Abstract:

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.