Home healthcare and family responsibility: a critical discourse analysis of talk and text

This paper addresses how families' roles and responsibility for care are constructed within home health (in contrast to the responsibility of home health). A discourse analysis informed by a critical theoretical approach was used to analyze qualitative interviews with 13 home health managers and clinical leaders in British Columbia, alongside home care documents. When referring to family involvement, there was an emphasis on the importance of supporting a client's choice to stay at home. Government and agency documents describe family members as primary providers, with home health having a supplementary role. Agencies seek to avoid "substituting" for family care. Family responsibility is characterized as having both moral and structural value. Nonetheless, some participants advocated flexibility and recognized potential caregiving challenges. Data provide examples of how agency expectations are communicated to clients and families and become embedded within practice and policy. Findings are viewed within the broader organizational context as representing the "responsibilization" of support.