Laura Megan Funk

Care poverty describes situations where people do not receive enough care due to both individual and structural factors. Care poverty, as a novel concept, is gaining traction internationally, and this article is the first to examine care poverty in the Canadian context. Using nationally representative data from Statistics Canada’s 2018 General Social Survey on caregiving and care receiving, we estimate the prevalence of care poverty among Canadians over the age of 15 and examine the independent effects of socio-economic factors. Over one quarter (27.35 per cent) of Canadians with care needs experience care poverty. People living alone, those born outside of Canada and those between the ages of 45 and 64 are more likely to report receiving no support. High levels of self-rated stress, more severe disability and being female increase the odds of receiving some, though not enough, care. Our findings are contextualized in light of Canada’s social-liberal policy landscape and universal healthcare system, suggesting that Canadians whose care needs are perceived as medical and those who are able to rely on their family or the market to meet their needs may be less likely to experience care poverty. Further, our findings suggest that those living in absolute care poverty may only need small amounts of support to live independently at home.

Background and Objective: In this article, we explore how Long-Term Residential Care (LTRC) features contribute to violence against staff. Methods: Data were collected using a mixed-methods case study in LTRC, including an online survey (N = 240) and interviews with staff (N = 29) in two Canadian provinces. Findings: Survey data showed 97.2% of staff reported experiencing at least one form of violence from residents, and 53.2% experienced one or more forms of violence from family carers. Severe physical violence from residents was significantly correlated with the number of different types of training staff received and working with a higher proportion of residents with cognitive impairment. Staff attributed violence from family carers to mistrust, lack of understanding, and ‘unrealistic expectations’ while they attributed violence from residents to insufficient resources. Discussion: Violence in LTRC occurs across multiple relationships. To address this, structural changes to staffing and working conditions that enhance trust and relational care are essential.

Background: This study engages with the experiences and challenges reported by Punjabi family carers of older adults from one census metropolitan city in Canada. Objective: Our focus was on understanding carers’ interpretations of family and public responsibilities for supporting older adults. Methods: We interviewed eight Punjabi carers in one Canadian city who provide any form of unpaid help to an older adult living at home, about their experiences and ideas for advocacy. The interviews were analyzed through abductive thematic analysis, using politicization as a sensitizing concept. Findings: While participants identified ideas for changes in public policy, their underlying mistrust of formal care systems often seemed to reinforce familial responsibility for care and restrict advocacy efforts to local family systems. Discussion: These truncated networks of support contributed to alienating conditions for carers and limited opportunities for inclusive collective action to improve the current social organization of care for older people at home in Canada.

Longitudinal qualitative inquiry from a social gerontological perspective can offer unique insights into older adults’ wellbeing and home care service trajectories. This temporal case study of 12 older home care clients analysed 136 interviews over three time points with 53 home care network actors in Manitoba and Nova Scotia. Many clients and families grappled with service changes almost daily, even if the level or type of service appeared officially stable. The pandemic added further disruption, shaping clients’ lives, wellbeing, and relationships, as well as their access to and use of service. Notably, changes in clients’ wellbeing and needs for help were not necessarily straightforward nor always apparent to case coordinators, especially when these were tied to social, emotional, or relational wellbeing, or to clients’ living arrangements, housing, family, and community integration. Findings can enhance theorizing of change for older adults receiving home care and guide equity-informed policy and practice.

"Non-forced care policy as a harm reduction approach to violence in residential care" published on 09 Jan 2025 by Policy Press.

How are problems of family/friend care framed and politicized, and with what socio-political implications? This feminist rhetorical analysis examines how carers are positioned, how problems and solutions of care are framed, and how carers’ social and political rights are supported by Canadian caregiver organizations. Organizations’ public materials draw on and expand narratives that foreground individual risk and recognition, decentring the state’s role. We elaborate on how carers’ citizenship rights are discursively bounded with proposed individualized solutions that support them in continuing to care. Broader narratives could consider carers’ human or citizenship rights or otherwise foreground relationality and complex collective care solidarities.

Background and Objectives: In long-term residential care (LTRC), sometimes workers provide treatment that residents refuse or resist, which can cause harm to both workers and residents. In this analysis, we explored how and when workers provide involuntary treatment, when they accept or see this practice as necessary and when they reject this practice. Research Design and Methods: Following a qualitative research design, data were collected through interviews with nurses, health care aides, recreation, and housekeeping staff in two Canadian provinces and observations in two LTRC facilities in the province of Manitoba. Using an interpretive coding approach and guided by Foucauldian concepts of power and structural violence, we examined descriptions of violent situations and everyday interactions with a particular focus on involuntary treatment. Results: Beliefs about the potential for physical harm toward workers influenced the perceived acceptability, or rejection, of involuntary treatment. However, workers often expressed ambivalence about the acceptability of certain practices (e.g., using multiple workers to hold down a resident to provide personal care). The potential for worker injury and risk of being reprimanded were frequently identified by workers as shaping their decisions about whether to proceed with treatment to which the resident had not consented. At times, workers also expressed obligation to provide involuntary treatment for biomedical reasons, or because there seemed to be no good alternative. Discussion and Implications: Workers’ narratives about involuntary treatment reflect a lack of interpersonal and organizational safety that undermines the autonomy and dignity of those for whom they provide care.

The purpose of this article is to assess whether COVID-19 shaped Canadians’ preferred settings of dying. We compared data collected using the same survey from two independent but comparable sets of panel respondents, prior to and after the onset of the pandemic. A vignette methodology was used to assess preferences for dying in each of four settings: home, acute/intensive care, palliative care, and long-term residential care. Although preferences for dying at home, in acute/intensive care and palliative care units did not change, preferences for dying in nursing homes significantly declined. In the pandemic’s first and second waves, the spread of knowledge about problems of poor care, visitation restrictions, and fears of contagion in Canadian long-term residential care may have shaped public perceptions of and preferences for dying these settings. If this change persists, it may influence advance care planning decisions. That preferences for dying at home did not shift is noteworthy.