Home care program flexibility as a relational phenomenon

Abstract

The capacities of home care programs to respond to clients’ holistic, everyday needs and changing circumstances can shape trajectories of clients and family caregivers. This analysis examines how such flexibility emerges in relations between home care actors within the constraints of policies, regulations and funding contexts. A relational lens broadly informs the analysis of interview data from 46 participants in two Canadian regions. Twelve configurations of participants centre around older adults receiving publicly-funded, non-medical home support, and include their case/care coordinators (CCs), support workers, and where applicable, family carers and private agency supervisors. Case-based and thematic analyses were conducted within and between configurations. Findings illuminate how flexibility to client situations arises around tasks, schedules, roles, and social connection can arise in relations, and how policies, protocols and institutionalized practices shape this process. When bounded professional power is accompanied by minimal interaction with or knowledge of clients, system flexibility to emergent needs, preferences and situations relies heavily on worker prompting and effort, client assertion of needs, and professional exception-making. Participants contributed to an understanding of system flexibility emerging in this context as key actors develop and respond to concerns about others. Findings illuminate the importance of relationally embedded knowledge and (inter)action and are discussed with regards to client-centred care and current policy shifts in some provinces towards direct-managed home care. Further research should examine how system flexibility may shape care pathways over time.

Keywords

• Home care
• Older adults
• Client-centred care
• Program flexibility
• Relational gerontology