In this research, we are re-imagining long-term residential care as viable option that has the potential to:
- be cost-efficient over outfitting and providing care in widely dispersed private dwellings;
- offer community, social life and meaningful activity for residents who, if living independently, may be isolated and restricted at home;
- be a workplace that workers can take pride in, where they enjoy providing quality care that is valued by residents, families and funders.
We have big dreams, but realizable dreams, for long-term care.
Long-term residential care is often considered as failure, failure of the individual to maintain themselves, failure of their family to care and failure of the medical system to cure. But some people will always need residential care, and this should be a place where residents and workers who provide care experience a healthy, safe and joyful environment. However, in these neoliberal times, residents tend to be viewed as a growing burden to the system and workers are often viewed as an expense to be controlled and managed.
Our study is of a moving target of change that affects us all, sooner or later. It is a gender issue, because women make up most of the residents, most of the workers and most of the people in communities and households who provide care. It is a social issue, in that it begs the question about who we, as a society, treat well and who we don’t. And it is a political issue, because the choices we make about long-term residential care are made in the realm of politics. It is complex, and our study reflects that complexity.
We are searching for what we call “promising practices” in long-term residential care through international comparisons and conversations in order to understand what works, for whom and where. We focus on promising practices as opposed to “best practices”, because we don’t believe that there is only one way to go, no matter where you live, how your society is organized, or no matter what kind of situation you are in. There is no simple, single answer to the challenges before us.
Our starting point is the World Health Organization statement that says “a society that treats its vulnerable members with compassion is a more just and caring society for all.” Our study is both Canadian, in that we are studying six provincial jurisdictions across the country, and international, in that we include two American states, Germany, Sweden, Norway, and the UK. In every jurisdiction, long-term residential care is organized differently, yet all face similar pressures of neoliberal governance, in brief, those pressures of privatization, marketization and globalization.
Our investigation is organized around four broad and overlapping themes that our scholars from nursing, medicine, social work, sociology, architecture, philosophy, history, cultural studies and others on our team will study. First, we are looking at Approaches to Care. Here we are looking at how long-term care is organized in different countries, to see what is familial, what is bio-medical, what is social care and what is left for markets to provide. We look at how these overlap and interact to shape how care is provided, funded, practiced, located and discussed or understood. So we are looking at only what constitutes necessary, appropriate, effective and efficient care, but also about how ideas of gender, individual and family responsibility, citizenship and self-worth are involved.
Our second related theme is Work Organization. Here we are examining the impact of new regulatory regimes, designs for physical space, issues of full-time vs part-time work, worker credentials and who does what, as well as whistle-blowing mechanisms and much more. But our premise is that the conditions of work are the conditions of care, and we need to attend to the ways in which work organization is arranged to facilitate the best of working and caring environments.
Our third theme is Accountability. We reject the notion that accountability is always about money, or that it is about those who do care work being responsible to those who fund it. We see accountability as addressing issues of accountability and democracy and operating in reciprocal fashion, with residents and their families at the centre of promising practices accountability measures.
Our fourth and final theme is Financing and Ownership, where we are exploring which capital and operating funding mechanisms and models are most likely to promote equitable access to quality care. We are investigating the effects of for–profit, not-for-profit and public forms of ownership as they exist in different regions and countries.
Right now we are mapping data about these four theme areas in the many jurisdictions of our study. We are developing ways to compare this data while keeping the fact that context matters in mind, and we are vigorously pursuing how best to identify promising practices that we can then go out and study in detail.
The project is exciting because it is as democratic and collaborative as we can make it. Beyond our research team, we are meeting with government, union and employer groups continually, participating in forums to exchange knowledge and perspectives.
Our methodology is also innovative, in that we are challenging ourselves and each other to bring fresh eyes to the challenges of long-term residential care.
We have seven years to complete this study, but we won’t wait seven years to provide information and contributions to debates about long-term residential care. When we have talked about this project, people are anxious to have us produce results quickly. Our team of 25 researchers and our partners are committed to being part of the conversations about policy and practice as we go forward. We do not have those easy quick answers, but we won’t withhold what we learn as we go along.