Objective: Through close, critical readings of everyday practice of homecare case managers in Canada and Iceland, we demonstrate how contemporary neo-liberal policy that focuses on enhancing efficiency in the health care system has the effect of undermining forms of flexibility that previously enabled the delivery of home-based care and respected the unique needs of older adults. Method: A case study method is used, drawing on a single case from Canada and another from Iceland to undertake an ethnomethodological analysis of how assessments of older adults' needs for homecare support that is largely performed by women are accomplished. Results: The interpretation of data illustrates both individual and collective strategies for the conduct of care in homes and communities. The effects of such strategies in terms of their effects in diminishing resistance to further shifts of responsibility for care over to individuals are demonstrated. Professional imperatives are shown to be effective in repairing and even extending the effects of responsibilization. Discussion: This paper explores the effects of a variety of strategies employed by health care organizations as they both shape and respond to a changing care provision landscape. We illustrate how gendered organizational policies and professional practices support wider political interests in performance management and efficiency and, in so doing, further the effects of individualization in what could otherwise be mobilized collective responses to aging, poverty, illness and isolation.
- Home care