Exploring How Policy, Practice and Regional Perspectives of Caregiving Combine to Mitigate Unpaid Caregiver Distress: A Case Study of the Former South West Local Health Integration Network of Ontario
Unpaid caregivers , Older adults , Community care , Moral distress , Case study
The impact of unpaid caregiving is significant and potentially detrimental to the overall health of caregivers themselves. The consequences of caregiving can contribute to unsustainable care circumstances for the care recipients in the community, leading to hospitalization or early mortality for both parties. Distress among caregivers can be high in rural and remote areas where access to appropriate services, particularly personal support work and respite care can be challenging to reliably deliver. Unexpectedly, the former South West Local Health Integration Network (SW LHIN) in Ontario, with a large rural population, consistently documented the lowest rates of caregiver distress across the province for a near decade. The aim of the dissertation was to explore how the policies, practices and geographic culture of the former SW LHIN interconnected in a manner that enabled caregivers to mitigate distress. Using a constructionist case study methodology, this qualitative study adopted a single case design with multiple units of analysis. The case was bound by time and place: the geographical boundaries of the SW LHIN as of 2019, when the study began. The individual caregiver interviews, (n=13) the focus group and interviews with community service providers (n=24) and an analysis of 92 documents were the data sources for the case. Braun and Clarke’s strategy for thematic analysis was used to analyze the data. Three manuscripts were generated from the data, with themes from manuscripts one and two shared several overlapping meanings, particularly around service support assumptions, community connections, partnerships, and care expectations. Manuscript three provides a discussion on the moral distress experience that arises, in part, from the tensions of being both a member of a community and professional serving the community. Taken together, the case study findings suggested that two overarching meso-level elements combined to minimize caregiver distress in the region: the presence of a regional identity and the perception of social support at the community and organizational level. The spotlight on caregiving today suggests that there has never been a better time for research or interventions to look beyond individualistic interventions and towards the wider social landscape to mitigate caregiver distress.