Bridging gaps in risk discourse: Home care case management and client choices

Abstract

This paper examines, and problematises, a well-entrenched conceptualisation of how home care case management practice works - that is, that case managers offer alternatives, and clients make choices. This understanding of practice is reinforced by organisational policy that states that clients have the right to live at risk if that is their choice. Analysis of data from a field study of home care practice in a western Canadian city, drawing predominantly on case managers' accounts of actual practice situations, underscores the limitations of such a view, and suggests that conceptualising such practices as ongoing and fragile negotiations between freedom and security offers a more useful frame for thinking through the distance and difference between current home care policy and practice and what people might actually need. © 2009 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.