[Perceptions, adaptation and health care strategies of the elderly family caregivers from the standpoint of the shift to ambulatory care].

This article presents the results of an exploratory study funded by the Social Sciences and Humanities Research Council of Canada. The objectives of this research were to explore (a) the perception by elderly women caregivers of the shift to ambulatory care; (b) their use of coping behaviours in the face of this major change within the health care system; and (c) their perceptions of health care services. In a theoretical framework of stress and coping, and using standardized questionnaires and open-ended questions, 40 home interviews were initially conducted with elderly women, each of whom was caring for her spouse after his discharge from hospital. Additional data were collected through focus groups. Quantitative and qualitative analyses revealed that elderly women caregivers perceive ambulatory care in a positive manner and as a change involving challenges only when they feel in control of the health care situation and when the care does not necessitate specialized abilities. When the care to be provided is complex and requires continued involvement and specific competence on the caregiver's part, the situation results in insecurity for elderly women. Caregivers use cognitive coping strategies to deal with their problems and are not inclined to use formal services in their social support network. Participants in this study wished to be better informed about the health care system in general ("how the system works") so that they could acquire a sense of predictability. Other expectations of elderly women caregivers concerned the importance of continuity in health services delivery, better preparation for the transition from hospital to home and availability of psychological support for themselves. These results suggest a critical analysis of the present paradigm guiding health care services, in which family caregivers are considered as resources or coworkers instead of coclients.