Moral Discourse and Public Policy in Aging: Framing Problems, Seeking Solutions, and “Public Ethics”

“Me? At this age?”: A narrative analysis of older South Asian Muslim immigrant women’s subjectivity-formations in migration arrangements

Critical and feminist ageing scholarship has drawn attention to how dominant discourses of ageing negatively impact older women's identities and social lives. While research intersecting migration and ageing has broadly focused on older immigrants' settlement experiences, very little is known about the discursive influences over older immigrant women's sense of agency and social relations. To address this knowledge gap, this study explores the subjectivity-formations of older South Asian Muslim women engaged in transnational migration. Narrative and discourse analysis principles were used to conduct and analyse life story-based interviews with 15 South Asian Muslim older women who recently migrated to Toronto, Canada. Findings indicate that participant subjectivity-formations are shaped by: (a) discourses of ageing; (b) socio-cultural–religious discourses; and (c) discourses of transnational migration. In response, participants engaged in dynamic strategies including conforming, negotiating, creating alternative narratives and/or resisting these discourses to organise their lives. These findings reinforce the continued need to trace the governmentality of structural conditions over ageing migrant women's lives and their responsive strategies to manage these impacts.

Imperfect Solutions to the Neoliberal Problem of Public Aging: A Critical Discourse Analysis of Public Narratives of Long-Term Residential Care

Public representations of long-term residential care (LTRC) facilities have received limited focus in Canada, although literature from other countries indicates that public perceptions of LTRC tend to be negative, particularly in contexts that prioritize aging and dying in place. Using Manitoba as the study context, we investigate a question of broad relevance to the Canadian perspective; specifically, what are current public perceptions of the role and function of long-term care in the context of a changing health care system? Through critical discourse analysis, we identify four overarching discourses dominating public perceptions of LTRC: the problem of public aging, LTRC as an imperfect solution to the problem, LTRC as ambiguous social spaces, and LTRC as a last resort option. Building on prior theoretical work, we suggest that public perceptions of LTRC are informed by neoliberal discourses that privilege individual responsibility and problematize public care.

Addressing the ageing workforce: a critical examination of legal policy objectives and values in the United Kingdom

Population ageing is a key challenge confronting European policy makers. Ageing is a complex issue, requiring a value-driven approach to law and policy. However, there has been limited consideration of what values are driving ageing law and policy in the European Union, or if these values are appropriate. Drawing on an empirical study of United Kingdom (UK) legal policy documents, this paper identifies and critiques the primary values and objectives driving ageing law and policy in the field of employment. It is argued that the values driving UK law and policy are often contested, contradictory and under-defined, and there has been limited thought given to how they should be prioritised in the event they conflict. Thus, there is a serious need to reconsider the approach to age and employment taken by policy makers, and to clarify better the key values on which law and policy rest.

Conceptual Framework for Development of Long-Term Care Policy 1. Constitutive Elements

Les éléments pour la conception d'un schéma conceptuel pour la planification des services de longue durée (SLD) sont élaborés en se fondant sur deux courants de pensée. L'un, plus pratique d'orientation, emprunte aux réflexions sur la démarche de planification, l'autre, théorique, est celui des théories sociologiques de l'action. La planification est définie comme une action qui vise le développement d'un plan, c'est-à-dire qu'à partir à la fois de valeurs et de désirs et de ressources et de contraintes, des objectifs opérationnels sont défïnis et des moyens sont choisis. La planification s'articule done autour de quatre thémes: (1) l'établissement d'un ordre de priorités, (2) la mise en place d'organisations sous la forme d'établissements, (3) le choix d'objectifs et (4) la détermination des ressources. Ces quatre thémes sont analysés tour à tour pour donner chacun quatre éléments qui définissent 16 thèmes, dilemmes, problèmes ou enjeux propres aux SLD. Les rapports entre ces éléments, normatifs par définition, formeront l'essentiel de notre proposition de modèle pour la planification des SLD.

Permanent Childlessness: Perceived Advantages and Disadvantages Among Older Persons

Cette étude examine les perceptions des 287 répondants, eux-mêmes sans enfant, sur le fait de ne pas avoir d'enfants; ils sont âgés de 55 ans et plus et font partie d'une étude plus vaste (rc = 678) sur le vieillissement et le soutien social. Soixante-sept pour cent (n = 193) font état des avantages de ne pas avoir d'enfants et 64 pour cent (n = 185) signalent des désavantages. Les données qualitatives révèlent moins de soucis ou de problèmes, des avantages financiers, une liberté et une disponibilité professionnelle plus grandes parmi les principaux avantages perçus. Le manque de compagnie, la solitude, le manque d'appui et de soins en vieillissant et le manque d'expérience des responsabilités parentales comptent au nombre des principaux désavantages. Les analyses — à deux variables ou à plusieurs variables — des effets qu'ont le genre, l'état civil, l'âge et le fait de ne pas avoir d'enfants (par choix ou selon les circonstances) sur la perception des avantages et des désavantages de ne pas avoir d'enfants démontrent des variations uniquement dans la perception des avantages. Lorsque nous comparons les avantages et les désavantages particuliers tirés de l'expérience, seuls certains avantages (avantages financiers) perçus sont associés à l'expérience réelle. Nous examinons les conclusions à partir d'expériences concrètes des coûts et des avantages par opposition au partage de croyances largement répandues sur le fait de ne pas avoir d'enfants.

