Researchers, practitioners, and many older adults value care in the home for maintaining continuity and well-being in later life. Studies of home care are important substantively for developing practices that best meet the needs of older adults and those caring for them. Theoretically, research on home care provides insight into the complex boundaries between the public world of paid work and the private world of the home, and between contested notions of independence and dependence in later life. Perspectives on Care at Home for Older People provides rich substantive and theoretical insight on the practice, ethics, and logic of care for older adults in home settings.

This book’s aim is to explore (1) the relationship between everyday life and the discourses and material conditions shaping home care, and (2) the ways communities might best be organized to meet the needs of frail older adults. Mol’s (Reference Mol2008) work on the logic of care is a common frame of reference in several chapters, drawing attention to the qualities that make care “good” (including attentiveness to the particularities of the people involved and the contexts in which care is practiced) as well as to the ways dominant discourses of individualism and consumerism might undermine the practice of good care. Qualitative methods, including ethnography and discourse analysis, provide insight on the ways people negotiate knowledge, power, and social relationships in home care.

Perspectives on Care at Home for Older People is divided into three sections. The first, titled “Home”, aims to develop a theoretical framework for the practice of home care. Mary Ellen Purkis, in chapter 1, engages the meaning of community presented in Marilynne Robinson’s novel Gilead (2004) and Giorgio Agamben’s text The Coming Community (1993) to explore how accommodations might enable frail older adults to live in home rather than institutional settings. Making communities more accommodating, Purkis argues, is a key aspect of humane practice. In chapter 2, Joanna Latimer discusses the contested meanings of home and care. She draws on film, literature, and ethnographic description to explore the affective, processual, and relational aspects of care and their capacity to provide frail older adults opportunities for creativity and vitality. These aspects of care, Latimer suggests, are often eclipsed by the emphasis on individualization, autonomy, and choice in health and social services. In chapter 3, Isabel Dyck and Kim England discuss their study of the ways that formalized care reconfigures the home space. Relations of power – among care providers and recipients, but also emanating from policies and regulations – impact the discursive and material construction of the home.

“Care”, the book’s second section, explores the delivery of home care. Drawing on research with case managers, Christine Ceci argues in chapter 4 that management strategies reflect a view of older adults as rationally calculating actors. Here, the logic of choice inhibits good care because it does not consider the relational situations in which older adults experience frailty. In chapter 5, Davina Allen discusses the implications of shifting professional to family responsibility for elder care. Her research finds that nurses and family members hold different understandings of patients’ needs and interests. Theory and policy, Allen suggests, must account for the divergences and intersections among the various professionals and family members involved in care relations. Kristín Björnsdóttir, in chapter 6, examines the implications of flexible organizational structure for home care nursing. Flexibility enables nurses to accommodate individuals’ needs and interests. If nurses’ interests override those of patients, though, flexibility might threaten the provision of good care.

The final section of the book, “Practices”, explores how policies shape the organization of home care services and the relations among care providers and older adults. In chapter 7, Hanne Marlene Dahl discusses how the logic of self-governance in home care policies constructs care recipients as rational, autonomous service consumers who employ home helpers. In the process, helpers’ identities are silenced and the weakest older adults, who cannot act “responsibly”, are marginalized. Next, Anna Olaison’s textual analysis in chapter 8 considers the standardized, evidence-based language in assessments of home care clients. The medical and physical needs of older adults take precedence in these texts while social needs play a lesser role in determining service allocation. In the concluding chapter, Lea Henrikkson and Sirpa Wrede explore how welfare and neo-liberal ideologies shape various social institutions involved in public care provision. With the shift from socially defined care to a medico-managerial culture, public services are regarded as a last resort for the sickest people rather than a right of citizenship to support the well-being of all older adults. Consequently, social care is institutionally devalued and is positioned as the responsibility of individuals and families.

Perspectives on Care at Home for Older People’s main contribution is a rich theoretical framework for examining the contradictions and complexities of home care in contemporary societies. It clearly demonstrates how the logic of choice limits the potential for practicing attentive and responsive care and for valuing the contributions of people involved in care relations. Contributors emphasize the particularities of home care in Canada, the United Kingdom, and the Nordic countries. The similarities among these countries regarding the retrenchment of the state in care provision, and theoretical insights on the social organization of home care, make the issues discussed in each chapter relevant to a broad international audience. This book will appeal most to practitioners, researchers, and students interested in the social aspects of home care and the ways it might maintain or improve older adults’ well-being. This book is theoretically dense and will be most useful to readers who are well versed in social theory.

Theoretical contributions are accompanied by suggestions for improving home care practice. Björnsdóttir, for example, provides insight on the potential and limitations of a flexible organizational structure in community health centers. Practical suggestions, though, are sometimes buried in complex theoretical discussions. A concluding chapter, drawing together the most important suggestions from each contributor, could make this book more useful to practitioners.

Contributors to this book make useful connections between policy contexts and individual experiences in the private – often invisible – space of the home. Two issues in home care and aging, however, merit further exploration. First, there is little discussion of what might make care for older adults distinct from care for younger populations and how this might shape practices. A critical focus on age relations could be helpful here (e.g., Calasanti & Slevin, Reference Calasanti and Slevin2006; McMullin, Reference McMullin2009). Second, it would be useful to consider how concerns regarding population aging, often framed in terms of apocalyptic demography, shape discussions and debates regarding care for older adults. Considering the intergenerational relations of reciprocity, obligation, and entitlement might enrich the arguments put forward in this book (e.g., Gee & Gutman, Reference Gee and Gutman2000).

Although some aspects of aging could be explored further, Perspectives on Care at Home for Older People remains an informative and timely book. Readers will gain a thorough knowledge of the debates and issues relevant to home care and aging in Canada and in Europe.