title: Silenced complaints, suppressed expectations: the cumulative effects of home care rationing.
abstract: In many Western welfare jurisdictions, publicly provided home care is being eroded and its provision increasingly individualized. These shifts are of a particular significance for older women, a group for whom supportive home care has been an important buttress against the social and physical jeopardies of old age. A longitudinal, qualitative study of such women in Ontario, Canada, spanned the implementation of managed competition in home care and a period of rapid privatization and service rationing. Study participants experienced cuts and, stemming from increasingly precarious employment conditions in the home care workforce, inconsistent care providers. These changes generated distress, insecurity, and isolation in participants' lives. This article explores how their complaints about insufficient care were silenced: by fear, hopelessness, and the cultural injunction to put a stoic and selfless face on the limitations of old age. Their accounts reveal how large material and discursive shifts and state restructuring come to penetrate identity, feeling, and speech. This examination of the silencing of complaint at home care's front lines reveals the cumulative effects of rationing; it also illuminates how, if heard, service users' voices can inform collective struggles to resist the degradation of home care and reposition older people in relation to the state.
authors.affiliation: School of Social Work, McMaster University, Hamilton, Ontario, Canada. aronsonj@mcmaster.ca
authors.forename: Jane
authors.initials: J
authors.lastname: Aronson
mesh_terms: D000328:Adult; D003258:Consumer Behavior; D005260:Female; D015276:Health Care Rationing; D006699:Home Care Services; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009313:National Health Programs; D009864:Ontario