Long-term care restructuring in rural Ontario, retrieving community narratives through a case study approach
Notice bibliographique
Résumé
This research examines how restructuring processes have affected the ability of elderly and disabled persons, reliant upon public sector services, to remain in their communities. In Ontario, community-based long-term care systems have been extensively restructured since 1996. This research is guided by an interpretive framework that is based upon hermeneutics to illuminate important theoretical and empirical components that can enhance understanding of the impacts of restructuring. Empirically, the framework draws attention to findings at three scales; macro scale (provincial), meso (or community scale) and micro scale of individuals. Theoretically, the framework draws upon corresponding scale-sensitive bodies of theory notably political economy, structuration theory and humanism for developing understanding. A case study focussed on small communities in Wellington County facilitates exploring the experiences of 'real' individuals living within 'real' communities. As a consequence, an appreciation for the 'situated meaning' of restructuring is fostered. Prior to the presentation of the case study results, the general and specific antecedents of long-term care restructuring are considered. General antecedents include the rapid aging of Canada's population and aggressive strategies to reduce government deficits. Broad processes of change at the macro and meso scales include privatization, downsizing, amalgamation and labour force change. More specific antecedents flow from a decade of failed attempts to address longstanding issues of service coordination and case management. The current Progressive Conservative government, elected in 1995, has been strongly driven by an ideology in which the free-market is viewed as a source of regulatory efficiency and public sector downsizing is viewed as a key strategy to aid deficit control. Interviews were conducted with a range of elderly and disabled service users and their caregivers. Long-term care service providers, hospital providers, administrators and municipal representatives were also interviewed. The results emphasize the particular vulnerabilities of service users who are disabled, who have both physical and mental health needs, and those with low income. As restructuring proceeds, this research highlights the fact that individuals, family members and formal care providers are being forced to enlist the support of a diverse range of formal and informal supportive services when it comes to maintaining their independence.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».