client and/or a family member is given funding to make their own decisions about their care services. Having more choice is generally accepted as automatically beneficial, but choice also involves making decisions and accepting any risks involved in taking on that responsibility. The literature indicates there are several benefits for working-age adults who take responsibility for their own care, but there are a number of gaps in our understanding of the ways older adults and their caregivers experience having more choice over their home care services. The objectives of this dissertation are to identify whether and how having choice in home care may have policy implications, and to explore and describe experiences of choice, risk, and responsibility among clients and families using DF home care. This is a thesis by publication presenting findings from three qualitative studies conducted in the context of Manitoba’s home care system. Each study examines different aspects of choice and risk and each uses different means of collecting and analyzing data. Nevertheless, all three studies are conceptually linked by the overall research objective and are philosophically linked by feminist care ethics following Tronto’s political ethics of care and Mol’s logic of care. Together, the research presented in this dissertation provides new insight into the way clients and families experience the responsibilities and risks of having choice in home care. This dissertation concludes with a set of recommendations to improve home care services in Manitoba.