This thesis presents a study about the experience of becoming a nursing home resident as it affects the identity and self-esteem of very old persons. / In a qualitative study with six female residents of an English-speaking Centre d'Acceuil in Montreal, themes are explored in the light of theory about the effects of institutionalization. Consideration is given to the dynamics of relationships with family, friends, peers and staff. Loss of autonomy is singled out as the factor having the most impact on the individuals in the study. / As life draws to a close, each of the women interviewed struggles in her own way with conflict between the value of self-determination and the value of acceptance of dependence on others. The author suggests that the attempt to reconcile these two values may be a "life-task" for very old institutionalized persons. Questions are raised at the level of planning for institutional policy and a direction is indicated for the education of social workers planning to work with an elderly clientele.

This research evaluates Quebec's health care policy by analyzing how the partnership metaphor is implemented in policy and practice. The partnership construction is identified in 4 interpretive communities within long-term community services to the elderly population. This analysis focuses on the placement decision for cognitively impaired clients in home care. Interpretive policy analysis is employed to examine 3 policy documents and 3 client files, while grounded theory serves to analyze 13 semi-structured interviews with 2 administrators and 3 open triads of client, caregiver, and case manager. The findings show partnership to be an egalitarian, collaborative ideal widely adopted but with little consensus on the pertinent objects and actors. Important differences emerge in how partnership is applied to the placement decision, indicating a too flexible application. Specific restrictions are recommended on the application of the partnership metaphor in order to improve community services and organizational structures in health care.

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