Re-Imagining Long-Term Residential Care: An International Study of Promising Practices
39 Pages Posted: 14 Aug 2011
Date Written: August 12, 2011
“A society that treats its most vulnerable members with compassion is a more just and caring society for all” (WHO 2002:5). Long-term residential care is where many of our most vulnerable members live and, in spite of moves towards aging in place, where many will continue to live in the future. It is also a workplace for thousands of paid and unpaid providers, most of whom are women and many of whom are from minority communities. It is a barometer of values and practices; a signal of economic, cultural and social perspectives, raising issues that go beyond specific services and practices; issues such as human and social rights, the role of the state, responsibilities of individuals, families and governments, work organization and skills; and notions of care. Yet too often it is characterized as failure; failure of the family to care, failure of the health care system to cure and failure of the individual to live independently, perhaps explaining why it has received so little research and policy attention.
Instead of focusing primarily on failures, this paper will sketch out an innovative program to identify promising practices for conceptualizing and organizing long-term care, learning from and between countries. It looks to promising approaches to residential care, to work organization within those facilities, to accountability for quality, to financing and ownership in long-term residential care where the goal is to treat both providers and residents with dignity and respect, to understand care as a relationship and to take differences and equity into account. This paper will provide the first interim report of an international (6 countries), interdisciplinary, 7-year study funded by the Social Sciences and Humanities Research Council of Canada’ Major Collaborative Research Initiatives (2.5 million). The study’s research team includes not only academics, but experienced administrators, representatives of providers, unions, and employers from Canada, U.S., Germany, Norway, Sweden, the U.K (see Appendix 1 for the complete research team).
The study’s innovative multi-method approach, with site switching, rapid ethnography used for primary data collection will be presented. Its four theme areas will be explained beginning with analytical mapping of residential care in each jurisdiction, providing both a portrait and analysis of each. The challenges of employing key informant interviews in different countries, with team development between countries, and rapid ethnography techniques of residential care facilities in several locations, with protocols and web-based systems ensuring data sharing across the team in a timely and rigorous manner, will be presented. The goals of iterative analysis of theory and data and reflexive analysis methods will be explained. The paper concludes with a dialectical assessment of innovate methods designed to stimulate innovative thinking by constantly bringing fresh eyes to what is commonplace and ordinary to local observers, but completely new to colleagues and partners from another country. The need to confront opportunities for comparison and rigor with openness to new insights and diverse contexts will be outlined. The philosophical underpinnings of the project are that practical implications of theory and the theoretical implications of practices and processes can create conditions for breakthroughs in theory, empirical results, processes of collaboration, policy and practices not only about conceptualization of residential care and their implications but also about ways of doing and sharing research, filling major gaps in knowledge about long-term care.
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