‘Hitting Home’: The Home as a Site for Long Term Health Care”

Funded by the Social Sciences and Humanities Research Council of Canada

Strategic Themes: Society, Culture and the Health of Canadians


Principal Investigator: Patricia McKeever (Faculty of Nursing, University of Toronto).

Co-Investigators: Jan Angus (Nursing, University of Toronto), Mary Chipman (Public Health Sciences, University of Toronto), Alf Dolan (Biomedical Engineering, University of Toronto), Isabel Dyck (Geography, Queen Mary, London), Joan Eakin (Public Health Sciences, University of Toronto), Kim England (Geography, University of Washington), Denise Gastaldo (Nursing, University of Toronto), and Blake Poland (Public Health Sciences, University of Toronto).


PROJECT SUMMARY: The Canadian health care system has changed dramatically due to treatment advances, technological innovations, demographic trends, and contemporary policy goals. Many institutional settings have been closed and those that remain have been reduced in size and function. Consequently, the community sector is providing more services, and home care programmes and markets are proliferating in every province. As a result, the homes of Canadians have become primary settings for formal health care and social support service provision. Since public funds are not meeting the escalating demands for services, care recipients and their families are assuming more responsibilities and absorbing new costs.  A large proportion of home care services are provided to people who have chronic illnesses, disabilities or the frailties of age. In these situations, on long-term bases, homes function simultaneously as personal or family dwellings and sites for complex, labour intensive health care work. Many of the consequences this system of care has for care recipients, households, homes and workers remain unknown. However, because many Canadians who have disabling conditions live in impoverished circumstances, high demands are being made on homes in which space, amenities and resources may be limited.  The “Hitting Home” Project will illuminate the living and working conditions in households receiving long-term home care services. The project is based on ideas from geography and sociology that underscore the significance of the home, the family, and health care work. Twenty case studies and a telephone survey of 900 households will be conducted in Ontario. Households from urban, rural and remote regions will participate because regional variations in climate, population characteristics and social life may affect the delivery and/or the receipt of home care. Information will be collected about the housing circumstances, household amenities, distribution of responsibilities and resources, use of space, working conditions and social relations in these homes. The findings will be useful to policy makers in health, social service, housing, and employment sectors, home care administrators and providers, social scientists and advocacy groups. Ultimately, the findings could contribute to the design of equitable home care systems in which services are provided and received in circumstances that do not compromise other important aspects of Canadian cultural life.