Article

An institutional ethnography of elder care [microform] : understanding access from the standpoint of ethnic and racial minority women.

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Abstract

Thesis (Ph. D.)--University of Toronto, 2000. Includes bibliographical references.

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... Some older women's experiences may be better reflected by a focus on 'racial' and minority status, for example (Brotman, 1999). ...
... Two concerns for recruitment identified in my proposal however, were the inclusion o f varying social locations and informed consent. There is often a difficulty in gerontological studies to recruit and include older and ethnic minority women (Brotman, 1999 ...
Article
This study explores women's narratives from within and outside of the frail/non-frail binary of public home care services. It focuses on the stories that are commonly told about older women's needs and bodies and the regulatory potential of these accounts. Considering power, language, diversity and change, this study focuses on the way that twelve diverse older women at various social locations (e.g., ability, age, culture, ethnicity, 'race', sexual orientation, and socio-economic status) understand, make meaning, and negotiate the concept of frailty in relation to their everyday lives. The sample includes six women considered 'frail' in relation to service (i.e., according to clinical judgement & home care eligibility guidelines), as well as women not considered 'frail' (i.e., non-service recipients). The twelve older women's storied responses, illustrations and experiences challenge the various stories that are told about them. Their complex accounts both reflect and reject dominant notions, blur the boundary between the frail and non-frail classifications, expose frailty as contextual, temporal and relative, as well as illustrate the connections between medical and social needs. Their individual accounts highlight how they make meaning of their life events in relation to their diverse experiences and identities, as well as how these identities and interpretations are key to their negotiations of life and needs. The variations between the imposed stories about frailty and women's self-perceptions highlight the research, policy and practice relevance of a narrative approach focused on in-depth local accounts, raise questions about the current priorities within home care services, as well as the future of social work practice with older women considered frail.
... Some research has placed specific emphasis on culturally charged components of the care experience such as food (Forster-Coull and Koehn 2001) and language and communication styles (e.g., Saldov and Chow 1994), or explored the cultural appropriateness of models of care (e.g., the Eden Alternative: Fung 2006). Relatively few researchers (Brotman 2000;Koehn 2009;Mullings 2006) have spoken to the intersecting oppressions experienced by visible minority older adults, especially women, which influence their admission to and shape their quality of life in long-term Final before proofs version for self-archiving-please cite published version only 24 care facilities. Culturally-targeted long-term care facilities are positively evaluated as meeting the needs of ethnocultural minority older adults (Fung 2006;Kromer 2004;Pereira Lazarowich, and Wister 1996). ...
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This paper uses an intersectionality theoretical lens to interrogate selected findings of a scoping review of published and grey literature on the health and health care access of ethnocultural minority older adults. Our focus was on Canada and countries with similar immigrant populations and health care systems. Approximately 3300 source documents were reviewed covering the period 1980-2010: 816 met the eligibility criteria; 183 were Canadian. Summarized findings were presented to groups of older adults and care providers for critical review and discussion. Here we discuss the extent to which the literature accounts for the complexity of categories such as culture and ethnicity, recognizes the compounding effects of multiple intersections of inequity that include social determinants of health as well as the specificities of immigration, and places the experience of those inequities within the context of systemic oppression. We found that Canada’s two largest immigrant groups— Chinese and South Asians—had the highest representation in Canadian literature but, even for these groups, many topics remain unexplored and the heterogeneity within them is inadequately captured. Some qualitative literature, particularly in the health promotion and cultural competency domains, essentializes culture at the expense of other determinants and barriers, whereas the quantitative literature suffers from oversimplification of variables and their effects often due to the absence of proportionally representative data that captures the complexity of experience in minority groups.
Chapter
Institutional ethnography (IE) is a useful and systematic process for examining organizations and work data through the lens of stakeholders, at different levels, and different forces. Drawing from ethnomethodology, IE focuses on how everyday experience is socially organized. As an analytic focus, power crosses boundaries, providing researchers a view of social organization that illuminates practices that marginalize. This chapter provides the conceptual underpinnings for considering IE as a methodological tool and affords researchers the opportunity to see how IE has been used in adult and workforce education settings to make invisible practices visible to the victim. The result can often be information that leads to exploring or engaging in emancipatory efforts that lend to different and better future outcomes for other victims in similar situations.
