The Privatization of Care

Nursing homes are where some of the most vulnerable live and work. In too many homes, the conditions of work make it difficult to make care as good as it can be. For the last eight years an international team from Germany, Sweden, Norway, the UK, the US and Canada have been searching for promising practices that treat residents, families and staff with dignity and respect in ways that can also bring joy. While we did find ideas worth sharing, we also saw a disturbing trend toward privatization. Privatization is the process of moving away not only from public delivery and public payment for health services but also from a commitment to shared responsibility, democratic decision-making, and the idea that the public sector operates according to a logic of service to all. This book documents moves toward privatization in the six countries and their consequences for families, staff, residents, and, eventually, us all. None of the countries has escaped pressure from powerful forces in and outside government pushing for privatization in all its forms. However, the wide variations in the extent and nature of privatization indicate privatization is not inevitable and our research shows there are alternatives.

Patricia Armstrong is Distinguished Research Professor of Sociology at York University, Canada, and Fellow of the Royal Society of Canada. Dr. Armstrong is the author, co-author, editor, and co-editor of over 30 books as well as numerous articles and book chapters focusing on the fields of social policy; women studies; work; and the health and social services. She is Principal Investigator on the project that is the basis for this book. Hugh Armstrong is a Professor Emeritus of Social Work, Political Economy, and Sociology at Carleton University, Ottawa, Canada, and a co-investigator on the Reimagining Long-Term Residential Care project.

An Introduction to the Team and to Teamwork by Pat Armstrong, Privatization in Six Countries., 1. Privatizing Care: Setting the Stage by Pat Armstrong and Hugh Armstrong, 2. The Growth of the For-Profit Nursing Home Sector in Norway and Sweden: Driving Forces and Resistance by Gudmund Ågotnes, Frode F. Jacobsen, and Marta Szebehely, 3. Privatization of Nursing Homes in the United Kingdom and the United States by Charlene Harrington, Allyson M. Pollock, and Shailen Sutaria, 4. The Marketization and Commidification of Long-Term Care in Germany: Effects on Work and Relationship-Based Care in Nursing Homes by Beatrice Müller, 5. Privatization of Long-Term Residential Care in Canada: The Case of Three Provinces by Pat Armstrong, Hugh Armstrong, Martha McDonald, and Malcolm Doupe, 6. Labor Restructuring and Nursing Home Privatization in British Columbia by Andrew Longhurst, Sage Ponder, and Margaret McGregor , Key Issues, 7. Public Funding, Private Data in Ontario by Tamara Daly, 8. Towards Accountable For-Profits in Nursing Home Services? by Frode F. Jacobsen and Gudmund Ågotnes, 9. Marketing Long-Term Care: Website Analysis of For-Profit Corporations in Sweden and Canada by Ruth Lowndes, Jacqueline Choiniere, and Sara Erlandsson, 10. Nurse Staffing in Nursing Homes in Industrialized Countries by Charlene Harrington and Frode F. Jacobsen, 11. Devalued Later Life: Older Residents' Experiences of Risk in a Market System of Residential and Nursing Homes by Liz Lloyd, 12. Shifting Responsibilities for Care: The Experiences of Staff and Families in Long-Term Residential Care by Rachel Barken and Pat Armstrong, 13. Promoting Public Care by Pat Armstrong