Graying States: Elder Care Policy in Alberta, Canada and Sweden By Gabrielle Betts A thesis submitted to the Faculty of Graduate and Postdoctoral Affairs in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Political Science Carleton University Ottawa, Ontario © 2014 Gabrielle Betts 1 ACKNOWLEDGEMENTS Undergoing the six-year adventure towards the completion of my thesis would not have been possible without the care and support of many people along the way. First and foremost, I could not be more grateful to have worked under the direction of my talented co-supervisors Dr. Rianne Mahon and Dr. Fiona Robinson. I am thankful for the intellectual stimulus they provided throughout my PhD studies, the countless hours that they spent reading through my thesis drafts, the insightful and invaluable feedback they offered throughout the research and writing process, and their help in overcoming any challenges that presented themselves along the way. My thesis would not be the same without their excellent supervision. I am fortunate to have also had the opportunity to work with Dr. Hugh Armstrong, who was a member on my thesis committee in addition to being one of my professors while pursuing my PhD studies at Carleton University. His course and work on the political economy of health and elder care have influenced my research and work. I am also grateful to Dr. Marta Szebehely for sharing her expertise on Swedish elder care, and for being so helpful and kind when I prepared for and undertook my fieldwork in Sweden; with one of the highlights of my trip being the day I spent at her beautiful cottage. I am also thankful to Dr. Lois Harder and Dr. Linda Trimble. They have greatly impacted my life as they were the ones who initially sparked my interest in gender politics, and have since become inspiring mentors. Moreover, this thesis would not have been possible without my parents Lucie and Jim Mason. I am grateful to my Mom for helping me to maintain balance and perspective while pursuing my PhD by taking me out for much needed shopping and coffee breaks away from my work. I am thankful to my Dad for carefully reading countless drafts of my work, and helping me to rehearse my presentations; offering thoughtful feedback throughout my university years. It is thanks to my parents’ perpetual faith in my abilities and their unconditional support that I have been able to pursue my life dreams. I am also indebted to my husband Kenton Betts, who could not have been a more solid partner throughout my PhD studies. He coached me through the successful completion of my PhD comprehensive exams, helped me to overcome many intellectual roadblocks that came up while writing this thesis, and helped me to prepare for my defense. Most importantly, I am grateful for the love and happiness he brings me every day. 2 TABLE OF CONTENTS Acknowledgements ..........................................................................................................................2 Abstract ............................................................................................................................................5 Acronyms and abbreviations............................................................................................................6 Glossary ....................................................................................................................................... 7-8 Chapter 1 – Introduction………………………………………………………………………..9 Problem pressures - demographic trends in Alberta and Sweden..................................................11 Feminist political economy ............................................................................................................18 Elder care within the welfare regimes of Alberta and Sweden ......................................................22 Choice of cases ..............................................................................................................................23 Divergence/convergence theories ..................................................................................................24 Theory and methodology ...............................................................................................................27 Conclusion .....................................................................................................................................30 Chapter 2 - Macro-theoretical Framework ...............................................................................31 Feminist political economy ............................................................................................................32 Feminist ethics of care ...................................................................................................................48 Conclusion .....................................................................................................................................60 Chapter 3 - Neo-liberal Divergence with a Common Trajectory in the Welfare Regimes of Alberta and Sweden .....................................................................................................................61 Welfare regimes .............................................................................................................................62 Feminist critiques of Esping-Andersen’s welfare regime models and his response .....................69 Varieties within welfare regimes ...................................................................................................76 Path-dependence and divergence/convergence theories ................................................................96 Conclusion ...................................................................................................................................106 Chapter 4 - Political Context and Historical Background of Elder Care in Alberta and Sweden ........................................................................................................................................108 The politics of Alberta and resulting elder care policies in historical perspective ......................108 The politics of Sweden and resulting elder care policies in historical perspective .....................121 Conclusion ...................................................................................................................................138 Chapter 5 - The Marketization of Elder Care in Alberta and Sweden .................................140 Marketization and the discourse of choice ...................................................................................141 Supply side marketization ............................................................................................................149 Demand side marketization..........................................................................................................162 Conclusion ...................................................................................................................................180 Chapter 6 - Concluding Thoughts ............................................................................................181 Central themes .............................................................................................................................183 Research limitations .....................................................................................................................189 Directions for future research ......................................................................................................190 Conclusion ...................................................................................................................................191 3 Appendix A - Interview methodology .........................................................................................193 Appendix B - List of key stakeholders interviewed.....................................................................195 Appendix C - Ethics application forms ........................................................................................197 Appendix D - Master list of interview questions .........................................................................225 Appendix E - Table outlining elder care in Alberta .....................................................................230 Appendix F - Table outlining elder care in Sweden ....................................................................233 Appendix G - Bibliography .........................................................................................................236 4 ABSTRACT Graying States: Elder Care Policy in Alberta, Canada and Sweden Elder care is becoming an important issue across Organization for Economic Co-operation and Development (OECD) countries. This dissertation examines how, in the postwar period many OECD countries began to develop elder care policies, but did so in different ways. In the postwar period, Sweden came closer to what would be considered the 'gold standard' for elder care, investing a substantial share of its Gross Domestic Product (GDP) in a comprehensive, publicly financed elder care system while jurisdictions like Alberta have left it largely to private - household and market - solutions. However, in an era of neo-liberal globalization, fiscal pressures associated with population aging may be leading not only 'liberal' jurisdictions like Alberta, but also 'social democratic' ones like Sweden to rely increasingly on markets