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Inequities in access to directly-funded home care in Canada: a privilege only afforded to some

BACKGROUND: Directly-funded home care (DF) provides government funds to people who need assistance with the activities of daily living, allowing them to arrange their own services. As programs expand globally, many allow DF clients to hire home care agencies to organize their services rather than fi...

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Autores principales: Kelly, Christine, Dansereau, Lisette, FitzGerald, Maggie, Lee, Yeonjung, Williams, Allison
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9847438/
https://www.ncbi.nlm.nih.gov/pubmed/36653820
http://dx.doi.org/10.1186/s12913-023-09048-9
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author Kelly, Christine
Dansereau, Lisette
FitzGerald, Maggie
Lee, Yeonjung
Williams, Allison
author_facet Kelly, Christine
Dansereau, Lisette
FitzGerald, Maggie
Lee, Yeonjung
Williams, Allison
author_sort Kelly, Christine
collection PubMed
description BACKGROUND: Directly-funded home care (DF) provides government funds to people who need assistance with the activities of daily living, allowing them to arrange their own services. As programs expand globally, many allow DF clients to hire home care agencies to organize their services rather than finding their own workers. In Canada, half of the DF home care programs allow users to purchase agency services. The goal of this research is to describe the role of agency providers in DF home care in Canada and consider potential equity implications for service access from the perspectives of clients and families. METHODS: Framed with intersectionality, the study included online focus groups with families and clients (n = 56) in the two Canadian provinces of Alberta and Manitoba between June 2021-April 2022. All transcripts underwent qualitative thematic analysis using open and axial coding techniques. Each transcript was analyzed by two of three possible independent coders using Dedoose qualitative analysis software. RESULTS: The article presents five thematic findings. First, the focus groups document high rates of satisfaction with the care regardless of whether the client uses agency providers. Second, agency providers mediate some of the administrative barriers and emotional strain of using DF home care, and this is especially important for family caregivers who are working or have additional care responsibilities. Third, there are out-of-pocket expenses reported by most participants, with agency clients describing administrative fees despite lower pay for the frontline care workers. Fourth, agencies are not generally effective for linguistic and/or cultural matching between workers and families. Finally, we find that DF care programs cannot compensate for a limited informal support network. CONCLUSIONS: Clients and families often intentionally choose DF home care after negative experiences with other public service options, yet the results suggest that in some Canadian contexts, DF home care is a privilege only afforded to some. Given the growing inequalities that exist in Canadian society, all public home care options must be open to all who need it, irrespective of ability to pay, degree of social support, or competence in the English language. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-09048-9.
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spelling pubmed-98474382023-01-18 Inequities in access to directly-funded home care in Canada: a privilege only afforded to some Kelly, Christine Dansereau, Lisette FitzGerald, Maggie Lee, Yeonjung Williams, Allison BMC Health Serv Res Research BACKGROUND: Directly-funded home care (DF) provides government funds to people who need assistance with the activities of daily living, allowing them to arrange their own services. As programs expand globally, many allow DF clients to hire home care agencies to organize their services rather than finding their own workers. In Canada, half of the DF home care programs allow users to purchase agency services. The goal of this research is to describe the role of agency providers in DF home care in Canada and consider potential equity implications for service access from the perspectives of clients and families. METHODS: Framed with intersectionality, the study included online focus groups with families and clients (n = 56) in the two Canadian provinces of Alberta and Manitoba between June 2021-April 2022. All transcripts underwent qualitative thematic analysis using open and axial coding techniques. Each transcript was analyzed by two of three possible independent coders using Dedoose qualitative analysis software. RESULTS: The article presents five thematic findings. First, the focus groups document high rates of satisfaction with the care regardless of whether the client uses agency providers. Second, agency providers mediate some of the administrative barriers and emotional strain of using DF home care, and this is especially important for family caregivers who are working or have additional care responsibilities. Third, there are out-of-pocket expenses reported by most participants, with agency clients describing administrative fees despite lower pay for the frontline care workers. Fourth, agencies are not generally effective for linguistic and/or cultural matching between workers and families. Finally, we find that DF care programs cannot compensate for a limited informal support network. CONCLUSIONS: Clients and families often intentionally choose DF home care after negative experiences with other public service options, yet the results suggest that in some Canadian contexts, DF home care is a privilege only afforded to some. Given the growing inequalities that exist in Canadian society, all public home care options must be open to all who need it, irrespective of ability to pay, degree of social support, or competence in the English language. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-09048-9. BioMed Central 2023-01-18 /pmc/articles/PMC9847438/ /pubmed/36653820 http://dx.doi.org/10.1186/s12913-023-09048-9 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Kelly, Christine
Dansereau, Lisette
FitzGerald, Maggie
Lee, Yeonjung
Williams, Allison
Inequities in access to directly-funded home care in Canada: a privilege only afforded to some
title Inequities in access to directly-funded home care in Canada: a privilege only afforded to some
title_full Inequities in access to directly-funded home care in Canada: a privilege only afforded to some
title_fullStr Inequities in access to directly-funded home care in Canada: a privilege only afforded to some
title_full_unstemmed Inequities in access to directly-funded home care in Canada: a privilege only afforded to some
title_short Inequities in access to directly-funded home care in Canada: a privilege only afforded to some
title_sort inequities in access to directly-funded home care in canada: a privilege only afforded to some
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9847438/
https://www.ncbi.nlm.nih.gov/pubmed/36653820
http://dx.doi.org/10.1186/s12913-023-09048-9
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