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Long-term care restructuring in rural Ontario: retrieving community service user and provider narratives


  • Cloutier-Fisher, Denise
  • Joseph, Alun E.


This paper examines the extensive restructuring of community-based long-term care that was initiated in Ontario, Canada in 1996, and does so with particular reference to longstanding problems of provision in rural communities. Specifically, it draws on a case study focussed on two small rural towns to develop a 'situated understanding' of service-user and service-provider perspectives on service coordination issues and on service cuts, particularly as they affect the ability of elderly people reliant on publicly-funded community services to stay in their homes, to continue to 'age in place'. The general and specific antecedents of long-term care reform are considered prior to the presentation of the case study. General antecedents include the rapid aging of Canada's population and aggressive strategies to reduce government deficits, while specific antecedents flow from a decade of failed attempts to address longstanding issues of service coordination and from the ideologically-driven, free market stance of the provincial government elected in 1995. The analysis of interviews conducted with 14 community-service users and 17 providers suggests that the managed competition system introduced as the centerpiece of long-term care reform has resulted in increasing diversity and uncertainty on both sides of the service provision equation. Despite continued attempts by rural elderly people and their families to 'cut and paste' support packages, it seems that the restructuring of publicly-funded community services, combined with a substantial re-investment in long-term care facilities, will make some elderly people more vulnerable to institutionalization.

Suggested Citation

  • Cloutier-Fisher, Denise & Joseph, Alun E., 2000. "Long-term care restructuring in rural Ontario: retrieving community service user and provider narratives," Social Science & Medicine, Elsevier, vol. 50(7-8), pages 1037-1045, April.
  • Handle: RePEc:eee:socmed:v:50:y:2000:i:7-8:p:1037-1045

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    References listed on IDEAS

    1. Wagstaff, Adam, 1991. "QALYs and the equity-efficiency trade-off," Journal of Health Economics, Elsevier, vol. 10(1), pages 21-41, May.
    2. Gerdtham, U. -G. & Johannesson, M. & Lundberg, L. & Isacson, D., 1999. "A note on validating Wagstaff and van Doorslaer's health measure in the analysis of inequalities in health," Journal of Health Economics, Elsevier, vol. 18(1), pages 117-124, January.
    3. Newbold, K. Bruce & Eyles, John & Birch, Stephen, 1995. "Equity in health care: Methodological contributions to the analysis of hospital utilization within Canada," Social Science & Medicine, Elsevier, vol. 40(9), pages 1181-1192, May.
    4. Wagstaff, Adam & van Doorslaer, Eddy & Paci, Pierella, 1991. "On the measurement of horizontal inequity in the delivery of health care," Journal of Health Economics, Elsevier, vol. 10(2), pages 169-205, July.
    5. Culyer, A. J. & Wagstaff, Adam, 1993. "Equity and equality in health and health care," Journal of Health Economics, Elsevier, vol. 12(4), pages 431-457, December.
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    Cited by:

    1. Andrews, Gavin J. & Cutchin, Malcolm & McCracken, Kevin & Phillips, David R. & Wiles, Janine, 2007. "Geographical Gerontology: The constitution of a discipline," Social Science & Medicine, Elsevier, vol. 65(1), pages 151-168, July.
    2. James Ted McDonald & Angela Sherman, 2008. "Determinants of Mammography Usage across Rural and Urban Regions of Canada," Social and Economic Dimensions of an Aging Population Research Papers 238, McMaster University.
    3. Skinner, Mark W. & Rosenberg, Mark W., 2006. "Managing competition in the countryside: Non-profit and for-profit perceptions of long-term care in rural Ontario," Social Science & Medicine, Elsevier, vol. 63(11), pages 2864-2876, December.
    4. McDonald, James Ted & Worswick, Christopher, 2012. "The migration decisions of physicians in Canada: The roles of immigrant status and spousal characteristics," Social Science & Medicine, Elsevier, vol. 75(9), pages 1581-1588.


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