Framing home-care policy: A case study of reforms in a Canadian jurisdiction

Much of the literature on home-care services reform—an issue in the spotlight of policy debate across many ‘aging’ industrialized countries—has focused on the organizational, financial and clinical aspects of service provision. Less attention, however, has been paid to how particular issues and reform alternatives gain momentum in a given context; in particular to how a selective range of policy initiatives reach government's agenda and get incorporated into mainstream policy-making. This article seeks to advance our understanding of home-care policy by considering the influence of ideational factors on reform undertakings. More specifically, while concentrating on home-care policies in the province of Quebec, Canada, it examines how the organized perspectives and differing concerns of various stakeholders—i.e. their policy frames—appear to have shaped the form and content of policy. It is argued that framing provides a cogent and insightful means of understanding policy change and stasis in this area, most notably why managed competition or an all-out privatization of service delivery, as seen in other jurisdictions, has not been advocated by government in Québec.