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From home to hospital and back again: economic restructuring, end of life, and the gendered problems of place-switching health services

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  • Cartier, Carolyn

Abstract

Economic restructuring in the health services industry in the USA exemplifies general patterns of economic change propelled by neoliberalism, especially industry privatization, diminished social services, and dependence on "flexible" labor and management regimes. Combined with the widespread entry of women into the labor force, an aging population, and minimal assistance for high quality long-term care at the end of life, these economic and social conditions raise a set of difficult policy questions for health services planning. Set in these broad contexts, this paper situates access to and experience of health services in the home, the hospital, and nursing facility, to demonstrate how economic changes have relocated and redefined health services in ways that distinctively impact how people experience the places where they receive care. This place switching of health services externalizes costs of subacute and "daily life care" (the so-called custodial care) to the sphere of the individual, their family, and communities. The theoretical analysis uses current geographical and philosophical approaches to place and space, and considers the tensions between institutionally managed health care space, and the patient's experience of receiving health services in place. The place/space dilemma of health services provision is examined through several interrelated subjects: long-term care at the end of life, gendered characteristics of care giving, the limitations of Medicare and Medicaid, historical changes in hospital length of stay, the restructuring of nursing practices, and the "no-care zone". The analysis is based on examples of stroke and incontinence care to demonstrate the importance of considering place and space issues in health care planning.

Suggested Citation

  • Cartier, Carolyn, 2003. "From home to hospital and back again: economic restructuring, end of life, and the gendered problems of place-switching health services," Social Science & Medicine, Elsevier, vol. 56(11), pages 2289-2301, June.
  • Handle: RePEc:eee:socmed:v:56:y:2003:i:11:p:2289-2301
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    Cited by:

    1. Exley, Catherine & Allen, Davina, 2007. "A critical examination of home care: End of life care as an illustrative case," Social Science & Medicine, Elsevier, vol. 65(11), pages 2317-2327, December.
    2. 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.
    3. Lehoux, Pascale & Daudelin, Geneviève & Poland, Blake & Andrews, Gavin J. & Holmes, Dave, 2007. "Designing a better place for patients: Professional struggles surrounding satellite and mobile dialysis units," Social Science & Medicine, Elsevier, vol. 65(7), pages 1536-1548, October.
    4. Stonington, Scott D., 2012. "On ethical locations: The good death in Thailand, where ethics sit in places," Social Science & Medicine, Elsevier, pages 836-844.
    5. Lowton, Karen, 2009. "'A bed in the middle of nowhere': Parents' meanings of place of death for adults with cystic fibrosis," Social Science & Medicine, Elsevier, vol. 69(7), pages 1056-1062, October.
    6. Martin, Graham P. & Nancarrow, Susan A. & Parker, Hilda & Phelps, Kay & Regen, Emma L., 2005. "Place, policy and practitioners: On rehabilitation, independence and the therapeutic landscape in the changing geography of care provision to older people in the UK," Social Science & Medicine, Elsevier, vol. 61(9), pages 1893-1904, November.

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