Long-term care restructuring in rural Ontario, retrieving community narratives through a case study approach
Bibliographic record
Abstract
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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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 | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| 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".