Negotiating the System: Social Workers in Home Support in New Brunswick

By Theriault, Luc; Low, Jaqueline et al. | Canadian Review of Social Policy, January 1, 2014 | Go to article overview

Negotiating the System: Social Workers in Home Support in New Brunswick


Theriault, Luc, Low, Jaqueline, Luke, Alison, Canadian Review of Social Policy


Introduction

This paper is based on findings from a larger qualitative study of home support for seniors in New Brunswick (Low et al., 2011; Mather et al., 2011). While the focus of this broader project was the sustainability of home support services for seniors in the province, among our findings were issues relevant to social work administration. It is these findings that we discuss in this paper. In particular, our analysis reveals that the strategies used by these social workers in negotiating bureaucratic regulations that constrain their ability to provide what they deem to be appropriate services to their clients. These strategies are instances of "positive deviant social work" (Carey & Foster, 2011, p.590) and reflect the relative lack of power and autonomy these social workers have as "street-level bureaucrats" (Evans & Harris, 2004; Harris, 1998; Lipsky, 1980, p.3; Rowe, 2102). Our purpose in this paper is to reflect on these findings and to offer recommendations for policy change based on them.

The Context

New Brunswick is a small province with a population of approximately 753,000 (Stats Can, 2011a). It also has a population that is older than the Canadian average, such that, by 2005, 15% of New Brunswickers were already over sixty-five years of age (Stats Can, 2010). New Brunswick spends more, ranks among the highest in per capita provision of, and boasts the highest percentage of users of home care or home support for seniors in Canada (CIHI, 2007; MacAdam, 2009). In 2011, 4,289 New Brunswick seniors received home support services from the Department of Social Development (SD/DS), the provincial government department responsible for administration and provision of long-term care in the province (Low et al., 2011; Mather et al., 2011). In the New Brunswick context, home care is provided by the Department of Health and refers to extra-mural healthcare services, whereas home support, administered by the Department of Social Development, includes "non-professional assistance" with "personal care, activities of daily living, and home management" (SD/DS, 2009:8, SHAS, 2009:34). The province follows a "public-professional and private home support model" where almost all services are obtained through contracts with not-for-profit or private service providers (Anderson & Parent, 2000:5; CHCA, 2008a; SD/DS, 2008).

Home support services are critical to the well-being of seniors in New Brunswick. A principal and recurring finding of the literature on home care and home support is that seniors prefer to stay in their own homes whenever possible (CHA, 2009; CHCA, 2008; HCC, 2008; McCann et al., 2005; Sanders et al., 2005; SD/DS, 2009). Further, home support is as important as medical services in enabling seniors to remain healthy and independent (Hollander & Prince, 2007; Nugent, 2004). Home support has also been shown to be more cost effective than institutional care in the case of seniors without serious health problems, even when informal caregiver time is valued at replacement wage (CHA, 2009; Chappell et al., 2004; CIHI, 2007; Forbes & Janzen, 2004; Hollander & Chappell, 2002; Hollander et al., 2007, 2009; Shapiro & Havens, 2000; VON, 2008). Equally critical in this care equation are social workers that play an integral part in the provision of home support services for seniors in New Brunswick through their roles in assessment, case management, and crisis intervention.

Methods

Working in an arms-length partnership with the Department of Social Development, Government of New Brunswick (GNB), the overall goal of this project was to produce knowledge to inform evidence-based policy aimed at improving the effectiveness and sustainability of home support for seniors in the province. By arms-length we mean that while our government partners supported this research by facilitating recruitment and providing us with access to provincial data on home support for seniors in New Brunswick, they played no role in the research design, nor were they involved in analysis of the data. …

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