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OBJECTIVE: To explore the social organization of food provision and dietary intake in seriously mentally ill people with diabetes who reside in a for-profit group home. METHODS: Institutional ethnography was used to explore diabetes-related care practices among 26 women in a rural residential care facility in southern Ontario. Semi-structured, in-depth interviews were conducted with residents with diabetes, care providers, field workers, and health professionals. Observations and document analysis were also used to understand the lack of congruence between diabetes guidelines and the possibilities for diabetes management within the confines of group home care. RESULTS: Although it was mandated in group home guidelines that 'Health Canada's Eating Well with Canada's Food Guide' (2007) be followed, menus were planned within the context of a limited food budget of approximately $1.91 per day per resident. Group home policies regulated systems of safety, reporting, and financial accountability, but not health promotion. Inspections carried out by the Public Health Department focused primarily on food safety during handling, preparation, and storage, and compliance to regulations regarding environmental cleanliness and infection control. CONCLUSION: Resource rationing found in group home care exacerbates illness in an already marginalized group. Financial support is required to enable provision of healthy food choices, including dairy products, fresh fruits, and vegetables. Additional support is required for care of co-morbid conditions such as diabetes for associated food costs and education to improve outcomes. Group home policies must take into consideration health threats to this population and give primacy to health promotion and illness prevention. KEY WORDS: Diabetes; dietary intake; serious mental illness; group home care; institutional ethnography OBJECTIF : Explorer l'organisation sociale de l'approvisionnement en aliments et les apports alimentaires de personnes diabetiques gravement atteintes de maladies mentales vivant dans un foyer de groupe a but lucratif. METHODE : Nous avons utilise l'ethnographie institutionnelle pour explorer les pratiques de soins du diabete chez 26 femmes vivant dans un etablissement de soins residentiels en milieu rural dans le sud de l'Ontario. Nous avons mene des entretiens semi-directifs approfondis avec des residentes diabetiques, des fournisseurs de soins, du personnel de terrain et des professionnels de la sante. Nous avons aussi eu recours a l'observation et a l'analyse documentaire pour comprendre le manque de concordance entre les lignes directrices sur le diabete et les possibilites de prise en charge de cette maladie dans le cadre des soins en foyer de groupe. RESULTATS : Malgre les lignes directrices des foyers de groupe, qui doivent suivre les directives de l'ouvrage Bien manger avec le Guide alimentaire canadien de Sante Canada (2007), les menus etaient planifies dans le contexte d'un budget alimentaire limite (environ 1,91 $ par jour par residente). Les politiques du foyer abordaient les systemes de securite, de production de rapports et de responsabilite financiere, mais pas la promotion de la sante. Les inspections menees par le Service de sante publique etaient axees principalement sur la salubrite des aliments durant leur manipulation, leur preparation et leur entreposage et sur la conformite aux reglements de proprete de l'environnement et de controle des infections. CONCLUSIONS : Le rationnement des ressources observe dans les soins en foyer de groupe exacerbe les maladies au sein d'un groupe deja marginalise. Une aide financiere est necessaire a un approvisionnement en aliments sains, notamment en produits laitiers et en fruits et legumes frais. Un soutien supplementaire est egalement necessaire pour le soin des comorbidites comme le diabete, afin de couvrir les couts des aliments et de la sensibilisation connexes afin d'ameliorer les resultats. Les politiques des foyers de groupe doivent prendre en consideration les menaces pour la sante dans cette population et accorder la priorite a la promotion de la sante et a la prevention de la maladie. MOTS CLES : diabete; apport alimentaire; maladie mentale grave; soins en foyer de groupe; ethnographie institutionnelle, While diabetes affects 6 to 8% of the general population in Canada, (1) people with serious mental illness such as schizophrenia or mood disorders have 2 to 4 times greater [...]

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Mealtimes are among the busiest times in nursing homes. Austerity measures resulting in insufficient staff with heavy workloads limit the amount of time available to assist residents with eating. Within a feminist political economy framework, rapid team-based ethnography was used for an international study involving six countries exploring promising practices and also for a study conducted in one Canadian province in which interrelationships between formal and informal care were investigated. Data collection methods included interviews and observations. In addition, dining maps were completed providing a cross-jurisdictional comparison of mealtime work organization, and illustrating the time spent assisting residents with meals. Dining maps highlight the reliance on unpaid care as well as how low staffing levels leave care providers rushing around, preventing a pleasurable resident dining experience, which is central to overall health and well-being. [ABSTRACT FROM AUTHOR]

Family members and friends provide significant support for older relatives in long-term residential care (LTRC). Yet, they occupy ambiguous positions in these settings, and their relationships with LTRC staff can involve conflicts and challenges. Based on an ethnographic project carried out in North America and Europe, this article identifies practices that promote meaningful family participation in care home life. We consider instances of rewarding family involvement upon admission to LTRC, throughout the time a relative is living in a care home, and during the final stages of life. Furthermore, we identify working conditions needed to support the well-being of family/friend carers as well as residents and staff. These include greater appreciation of relational care work, time for effective communication, teamwork, and appropriate, inclusive physical spaces. Findings make visible the importance of relational care and have implications for improving living and working conditions in LTRC. [ABSTRACT FROM AUTHOR]

In this article, we compare current Canadian nursing home workers’ experiences and conditions of care to past work and care conditions to determine changes and similarities over the period from 1970 to the present. Employing a feminist political economy framework and a team-based rapid ethnography approach, our study involved observations of and in-depth interviews with management, health providers, support staff, informal care providers, union officials, and residents between 2012 and 2015. The historical substudy drew on interviews of past and present workers of one large long-term residential care home in Ontario. While improvements have been made in training and in the physical safety of staff and residents in these gendered spaces of work, there has been a persistence, if not intensification, in job precarity; inadequate staffing levels coupled with heavy workloads; routinized, assembly-line types of work; and cost-cutting on supplies. [ABSTRACT FROM AUTHOR]

Meaningful social engagement in everyday activities can enhance resident quality of life in nursing homes. In this article, we draw on data collected in a multidisciplinary, international study exploring promising practices in long-term care homes across Canada, Norway, and Germany, to investigate conditions that either allow for or create barriers to residents' social participation. Within a feminist political economy framework using a team-based rapid ethnography approach, observations and in-depth interviews were conducted with management, staff, volunteers, students, families, and residents. We argue that the conditions of work are the conditions of care. Such conditions as care home location, building layout, staffing levels, and work organization, as well as governing regulations, influence if and how residents can and do engage in meaningful everyday social life in/outside the nursing home. The presence of promising conditions that facilitate resident social participation, particularly those promoting flexibility and choice for residents, directly impacts their overall health and well-being.

Nursing, personal care, food and cleaning are publicly funded in Ontario's long-term care facilities, but under-staffing usually renders all but the most basic of personal preferences superfluous. This individualization of responsibility for more personalized care has resulted in more families providing more care and opting to hire private, private companion care. With direct payment of companions becoming a growing but largely invisible facet of care, exploring companion's roles is important. Using a six site rapid ethnographic study in long-term care facilities (i.e. observations, documents and key informant interviews (n=167)), this paper argues that private companions occupy a liminal space between policy, family and market, and their role within institutions and in private homes may be the missing link in the care work chain in the sense that it can at once be classified as formal and informal and draws on their own and others paid and unpaid labour.