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. 2018 Aug;14(1):30-43.
doi: 10.12927/hcpol.2018.25550.

Community-Based Reform Efforts: The Case of the Aging at Home Strategy

Allie Peckham  1 , David Rudoler  2 , Joyce M Li  3 , Sandra D'Souza  4
Affiliations

Community-Based Reform Efforts: The Case of the Aging at Home Strategy

Allie Peckham et al. Healthc Policy. 2018 Aug.

Abstract
in English, French

This paper considers one of Ontario's largest reform efforts: the Aging at Home Strategy (AHS). The AHS was initiated in 2007 to enable people to live independent lives in their own homes. A document review was conducted on relevant government materials to assess the goals and objectives of the AHS as it was rolled out over the course of three years. The findings identify that by the third year of the AHS, there was a reduction in the discretionary powers of the regional health authorities to allocate funds based on local priorities. These findings also highlight that the "mainstream" subsectors of the healthcare system - medical and hospital services - and those outside the mainstream (or the "marginal" subsectors) face different institutional boundaries, policy legacies, political actors and policy agendas. While interests within the mainstream subsector are organized and institutionalized, the marginal subsectors are fragmented, creating a power imbalance where the priorities of the mainstream subsector dominate.

Cet article traite d'un des plus grands efforts de réforme en Ontario: la stratégie Vieillir chez soi (VCS). Cette stratégie a été créée en 2007 afin de permettre aux personnes de vivre en autonomie dans leurs propres foyers. La documentation gouvernementale pertinente a fait l'objet d'une revue afin d'évaluer les buts et objectifs de la stratégie VCS sur une période de trois ans. Les résultats indiquent qu'après trois ans, il y a réduction du pouvoir discrétionnaire des autorités régionales de la santé leur permettant d'allouer les fonds selon les priorités régionales. Ces résultats mettent également en lumière le fait que les sous-secteurs « dominants » du système de santé – services médicaux et hospitaliers – et ceux hors du courant dominant (c'est-à-dire les sous-secteurs « marginaux ») font face à différentes limites institutionnelles ainsi qu'à divers acteurs, programmes ou traditions politiques. Alors que les intérêts du sous-secteur dominant sont organisés et institutionnalisés, les sous-secteurs marginaux demeurent fragmentés, ce qui crée un déséquilibre des pouvoirs où les priorités du sous-secteur dominant l'emportent.

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Figures

Figure 1.
Figure 1.
Map of Ontario's 14 LHIN regions
Figure 2.
Figure 2.
Timeline of the Aging at Home vision
Figure 3.
Figure 3.
Timeline of the outcomes and goals of the Aging at Home Strategy
Figure 4.
Figure 4.
Timeline of documented funding of the Aging at Home Strategy
See this image and copyright information in PMC

References

    1. Baranek P.M., Deber R.B., Williams A.P. 2004. Almost Home: Reforming Home and Community Care in Ontario. Toronto, ON: University of Toronto Press. 10.3138/9781442670754.
    1. Bowen G.A. 2009. “Document Analysis as a Qualitative Research Method.” Qualitative Research Journal 9: 27–40. 10.3316/QRJ0902027.
    1. Canadian Healthcare Association. 2009. Home Care in Canada: From the Margins to the Mainstream. Retrieved April 15, 2018. <http://www.healthcarecan.ca/wp-content/themes/camyno/assets/document/Pol...>.
    1. Central East Local Health Integration Network. 2009. Aging at Home Strategy: Year Two Call for Proposals. Retrieved April 15, 2018. <http://www.centraleastlhin.on.ca/Page.aspx?id=7446>.
    1. Central East Local Health Integration Network. 2010. Central East LHIN Expands Aging at Home Programs. Retrieved April 15, 2018. <www.centraleastlhin.on.ca/Page.aspx?id=FC83E0C6EB524D419087C8EB1195EA28>.