Content area
Full text
Introduction
The care needs and issues faced by older adults and their families vary greatly, frequently blur the boundary between health and social needs, and are often especially salient for those with multiple chronic conditions (Ploeg et al., 2017) as well as during times of transition between service settings (Manderson et al., 2012), reflecting changes over time in the health and function of the older adults. These needs are compounded by health and social care systems that, although considerably diverse and complex, are also fragmented and uncoordinated, and are thus difficult for older adults and their families to navigate (Bookman and Harrington, 2007). For instance, typically home care and nursing home settings are organized and delivered in different ways, generating confusion for older adults and families during transition.
Support with system navigation is thus an often-unmet need among family carers (Farran et al., 2004; Funk et al., 2015; Martinez-Donate et al., 2013). Navigational work is particularly salient in the context of formal services that are fragmented, as well as, in more recent years, more difficult to access (Bookman and Harrington, 2007; Koehn, 2009). Although publicly funded, non-medical care resources have never been universally guaranteed in Canada, policy shifts since the 1980s have eroded access to both medically necessary services as well as formal social and preventive supports, such as home care (Segall and Chappell, 2000). Accompanied by the diffusion of market-based, individualizing ideologies across sectors involved in caring for older adults, such shifts are also aimed at moving care delivery for older adults out of institutions into home and community, where families take up increasing proportions of costs and responsibilities (Aronson, 2006; Chappell, 1993; Williams et al., 2001).
These shifts provide important context in which to understand the work that older adults and their families do to access and coordinate various services and resources. There is emerging concern in this regard about how the work required to navigate services can contribute to carer burden (Funk et al., 2017; Taylor and Quesnel-Vallée, 2017) as well as hinder access, generating inequities among older adults (Dixon-Woods et al., 2005). Challenges are faced by ethnocultural minority and low-income older adults and their families, for instance, in navigating and accessing care services...