title: Impoverishment of practice: analysis of effects of economic discourses in home care case management practice.
abstract: Home care is a health sector under increasing pressure. Demand is often said to be outstripping capacity, with constant change and retrenchment distinguishing features of the current context. This paper takes a reading of the current conditions of home care using data gathered during a field study of home care case management practices conducted in 2004. As economic discourses become increasingly influential in determining responses to client situations, case managers (and their managers) find themselves with limited capacity to exercise control over their practices. A growing gap between professionally influenced discourses--those presumably intended to guide practice--and organizational priorities creates a dissonance for case managers as the political-ethical dimensions of their practices are displaced by budget "realities." For front-line workers, such displacement cannot be sustained in their face-to-face encounters with clients, leading to a growing sense of frustration and powerlessness among these highly skilled practitioners.
authors.affiliation: University of Victoria, BC. c-jceci@shaw.ca
authors.forename: Christine
authors.initials: C
authors.lastname: Ceci
mesh_terms: D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D002017:Budgets / Q000458:organization & administration; D002170:Canada; D019090:Case Management / Q000458:organization & administration*; D003152:Community Health Nursing / Q000458:organization & administration*; D003363:Cost Control; D003659:Decision Making, Organizational; D005639:Frustration; D015276:Health Care Rationing / Q000458:organization & administration; D006301:Health Services Needs and Demand; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D009313:National Health Programs; D009718:Nurse Administrators / Q000458:organization & administration / Q000523:psychology; D015404:Nursing Methodology Research; D009936:Organizational Innovation; D016134:Organizational Policy; D018802:Patient-Centered Care / Q000458:organization & administration; D011057:Politics; D011209:Power, Psychological; D017009:Professional Autonomy