Direct Funding and the Depoliticization of Home Care Systems: Popular Rhetoric and Policy Directions in Ontario
Bibliographic record
Abstract
Home care systems have undergone major transformation in the last twenty years, manifesting as a volatile series of policy changes in Ontario, Canada. This includes increasing attention to direct funding (DF) home care where individuals receive cash transfers to arrange their own services. Through a textual analysis of 101 media and grey literature sources about DF home care in Ontario published between 2011 and 2018, we find three interrelated, yet sometimes conflicting, discourses in public circulation. DF is represented as: (1) a ‘fix’ to the challenges of mainstream home care; (2) a form of marketization; and (3) as social transformation. We argue that these discourses reflect a neoliberal policy climate that depoliticizes and instrumentalizes DF in ways that obscure how continual policy adjustments actually contribute to frustrating experiences with home care. The contradictory claims about DF home care in the public domain often untether DF from its social justice history and from the careful implementation needed for it to be an empowering and equitable home care model. We suggest that DF home care should not be approached primarily as an individual fix to systemic problems with home care nor as a strategy for cost saving. Rather, DF should be one component of a broad spectrum of social care policies that fully acknowledge both the social justice history of the program and the complex interdependencies of home care users, workers and informal caregivers.ResumeLes systemes de soins a domicile ont connu une importante transformation au cours des vingt dernieres annees, engendrant une serie de changements politiques en Ontario (Canada), dont une attention croissante au financement direct (FD) des soins a domicile ou les individus recoivent des fonds pour gerer leurs propres services. En analysant 101 textes des medias et de la litterature grise au sujet du FD des soins a domicile, nous trouvons trois discours en libre circulation qui sont etroitement lies mais parfois contradictoires. Le FD est presente comme etant (1) une « solution » aux defis que posent les soins a domiciles traditionnels, (2) une forme de marcheisation et (3) une transformation sociale. Nous soutenons que ces discours sont le reflet d’un milieu politique neo-liberale qui depolitise et instrumentalise le FD de maniere a masquer la facon dont l’ajustement continu des politiques concourt reellement aux experiences frustrantes liees aux soins a domicile. Les affirmations contradictoires au sujet du FD des soins a domicile du domaine public detachent souvent le FD de son histoire de justice sociale et de la mise en œuvre minutieuse necessaire pour qu’il devienne un modele de soins a domicile responsabilisant et equitable. Nous proposons que le FD des soins a domicile ne soit pas aborde comme une solution individuelle aux problemes systemiques lies aux soins a domicile ou comme une strategie visant a reduire les couts, mais plutot comme faisant partie d’un large eventail de politiques d’assistance sociale qui reconnait pleinement l’histoire de justice sociale du programme ainsi que l’interdependance complexe entre les usagers des soins a domiciles, les travailleurs et les aidants naturels. Mots cles: vieillissement; Canada; invalidite; soins autogeres
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".