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Almost Home

Almost Home: Reforming Home and Community Care in Ontario

Copyright Date: 2004
Pages: 350
  • Book Info
    Almost Home
    Book Description:

    Almost Homeis a rich and comprehensive study of the policy questions underlying the shift in medical care from hospitals to homes and communities, a change that is reshaping Canadian health care policy and politics. Using document analysis, and interviews with government officials and other key stakeholders in the policy community, the authors analyze the policy content and process of five different attempts to reform home and community care in Ontario between 1985 and 1996, as introduced by governments from three different political parties.

    As this study demonstrates, the ongoing shift from the Medicare 'mainstream' of physician and hospital care to the Medicare 'margins,' entails not only a shift in the site of care but an erosion of the post-war state's role in health care. While Medicare continues to resist political and ideological forces aimed at shrinking the state's role, cost constraints, demographic pressures and technological advancements are increasing pressure on home and community care.

    The authors have made a significant contribution to research on policy development and change. Their rigorously analytical approach fills a major gap in book-length literature on long-term health care in Canada.

    eISBN: 978-1-4426-7075-4
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-xii)
  3. Acknowledgments
    (pp. xiii-xiv)
  4. Abbreviations
    (pp. xv-2)
  5. CHAPTER ONE Introduction and Overview
    (pp. 3-18)

    Hospitals are changing; care is increasingly occurring outside hospital walls in outpatient clinics, offices, and even in people’s homes (Canadian Home Care Association, 1998; Canadian Institute for Health Information, 2000; Hospital Report Research Collaborative, 2001; Shamian and Lightstone, 1997; Sheps et al., 2000). The Federal-Provincial-Territorial Advisory Committee on Health Services Working Group on Continuing Care has defined home care as ‘an array of services which enables clients, incapacitated in whole or in part, to live at home, often with the effect of preventing, delaying, or substituting for long-term care or acute care alternatives’ (Dumont-Lemasson et al., 1999).

    But the home...

  6. CHAPTER TWO Conceptual Framework
    (pp. 19-48)

    From the ‘brokerage’ proposals of the politically moderate Peterson Liberals, to the centralized ‘command and control’ approach of the socialist-leaning New Democratic Party (NDP) under Bob Rae, to the ‘managed competition’ reform of the market-oriented Mike Harris Progressive Conservative (PC) Party, the series of reform initiatives analysed in this book involved substantially different and often contradictory decisions about how community-based long-term care (LTC) services should be funded and delivered. Two sets of questions arise.

    From the perspective of the policy analyst trying to develop optimal models for financing and delivering services and mechanisms for allocating resources, it is important to...

  7. CHAPTER THREE Research Methodology: The Case Study Approach
    (pp. 49-58)

    Data-gathering techniques cannot be divorced from theoretical orientations (Berg, 1998). Certain problems lend themselves to certain forms of enquiry; in turn, the sort of data collected influences the sort of questions that can be asked. In this study we examined the influence of ideas, institutions, and interests on LTC reform. The purpose was to understand more clearly the reasons for the shifts in ‘design decisions’ about financing, delivery, and allocation reflected in the successive reform proposals and how they related to the ideas and interests that were expressed by stakeholders regarding reform. To do so, we employed a particular qualitative...

  8. CHAPTER FOUR Long-Term Care Reform in the Liberal Period, 1985–1990
    (pp. 59-105)

    In 1985 the formation of the Liberal government of David Peterson ended forty consecutive years of Progressive Conservative (PC) rule. The 2 May election had given the PCs, under the relatively conservative leadership of Frank Miller, a plurality of 52 seats in the 125-seat Legislature; 48 seats went to the Liberals, and 25 to the social democratic New Democratic Party (NDP) under Bob Rae. Although the Liberals received fewer seats than the PCs, the NDP was unwilling to support Miller. Instead, it formed an ‘accord’ with the Liberals, promising support for at least the limited future as long as its...

  9. CHAPTER FIVE Long-Term Care Reform under the New Democratic Party, 1990–1993
    (pp. 106-147)

    Election of the first New Democratic Party (NDP) government in the history of Ontario was as much a surprise to the party as it was to the rest of the province. Most observers had believed that Peterson’s Liberals would easily be re-elected, but the combination of a summertime election and the popular cynicism concerning an early election call proved fatal. Many NDP candidates had run in the belief, and perhaps even the hope, that they would not be elected; other highly experienced candidates from that party had declined to seek re-election. The NDP was accustomed to playing the roles of...

  10. CHAPTER SIX The New Democratic Government and the Multi-Service Agency, 1994–1995
    (pp. 148-223)

    By 1994, near the end of its mandate, the New Democratic Party (NDP) was finally ready to introduce legislation to implement its new vision for long-term care (LTC). Bill 173, An Act respecting Long-Term Care (Government of Ontario, 1994), generated a further set of interest group submissions to the standing committee process, which in turn resulted in several amendments to the act. The legislation as passed reflected the central-planning elements often associated with social democracy. Within each designated region, the array of agencies currently delivering services would be largely displaced by the new Multi-Service Agencies (MSAs); services would now be...

  11. CHAPTER SEVEN The Progressive Conservatives Implement Long-Term Care, 1995–1996
    (pp. 224-267)

    In June 1995 the Progressive Conservatives (PCs), led by Mike Harris, were elected on a platform that advocated less government and more reliance on the private market and market mechanisms. The key promises were incorporated into a document entitledThe Common Sense Revolution(PC, 1994), which became the blueprint for the new government. Learning from the NDP government, whose consultation processes had delayed action on a range of policy initiatives until late in the election cycle, the Conservatives decided to act quickly and decisively. The province experienced a dramatic change in the nature of governmental decision making. Consultation and participation...

  12. CHAPTER EIGHT Moving towards Home: Policy Change and Policy Stasis beyond the Medicare Mainstream
    (pp. 268-306)

    The period between 1985 and 1996 in Ontario was characterized by marked volatility in government policy in the field of community-based long-term care (LTC). Three successive governments proposed five different reform initiatives. While each reform was cloaked in the rhetoric of improved access and quality, as well as consumer independence and choice, the five initiatives integrated different, and sometimes contradictory, decisions about how community-based services should be funded and delivered and how resources should be allocated by public government to private providers, both for-profit (FP) and not-for-profit (NFP). While the first three initiatives were essentially incremental variations on a brokerage...

  13. References
    (pp. 307-326)
  14. Index
    (pp. 327-340)