Our research sought to re-imagine long-term residential care by learning from and with other countries to identify promising practices for thinking about, planning and organizing care. Long-term residential care should be seen as a positive alternative for both those who need care and those who provide it.
Long-term residential care is often characterized as failure – failure of the individual to live independently, failure of the family to care for them and failure of the health care system to cure. But many people will still need to live in a residential care home, and it should be a place where both residents and the workers who provide care experience a healthy, safe and joyful environment.
Long-term residential care is a gender issue, because women make up most of the residents and most of the workers who provide care. It is a social issue, questioning 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 project reflected that complexity.
We were searching for “promising practices” in long-term residential care through international comparisons and conversations in order to understand what works, for whom and where. We focused on “promising practices”, not “best practices”, because we didn’t think it was either possible or desirable to find a single right way.
Our study included five Canadian provinces, and the U.S., the U.K., Germany, Sweden, and Norway. In every jurisdiction, long-term residential care is organized differently, yet all face similar pressures of privatization, marketization and globalization.
The project was divided into four broad and overlapping themes, separated as a way to organize our work. We also worked across themes to connect them.
Approaches to Care looked at how ideas about long-term care and about the right to care influences what long-term care looks like in different countries. Different approaches to care and models of care reflect not only ideas about what constitutes necessary, appropriate, effective and efficient care but also ideas about gender, individual and family responsibility, citizenship, dependency, and the sense of self. We looked at how these overlap and interact to shape how care is provided, funded, practiced, located and discussed or understood. So we looked 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.
Work Organization examined who does what for whom, with what kind of training and with what recognition. Our premise is that the conditions of work are the conditions of care. What kinds of work organization generate a positive and constructive experience for workers, residents, their families and communities?
Accountability looked for a broader context to quality than value for money. Standards and a means for guaranteeing that standards are met are required, but this theme sought strategies that nurture care and inspire quality workplace relations while encouraging the best use of resources.
Financing and Ownership explored which funding mechanisms and models are most likely to promote equitable access to quality care. Who pays for care and who owns the facilities impacts who gets care and how work and care are organized.
We mapped data about the four theme areas in the jurisdictions of our study and developed ways to compare this data while keeping in mind that context matters. We looked at how best to identify promising practices that we could then study in detail.
The project was as democratic and collaborative as possible. Beyond our research team, we met with government, union and employer groups continually, participating in forums to exchange knowledge and perspectives.
Our methodology was also innovative. We challenged ourselves and each other to bring fresh eyes to the challenges of long-term residential care.
We initially had seven years to complete this study, but we didn’t wait seven years to provide information and contributions to debates about long-term residential care. Our research team and our partners were committed to being part of the conversations about policy and practice as we moved forward.