A Critical Ethnography of the Process of Discharge Decision-Making for Elderly Patients

A critical ethnography of the process of discharge decision-making for elderly patients was conducted to examine the nature of the process over the total course of patients' hospital stays. The focus was on describing the timing and conditions of decision-making, the related activities of professionals, professionals' perceptions of the process, and the effects of the process on those involved and on the hospital organization. Data analysis demonstrated that the process is not intricately linked with patients' clinical progress, that often inaccurate assumptions about the importance of patient-related clinical and social factors and organizational parameters underlie decisions, and that professionals' perceptions of the process are shaped by organizational imperatives. In the current process, resources are used inefficiently and humanitarian and ethical consequences arise for participants. The analysis supports attempts to achieve greater congruence between the discharge decision process and the patient's clinical progress so that the fiscal and humanitarian goals of the hospital can be achieved.

Cadre de référence pour l'élaboration de politiques de services de longue durée 1. Éléments constitutifs

The elements of a conceptual scheme for long-term care (LTC) were developed based on two lines of thought. The first, more practical, borrows from planning. The second, which is more theoretical, reflects sociological action theories. Planning is defined as an action that targets the development of a plan. Using values, desires, resources and constraints as a starting point, operational objectives are defined and means chosen. Planning focuses on four themes: (1) establishment of priorities, (2) setting up organizations in the form of agencies, (3) choosing objectives and (4) defining resources. These four themes are analyzed in turn, with each producing four elements defining a total of 16 themes, dilemmas, problems or issues specific to LTC. The relationships between these elements, which are by definition prescriptive, form the core of our proposal for an LTC planning model.

From Cues to Action: Information Seeking and Exercise Self-Care among Older Adults Managing Chronic Illness

Drawing from the health belief model, cues to action have been theorized to influence health behaviours; however, few studies have examined these constructs explicitly. This study investigated the relationship between information cues to action and exercise self-care. It was hypothesized that reading about illness information, knowing about services, and consulting with others about one's illness triggers exercise self-care. The sample consisted of 879 chronically ill adults aged 50 and over, drawn from the Vancouver North Shore Self-Care Study. It was found that the odds of exercising almost doubled for readers of information about illness (compared to non-readers), after controlling for socio-demographic factors, illness context, and illness efficacy. Furthermore, knowledge of services and consultations were shown to increase the odds of exercise self-care. These findings provide support for the salience of cues to action as a pivotal theoretical construct. The implications of these findings for health promotion programs targeting persons with chronic illnesses are discussed.

Understanding Aging and Disability Perspectives on Home Care: Uncovering Facts and Values in Public-Policy Narratives and Discourse

Every public-policy problem can be defined in terms of its empirical (“facts”) and normative (“values”) dimensions and the interrelationship between them. An understanding of the connection between facts and values at the foundation of the home care policy debate in the Canadian health-care system is developed through the application of an analytical framework based on the concept of “narrative frame” analysis. The literature on home care policy reports and recommendations is examined within this conceptual structure – including especially publications and reports from the federal government, national organizations, and the aging and disability communities. Finally, observations and conclusions about the significance of home care policy discourse, and of the differences between the aging and disability constituencies in this debate, are offered as a guide for deconstructing the public-policy process.

Administrative decision making in response to sudden health care agency funding reductions: is there a role for ethics?

In October 1993, a survey of health care agency administrators was undertaken shortly after they had experienced two sudden reductions in public funding. The purpose of this investigation was to gain insight into the role of ethics in health administrator decision making. A mail questionnaire was designed for this purpose. Descriptive statistics and content analysis were used to summarize the data. Staff reductions and bed closures were the two most frequently reported mechanisms for addressing the funding reductions. Most administrators did not believe that these changes would have a negative public impact. In contrast, the majority indicated that future changes in reaction to additional funding reductions would have a negative public impact. Approximately one-third of the administrators reported ethics to be an element of recent administrative decision making, and one-half could foresee that ethics would be important in the future if reductions continued. These findings are discussed in relation to ethics. Issues for additional research are outlined.