Chapter
Full-text available
This paper introduces institutional ethnography (IE) as a useful and systematic process for examining organizations and work data through the lens of stakeholders, at different levels, and considering the different forces at play. Drawing from ethnomethodology, IE focuses on how everyday experience is socially organized. Ideological shifts have changed the view of research as purely technical and rational to one of social practice embedded in particular cultural, political, and historical contexts. Research has translated into partially unsuccessful practice because it negates individuals' unique experiences based on race, ethnicity, class, and gender, allowing for a monolithic view to become the given reality for all those who live in today’s society. Because adult vocational education is practiced in a highly charged political context, amongst a nexus of interconnected and interdependent social processes such as federal and state legislation, program funding and planning, literacy work, and employment training, discourse sets the parameters for a person’s ability or inability to navigate the structural and political subsystems that impact learning, teaching, and work. Power is critically important as an analytic focus which crosses boundaries providing researchers a view of social organization that illuminates practices that marginalize.
Chapter
The rate of population aging continues to be a serious preoccupation of health care professionals and policy makers. Much has been written about the potential impact of aging on the ability of the health and social service system to respond adequately to the increased demand placed upon it by the rapidly growing population of older people (Chappell, Strain, and Blandford 1986; Rittner, and Kirk 1995). In the past decade in Canada, the question of access to community elder care services has been taken up with greater frequency in elder care research and policy initiatives, partially in response to concerns about the financial and resource strains that older people place upon the health care system. Initiatives focused upon improving access have been undertaken largely in an attempt to improve service delivery, delay institutionalization, and streamline the system, thereby increasing efficacy, reducing service duplication, and lowering costs.
Article
Health care cuts and restructuring are shifting the site of acute care from hospitals to homes and prompting provincial governments to introduce varying forms of mixed economies in home care. Typically, such arrangements seek to drive down public costs and to reposition service users as “consumers” of market-modelled care. Drawing on an ongoing study of frail elderly women and women with disabilities receiving home care in Ontario, this paper explores the significance for service users of these economic and political objectives. Rather than feeling like consumers free to exercise choice and demand quality in the mixed economy of home care, they experienced their positioning within it as insecure and subordinate and its supply as unpredictable and meagre. The implications of these findings for fashioning secure and equitable public responses to elderly and disabled citizens who need assistance at home over the long term are discussed.
Article
There is a growing body of evidence that suggests that the prevailing public discourse around improving the health of Canadians has failed to provide any meaningful results. Despite universal access to a publicly funded system of health care delivery, the research clearly demonstrates that persons with low incomes can expect to be less healthy, suffer more and die earlier than their wealthier neighbours, simply because they are poor. In particular, women marginalized by poverty are at much higher risk for inequitable health care treatment as well as the gamut of health related concerns. As poverty becomes increasingly feminized and medicalized as a result of shifting socio-political priorities, the consequences for women may be particularly dire. This paper focuses on the health and health care needs of low-income women living in an urban setting. Based on the findings of a qualitative study, it explores the relationship between health, poverty and gender and discusses how those most impacted view their own health and the health care they receive. The results indicate that the traditional biomedical discourse that individualizes health matters does not adequately reflect the complex and multidimensional health needs of low-income women that are often rooted in their social locations. As a result, current health care responses offer only limited solutions to women's health problems. Further, based on participants' narrative accounts, women who experience poverty also experience significant marginalization when accessing mainstream health services. Using an institutional ethnographic analysis to frame the findings, this paper concludes that the health care oflow-income women is largely structurally determined as a product of dominant ruling relations that reinforce and perpetuate the feminization and medicalization of women's poverty. Poor health is a product of societal injustices and, therefore, requires responses beyond the individual including policy, practice and research initiatives.
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