Inequities in access to directly-funded home care in Canada: a privilege only afforded to some

Simple item page
dc.contributor.authorKelly, Christine
dc.contributor.authorDansereau, Lisette
dc.contributor.authorFitzGerald, Maggie
dc.contributor.authorLee, Yeonjung
dc.contributor.authorWilliams, Allison
dc.date.accessioned2023-03-01T22:52:41Z
dc.date.available2023-03-01T22:52:41Z
dc.date.issued2023-01-18
dc.date.updated2023-02-01T04:42:07Z
dc.description.abstractBackground Directly-funded home care (DF) provides government funds to people who need assistance with the activities of daily living, allowing them to arrange their own services. As programs expand globally, many allow DF clients to hire home care agencies to organize their services rather than finding their own workers. In Canada, half of the DF home care programs allow users to purchase agency services. The goal of this research is to describe the role of agency providers in DF home care in Canada and consider potential equity implications for service access from the perspectives of clients and families. Methods Framed with intersectionality, the study included online focus groups with families and clients (nā€‰=ā€‰56) in the two Canadian provinces of Alberta and Manitoba between June 2021-April 2022. All transcripts underwent qualitative thematic analysis using open and axial coding techniques. Each transcript was analyzed by two of three possible independent coders using Dedoose qualitative analysis software. Results The article presents five thematic findings. First, the focus groups document high rates of satisfaction with the care regardless of whether the client uses agency providers. Second, agency providers mediate some of the administrative barriers and emotional strain of using DF home care, and this is especially important for family caregivers who are working or have additional care responsibilities. Third, there are out-of-pocket expenses reported by most participants, with agency clients describing administrative fees despite lower pay for the frontline care workers. Fourth, agencies are not generally effective for linguistic and/or cultural matching between workers and families. Finally, we find that DF care programs cannot compensate for a limited informal support network. Conclusions Clients and families often intentionally choose DF home care after negative experiences with other public service options, yet the results suggest that in some Canadian contexts, DF home care is a privilege only afforded to some. Given the growing inequalities that exist in Canadian society, all public home care options must be open to all who need it, irrespective of ability to pay, degree of social support, or competence in the English language.en_US
dc.identifier.citationBMC Health Services Research. 2023 Jan 18;23(1):51
dc.identifier.citationBMC Health Services Research. 2023 Jan 18;23(1):51
dc.identifier.urihttps://doi.org/10.1186/s12913-023-09048-9
dc.identifier.urihttp://hdl.handle.net/1993/37181
dc.language.isoengen_US
dc.language.rfc3066en
dc.publisherBMCen_US
dc.rightsopen accessen_US
dc.rights.holderThe Author(s)
dc.subjectInequityen_US
dc.subjectDirectly-funded home careen_US
dc.subjectDirect paymentsen_US
dc.subjectConsumer directed careen_US
dc.subjectCanadaen_US
dc.titleInequities in access to directly-funded home care in Canada: a privilege only afforded to someen_US
dc.typeresearch articleen_US
local.author.affiliationRady Faculty of Health Sciences::Max Rady College of Medicine::Department of Community Health Sciencesen_US
oaire.citation.issue1en_US
oaire.citation.startPage51en_US
oaire.citation.titleHealth Services Researchen_US
oaire.citation.volume23en_US
project.funder.identifierhttps://doi.org/10.13039/501100000024en_US
project.funder.nameCanadian Institutes of Health Researchen_US
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
12913_2023_Article_9048.pdf
Size:
1.03 MB
Format:
Adobe Portable Document Format
Description:
Download
License bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
license.txt
Size:
2.24 KB
Format:
Item-specific license agreed to upon submission
Description:
Download
Collections
University of Manitoba Scholarship