Grant: Project Grant

Canadian home care systems are urgently in need of an overhaul.[1] There is increased demand due to aging demographics and because cultural norms now support home and community-based care over long-term residential care. It is difficult to recruit and retain workers to these fields, client needs are increasingly complex, and the system is infamously fragmented.[2] Direct Funding (DF) models of home care are innovative policy mechanisms designed to address some of these issues.[3] DF provides individuals with cash to hire and manage workers instead of receiving services through a home care agency. People with disabilities and older people in other countries report high levels of satisfaction with the flexibility, cultural sensitivity and autonomy linked to receiving DF home care, although the results for workers are mixed. Ontario is piloting DF for older adults in 2016. The proposed study aims to conduct primary research using qualitative methods to explore this development. Our research question is: How do DF programs shape the experiences, working conditions, policy landscape, and theoretical implications of community care? This project will also consider whether DF programs attend to inequalities related to disability, gender, racialization and immigration. The study includes an analysis of media and grey literature documents found in the public domain, interviews with policy makers, home care workers, older adults, and their families, and an international workshop to explore DF. The team includes seven established and emerging interdisciplinary qualitative health researchers, three community partners and one government collaborator. The knowledge created through this project will have value to Ontario policymakers to refine the program being studied and other DF programs, community organizations to inform their members, academics working around care theory, and individuals exploring their home care and work options.